Marilene Zimmer

The association of child abuse and neglect with adult disability in schizophrenia and the prominent role of physical neglect

OBJECTIVE To assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia. METHOD Ninety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by the Childhood Trauma Questionnaire (CTQ) and for functional impairment by the World Health Organization Disability Assessment Schedule (WHO/DAS). The schizophrenia diagnosis was assessed by ICD-10 and DSM-IV criteria according to the Operational Criteria Checklist for Psychotic Illness (OPCRIT). RESULTS Childhood trauma in general was associated with increased disability in adulthood, reflected by impaired Overall Behavior (p=.023) and Global Evaluation (p=.032). Analysis of specific traumatic domains revealed that increased childhood physical neglect was associated with functional impairment in Overall Behavior (p<.000), Social Role Performance (p=.037) and Global Evaluation (p=.014). Higher emotional abuse was associated with impaired Overall Behavior (p=.026), and higher emotional neglect with poor Global Evaluation (p=.047). Additionally, earlier onset of illness was associated with lower level of functioning evidenced by impairment in Overall Behavior (p=.042). Linear regression using WHO/DAS sections (Overall Behavior, Social Role Performance and Global Evaluation) as dependent variables and CTQ subscales indicated that only physical neglect had an effect on adult functionality. CONCLUSIONS Childhood trauma was associated with functional and social impairment in adult patients with schizophrenia. Specific types of abuse and neglect, such as physical neglect and emotional abuse and neglect, influenced disability, and the most robust association was physical neglect. Studies involving more patients, with normal controls and additional measurements of biological liability, should be conducted to confirm this association and to increase the understanding of gene-environment relationship in schizophrenia and pathways to disability. PRACTICE IMPLICATIONS Further investigation is warranted to clarify the association between childhood trauma and disability in schizophrenia, as well as to develop standardized instruments for the assessment of trauma and earlier detection of risk along with education of patients and families about adequate care, in an effort to reduce the incidence of disability in schizophrenia.

Psychological changes arising from an Antarctic stay: systematic overview

Long-term stays in extreme environments, such as Polar Regions, may cause significant changes in the health and well-being of individuals. A systematic overview aimed to map studies about the psychological effects on Antarctic expeditioners. The reviewed data were categorized and divided into two thematic axes: Negative Effects, resulting from harmful psychophysiological variations caused by exposure to the polar stressors, which may present seasonal symptom patterns, altering cognitive performance, mood and interpersonal relationships; and Positive Effects, such as salutogenic results arising from successful adaption to environmental adversities. Due to the great deal of evidence, it is suggested that protection factors should be promoted through preventive approaches, such as psychological training and support in order to reduce symptoms and generate satisfactory adaptation to Antarctica.

Avaliação neuropsicológica na esquizofrenia: revisão sistemática

This article aims at summarizing studies on the most commonly used neuropsychological tests in schizophrenia. A systematic literature review was performed on PubMed, MEDLINE (via PubMed) and LILACS, from 1995 through 2006. The keywords were cognition and schizophrenia; evaluation and cognition and schizophrenia; functioning and cognition and schizophrenia. A manual research of references in most frequently cited articles was performed, including meta-analysis studies, theoretical reviews, and the Measurement and Treatment Research to Improve Cognition in Schizophrenia. Inclusion criteria were studies on schizophrenia patients that reported use of neuropsychological tests. A review of the most frequently cited tests was performed to check nomenclature, indications, and which were validated for Brazil. A total of 98 studies were identified: 77 empirical studies, eight meta-analyses, six theoretical reviews and seven from the Measurement and Treatment Research to Improve Cognition in Schizophrenia. There were 102 different names of neuropsychological tests; 10 batteries of tests were cited, most of them composed by previously standardized subtests. Of the 77 empirical studies, 22 (28.57%) were about validation of instruments or batteries of tests. Of the 10 most frequently cited tests, only three had been validated for Brazil (WCST; Wechsler Adult Intelligence Scale; Mini-Mental Status Examination). These findings show a wide heterogeneity in the selection criteria of neuropsychological tests, disagreement as to the nomenclature, and a certain trend toward creation of new tests and batteries for evaluating cognitive functions. The relevance and characteristics of cognitive impairments in schizophrenia confirm the urgent necessity of specific and standardized identification of neuropsychological evaluation methods for Brazilian patients.