Mélanie Faugere

A structural equation modelling approach to explore the determinants of quality of life in schizophrenia.

OBJECTIVE This study aimed to analyse the relationships among psychotic symptoms, depression, neurocognition and functioning as determinants of quality of life (QoL) in patients with schizophrenia. METHODS In this cross-sectional study, we evaluated QoL with the Schizophrenia Quality of Life 18-item scale (S-QoL 18), neurocognition with multiple tests exploring memory, attention and executive functions, the severity of psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), depression with the Calgary Depression Scale for Schizophrenia (CDSS) and functioning using the Functional Remission Of General Schizophrenia (FROGS) scale. We used Structural Equation Modelling (SEM) to describe the relationships among the severity of psychotic symptoms, depression, neurocognition, functioning and QoL. RESULTS Two hundred and seventy-one outpatients with schizophrenia participated in our study. SEM showed good fit with χ(2)/df=1.97, root mean square error of approximation=0.06, comparative fit index=0.93 and standardized root mean square residuals=0.05. This model revealed that depression was the most important feature associated with QoL, mainly for the self-esteem, autonomy and resilience dimensions (direct path coefficient=-0.46). The direct path between functioning and QoL was also significant (path coefficient=0.26). The severity of psychotic symptoms and neurocognitive impairment were weakly and indirectly associated with QoL via functioning (path coefficients=-0.18 and 0.04, respectively). CONCLUSIONS This study contributes to a better understanding of the determinants of QoL in schizophrenia. Our findings should be considered in developing effective strategies for improving QoL among this population.

Quality of life is associated with chronic inflammation in schizophrenia: a cross-sectional study

Inflammation may play a crucial role in the pathogenesis of schizophrenia. However, the association between chronic inflammation and health outcomes in schizophrenia remains unclear, particularly for patient-reported outcomes. The aim of this study was to investigate the relationship between quality of life (QoL) and chronic inflammation assessed using C -Reactive Protein (CRP) in patients with schizophrenia. Two hundred and fifty six patients with schizophrenia were enrolled in this study. After adjusting for key socio-demographic and clinical confounding factors, patients with high levels of CRP (>3.0 mg/l) had a lower QoL than patients with normal CRP levels (OR = 0.97, 95% CI = 0.94–0.99). An investigation of the dimensions of QoL revealed that psychological well-being, physical well-being and sentimental life were the most salient features of QoL associated with CRP. Significant associations were found between lower educational level (OR = 4.15, 95% CI = 1.55–11.07), higher body mass index (OR = 1.16, 95% CI = 1.06–1.28), higher Fagerström score (OR = 1.22, 95% CI = 1.01–1.47) and high levels of CRP. After replications with longitudinal approaches, the association between QoL and chronic inflammation may offer interesting interventional prospects to act both on inflammation and QoL in patients with schizophrenia.

Elevated C-reactive protein is associated with sensory gating deficit in schizophrenia

Sensory and cognitive impairments and inflammatory processes are contributing factors to the pathogenesis of schizophrenia. A previous study found that an elevated CRP level (≥5mg/L) was associated with higher cognitive impairments in schizophrenia. We aimed to investigate the association between an elevated CRP level and sensory impairments defined by a sensory gating deficit (abnormal P50 suppression) in 55 outpatients. Fifteen patients (27.3%) had an elevated CRP level that was associated with higher rate of sensory gating deficit (60% vs. 12.5%, p<0.001). This is the first study suggesting a relationship between sensory gating deficit and inflammatory processes in schizophrenia.

Determinants of patient satisfaction with hospital health care in psychiatry: results based on the SATISPSY-22 questionnaire

Background The aim of our study was to identify patient- and care-related factors that are associated with patients’ satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient’s point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22). Methods This cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels. Results Two hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (β=0.15). Clinical improvement was moderately associated with higher global satisfaction (β=−0.15), higher satisfaction with quality of care (β=−0.19), and higher satisfaction with food (β=−0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (β, 0.20–0.43) except food, and for seclusion with global satisfaction (β=−0.33) and personal experience (β=−0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (β=−0.15). Conclusion This study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient’s satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients’ management, and health outcomes in psychiatric hospitals.

Natural speech comprehension in bipolar disorders: An event-related brain potential study among manic patients

BACKGROUND Thought and language disturbances are crucial clinical features in Bipolar Disorders (BD), and constitute a fundamental basis for social cognition. In BD, clinical manifestations such as disorganization and formal thought disorders may play a role in communication disturbances. However, only few studies have explored language disturbances in BD at a neurophysiological level. Two main Event-Related brain Potentials (ERPs) have been used in language comprehension research: the N400 component, elicited by incongruous word with the preceding semantic context, and the Late Positive Component (LPC), associated with non-specifically semantic and more general cognitive processes. Previous studies provided contradictory results regarding N400 in mood disorders, showing either preserved N400 in depression or dysthymia, or altered N400 in BD during semantic priming paradigm. The aim of our study was to explore N400 and LPC among patients with BD in natural speech conditions. METHODS ERPs from 19 bipolar type I patients with manic or hypomanic symptomatology and 19 healthy controls were recorded. Participants were asked to listen to congruous and incongruous complete sentences and to judge the match between the final word and the sentence context. Behavioral results and ERPs data were analyzed. RESULTS At the behavioral level, patients with BD show worst performances than healthy participants. At the electrophysiological level, our results show preserved N400 component in BD. LPC elicited under natural speech conditions shows preserved amplitude but delayed latency in difference waves. LIMITATIONS Small size of samples, absence of schizophrenic group and medication status. CONCLUSIONS In contrast with the only previous N400 study in BD that uses written semantic priming, our results show a preserved N400 component in ecological and natural speech conditions among patients with BD. Possible implications in terms of clinical specificity are discussed.

Validation of the French sensory gating inventory: A confirmatory factor analysis

The Sensory Gating Inventory (SGI) is an instrument investigating daily experiences of sensory gating deficit developed for English speaking schizophrenia patients. The purpose of this study is to design and validate a French version of the SGI. A forward-backward translation of the SGI was performed. The psychometric properties of the French SGI version were analyzed. A confirmatory factor analysis (CFA) was carried out to determine whether factor structure of the French version is similar to the original English version. In a sample of 363 healthy subjects (mean age=31.8 years, S.D.=12.2 years) the validation process revealed satisfactory psychometric properties: the internal consistency reliability was confirmed for each dimension; each item achieved the 0.40 standard threshold for item-internal consistency; each item was more highly correlated with its contributive dimension than with the other dimensions; and based on a CFA, we found a 4-factor structure for the French version of the SGI similar to the original instrument. Test-retest reliability was not determined. The French version of the SGI is a psychometrically sound self-report for measuring phenomenological sensory gating experiences.

High C-reactive protein levels are associated with depressive symptoms in schizophrenia

BACKGROUND Depressive symptoms are frequently associated with schizophrenia symptoms. C - Reactive protein (CRP), a marker of chronic inflammation, had been found elevated in patients with schizophrenia and in patients with depressive symptoms. However, the association between CRP level and depressive symptoms has been poorly investigated in patients with schizophrenia. The only study conducted found an association between high CRP levels and antidepressant consumption, but not with depressive symptoms investigated with the Calgary Depression Rating Scale for Schizophrenia (CDSS). OBJECTIVES The aim of this study was to evaluate CRP levels and depressive symptoms in patients with schizophrenia, and to determine whether high CRP levels are associated with depressive symptoms and/or antidepressant consumption, independently of potential confounding factors, especially tobacco-smoking and metabolic syndrome. METHODS Three hundred and seven patients with schizophrenia were enrolled in this study (mean age = 35.74 years, 69.1% male gender). Depressive symptoms was investigated with the CDSS. Patients were classified in two groups: normal CRP level (≤ 3.0mg/L) and high CRP level (> 3.0mg/L). Current medication was recorded. RESULTS 124 subjects (40.4%) were classified in the high CRP level group. After adjusting for confounding factors, these patients were found to have higher CDSS scores than those with normal CRP levels in multivariate analyses (p = 0.035, OR = 1.067, 95% CI = 1.004-1.132). No significant association between CRP levels and antidepressants consumption was found. LIMITATIONS The size sample is relatively small. The cut-off point for high cardiovascular risk was used to define the two groups. CRP was the sole marker of inflammation in this study and was collected at only one time point. The design of this study is cross-sectional and there are no conclusions about the directionality of the association between depression and inflammation in schizophrenia. CONCLUSION This study found an association between high rates of CRP levels and depressive symptoms in patients with schizophrenia, but no association with antidepressant consumption. Further studies are needed to investigate the impact of inflammation in schizophrenia.

“All that glitters is not … alone”. Congruity effects in highly and less predictable sentence contexts

CONTEXT Using natural connected speech, the aim of the present study was to examine the semantic congruity effect (i.e. the difference between semantically incongruous and congruous words) in sentence contexts that generate high or moderate final word expectancies. METHODS We used sentences with two levels of word expectancy in the auditory modality: familiar proverbs (that generate high final word expectancy), and unfamiliar sentences (that generate only moderate final word expectancy). RESULTS Results revealed an early congruity effect (0-200 ms) that developed across all scalp sites for familiar proverbs but not for unfamiliar sentences. By contrast, typical centro-parietal N400 and Late Positivity Component congruity effects developed later (200-500 ms and 600-900 ms ranges) for both familiar proverbs and unfamiliar sentences. DISCUSSION We argue that the early congruity effect for proverbs comprises both a Phonological Mismatch Negativity, reflecting the processing of the acoustic/phonological mismatch between the expected (congruous) and unexpected (incongruous) sentence completions and a typical N400 semantic congruity effect with an unusual short latency because final words can be predicted from the unusually high contextual constraints of familiar proverbs. These results are considered in the light of current views of anticipation and prediction processes in sentence contexts.

Quality of life is associated with chronic inflammation in depression: a cross-sectional study

BACKGROUND Inflammation may play a crucial role in the pathophysiology of depression. However, the association between chronic inflammation and health outcomes in depression remains unclear, particularly for patient-reported outcomes. METHODS The aim of this study was to investigate the relationship between quality of life (QoL) (physical and mental health, assessed by the SF-36) and chronic inflammation assessed using C-reactive protein (CRP) in patients with current major depressive disorder. RESULTS One hundred eighty-one patients with depression were enrolled in this study. After adjusting for key socio-demographic, clinical and biological confounding factors, patients with high levels of CRP (> 3.0mg/L) had worse physical health than those with normal CRP levels (OR = 0.95, 95% CI = 0.92-0.99). Significant associations were found between a higher rate of metabolic syndrome (OR = 0.10, 95% CI = 0.02-0.41) and high CRP levels. LIMITATIONS The cut-off point for high cardiovascular risk was used to define the two groups: normal CRP level and high CRP level. CRP was the sole marker of inflammation in this study and was collected at only one time point. The design of this study is cross-sectional and there are no conclusions about the directionality of the association between QoL and inflammation in depression. QoL was assessed only by SF-36 scores. CONCLUSION This study found an association between SF-36 physical health score and CRP in patients with depression, thereby showing the need to consider physical well-being in depression. This paves the way for interventions to act both on inflammation and QoL in patients with depression.

Association of metabolic syndrome with sensory gating deficits in patients with chronic schizophrenia

Metabolic syndrome is more prevalent in schizophrenia than in the general population and is associated with an increased rate of morbidity. It has been associated with cognitive impairments in schizophrenia, which are a core deficit in patients with chronic schizophrenia. Sensory gating deficit is also a core deficit in schizophrenia. The principal objective of this study was to investigate the relationship between sensory gating deficit and metabolic syndrome in patients with schizophrenia, after adjusting for key confounding factors. We hypothesized that patients with metabolic syndrome exhibit a higher rate of sensory gating deficit compared to those without metabolic syndrome. This study investigated sensory gating with the auditory event-related potential method by measuring P50 amplitude changes in a double click conditioning-testing procedure in 51 patients with schizophrenia. Patients with metabolic syndrome (n = 14) had a higher rate of sensory gating deficit (P50 suppression <50%) (p < 0.001) compared to those without metabolic syndrome (n = 37). This result remained significant (B = 2.94, Wald = 8.32, p = 0.004) after taking into account 5 potential confounding factors (age, gender, duration of disorder, Fagerström test, presence of clozapine or olanzapine). In patients without metabolic syndrome, sensory gating deficit was linked to a poorer attentional performance (rho = -0.371, p = 0.05). In patients with metabolic syndrome, sensory gating deficit was linked to poorer memory performance (rho = -0.635, p = 0.02). These findings suggest that metabolic syndrome may be linked to sensory gating deficit in patients with schizophrenia and that the relationship between neurocognitive function and sensory gating deficit could be affected by the metabolic status of the patients. Further studies are needed to address the causal relationship between sensory gating deficit related to schizophrenia, cognitive impairments and metabolic syndrome.