Michela Giugiario

Relative contribution of antipsychotics, negative symptoms and executive functions to social functioning in stable schizophrenia

The purpose of this study was to examine the relative contributions of antipsychotic medication, negative symptoms and executive functions to impairment in social functioning in a sample of outpatients with stable schizophrenia. One-hundred and sixty-eight consecutive outpatients with stable schizophrenia were enrolled in a cross-sectional study. We performed a path analysis using multiple regression technique in order to assess the specific effect of antipsychotic type (first-generation antipsychotics versus second-generation antipsychotics) on social functioning and the possible mediating role of executive functions and negative symptoms. Our findings suggested that (i) second generation antipsychotics (SGAs) use predicted better social functioning (Beta=.24, p=.003) and better executive functions (Beta=.25, p=.003); conversely SGAs use was not associated with lesser negative symptoms (Beta=.00, p=.981); (ii) impaired executive functions and severity of negative symptoms were associated with worse social functioning (Beta=.19, p=.016; Beta=.28, p=.001); (iii) when we inserted in the model Positive and Negative Syndrome Scale - Negative Symptom subscale (PANSS-N) and Wisconsin Card Sorting Test - number of achieved sorting categories (WCST-cat), the former failed to show a mediation effect, while the latter seemed to mediate partially the effect of SGAs on social functioning. Taken together, the present results suggest that it is critical to examine individually executive functions and negative symptoms because they seem to relate to social functioning in different and independent ways and thus might represent separable treatment targets. Furthermore, social functioning appears a complex outcome multiply determined with no single predictor variable explaining a sufficient amount of variance.

Cognitive function and competitive employment in schizophrenia: relative contribution of insight and psychopathology

PurposeThis study investigated the relationships among insight, psychopathology, cognitive function, and competitive employment in order to determine whether insight and/or psychopathology carried the influence of cognitive function to competitive employment.MethodsWe recruited 253 outpatients with stable schizophrenia and we further divided our sample into two groups of patients (unemployed and competitive employment subjects). Clinical and neuropsychological assessments were performed. All clinical variables significantly different between the two groups of subjects were subsequently analyzed using a binary logistic regression to assess their independent contribution to competitive employment in the two patients’ groups. On the basis of the regression results two mediation analyses were performed.ResultsVerbal memory, general psychopathology, and awareness of mental illness were significantly associated with competitive employment in our sample. Both awareness of mental illness and general psychopathology had a role in mediating the verbal memory–competitive employment relationship.ConclusionsTaken together, these findings confirmed the importance of cognitive function in obtaining competitive employment. Our results also highlighted the independent role of general psychopathology and awareness of illness on occupational functioning in schizophrenia. Thus, a greater attention must be given to the systematic investigation of insight and general psychopathology in light of an amelioration of vocational functioning in stable schizophrenia.

Quality of life and psychopathology during the course of schizophrenia.

OBJECTIVE This study evaluated a population of outpatients with stable schizophrenia to analyze if relationships between patterns of symptomatology and quality of life (QOL) change during the time course of illness. METHODS We recruited 168 outpatients with stable schizophrenia, and we further divided our sample into 3 groups of patients (<or=36, 37-72, and >72 months of illness). Psychiatric assessment included the Quality of Life Scale, the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, and the Clinical Global Impression-Severity Scale. All clinical variables significantly related to Quality of Life Scale scores were subsequently analyzed using a multiple stepwise regression to assess their independent contribution to QOL in the 3 patient groups. RESULTS Quality of life and symptoms profiles were similar among patient groups. After controlling for potentially confounding variables, multiple regression revealed that depressive symptoms appeared to have a stronger relationship with QOL during the early 3-year course of the illness. In the period between 4 and 6 years of illness, negative symptoms were the most reliable predictors of QOL. After the 6-year course of illness, negative symptoms remained the most reliable predictors of QOL, together with severity of illness, whereas positive and depressive symptoms had a minor role. CONCLUSIONS Despite similar QOL and symptoms profiles, these findings suggested that relationships among patterns of symptomatology and QOL change during the course of schizophrenia.

Quality of life in stable schizophrenia: The relative contributions of disorganization and cognitive dysfunction

OBJECTIVE The purpose of this study was to examine the relative contributions of disorganization and cognitive dysfunction to quality of life (QOL) in patients with stable schizophrenia. METHODS A total of 276 consecutive outpatients with stable schizophrenia were enrolled in a cross-sectional study. We performed a mediation analysis to assess the specific effect of disorganization on QOL, as assessed by the Heinrichs-Carpenter Quality of Life Scale (QLS), and the possible mediating role of cognitive dysfunction. RESULTS Our findings were as follows: (i) disorganization was negatively related to the total QLS score; (ii) disorganization was negatively related to two of the four QLS domains, namely the role-functioning domain (occupational/educational) and the intrapsychic functioning domain (e.g., motivation, curiosity, and empathy); and (iii) verbal memory was a partial mediator of the relationship between disorganization and QLS (the total score and the two above-mentioned domains). CONCLUSIONS Disorganization demonstrated direct and indirect effects via verbal memory on two domains of functioning, as measured by the QLS. These results highlight the importance of improving disorganization and cognition (particularly verbal memory) to improve the functional outcomes of patients with schizophrenia.

The Complaint of Oral Malodour: Psychopathological and Personality Profiles

Halitosis, a condition which may affect up to 30% of the population [1] , is used to describe any disagreeable odour of the breath [2] . However, despite patient complaints of halitosis, actual halitosis is often not found during sensory and instrumental examination [3] . If the complaint of a halitosis that does not exist is improved by counselling and simple oral hygiene measures, this condition has been defined as pseudo-halitosis; if the complaint persists, halitosis has been defined as halitophobia [4] . Pryse-Phillips [5] introduced the term ‘olfactory reference syndrome’ (ORS) to describe a syndrome in which patients claim to actually perceive a malodour that others cannot detect. ORS has not been included in the DSM-IV [6] as a separate category, but several anxiety or somatic disorders, i.e. obsessive-compulsive disorder and body dysmorphic disorder (BDD), have sufficient overlap with the symptomatology of ORS [7] . In the present study, we investigated the relationship between the degree of malodour, both objective and subjective, and the psychopathological and personality profile of patients who had been examined at the Division of Periodontology at the Dental School of the University of Turin, Italy, between February and December 2004. The study population included 66 consecutive subjects (n = 33, 50% women, and n = 33, 50% men) with a complaint of oral malodour. Subjects were excluded if they had non-oral aetiologies of halitosis, an organic disease that could cause halitosis, an upper or lower total prosthesis and if they were pregnant or breast-feeding. The subject’s oral malodour was evaluated by the measurement of volatile sulphur compound levels inside the mouth using a portable gas chromatograph (Oral Chroma). Subjects were requested to score their self-perception of oral malodour using a 10-cm visual analogue scale (VAS). The Revised Symptom Checklist 90 (SCL90-R) [8] , a 90-item self-report questionnaire, was given to assess psychopathology. We investigated the presence of a psychiatric disorder using the Structured Clinical Interview for DSM-IV [9] . In order to evaluate a subject’s personality profile, the Minnesota Multiphasic Personality Inventory (MMPI-2) [10] was used [11] . Statistical analyses were performed using the software Statistical Package for the Social Sciences, version 17 (SPSS Inc., 2008). The overall sample was divided into 3 groups. The first group (n = 15; n = 8, 53% women, and n = 7, 47% men) included patients with a complaint of halitosis but no appreciable or slight oral malodour (subjective halitosis). The second one (n = 42; n = 19, 45% women, and n = 23, 55% men) included subjects with a complaint of halitosis and clearly noticeable or strong oral malodour (objective halitosis). From those groups, subjects who fulfilled DSM-IV criteria for a psychiatric disorder were excluded and subsequently included in a third group (psychiatric patients, all showing clearCDS cutoff scores for clinical settings (two-stage screening) were derived by considering the cutoff score which provided maximum sensitivity with 6 75% specificity and then rounding to the nearest multiple of 5. The recommended CDS cutoff scores for research settings (single-stage screening) were derived by considering the score which produced the maximal Youden index and then rounding this score to the nearest multiple of 5. For major depression, the CDS has a very high area under the curve of 0.96. For screening in clinical (two-stage) settings, where the diagnosis can subsequently be confirmed clinically, we initially derived a CDS cutoff score of 6 90 for major depression, which provided 97% sensitivity and 79% specificity. For estimating the prevalence of depression in research settings, where overall diagnostic accuracy rather than just sensitivity is important, we derived a CDS cutoff of 6 95 for major depression, which gives 97% sensitivity and 85% specificity. We noted that moving from a CDS cutoff score of 6 90 to 6 95 produced no drop in sensitivity but a 6% gain in specificity (the cutoff of 6 90 was initially derived from the rounding up of 6 89). For the 25-item CDS, we therefore recommend a cutoff score of 6 95 for major depression for both singleand two-stage screening settings. This cutoff provides 97% sensitivity and 85% specificity. As the CDS was designed for cardiac patients, further validation in other medical populations with a high incidence of comorbid depression is warranted. This study demonstrates the utility of the CDS for diagnosing major depression. We have produced CDS cutoff scores for major depression that can be used effectively in routine clinical diagnosis as well as in future epidemiological and clinical studies.

Contents Vol. 79, 2010

R. Balon, Detroit, Mich. P. Bech, Hillerød M. Biondi, Roma M. Bouvard, Chambery G. Chouinard, Montréal, Qué. P.M.G. Emmelkamp, Amsterdam S. Fassino, Torino M. Fava, Boston, Mass. H.J. Freyberger, Greifswald/Stralsund S. Grandi, Bologna D. Hellhammer, Trier J.I. Hudson, Belmont, Mass. I.M. Marks, London M.W. Otto, Boston, Mass. E.S. Paykel, Cambridge P. Porcelli, Castellana Grotte C. Rafanelli, Bologna C.D. Ryff , Madison, Wisc. U. Schnyder, Zürich J. Scott, Newcastle T. Sensky, London T. Th eorell, Stockholm E. Vieta, Barcelona T. Wise, Falls Church, Va. R. Zachariae, Aarhus Offi cial Journal of the International College of Psychosomatic Medicine (ICPM) Offi cial Journal of the International Federation for Psychotherapy (IFP)

Advanced Training Workshop: Psychosomatic Assessment

On March 24–26, 2011, at Istituto Canossiano in Venice, Italy, there will be a workshop concerned with the novel techniques and strategies of psychosomatic assessment. The faculty includes Richard Balon (USA), Antonio Barbosa (Portugal), Giovanni Fava (Italy), Gabor Keitner (USA), Dennis Linder (Italy), Chiara Rafanelli (Italy), Tom Sensky (UK), Nicoletta Sonino (Italy), Tom Wise (USA) and Jesse Wright (USA). The faculty will share with the participants how psychosomatic assessment actually takes place by discussing clinical cases and the use of role playing. At the end of the workshop the participant will be able to use the new psychosomatic approach in his/her clinical practice, to enhance clinical effectiveness and to be aware of new treatment opportunities. The workshop is aimed at physicians or psychologists, with special reference to those who have already achieved or wish to get the title of Psychosomatic Specialist by the International College of Psychosomatic Medicine. Those who intend to attend should contact the Scientific Secretary, Elena Tomba, PhD, Department of Psychology, University of Bologna, Viale Berti Pichat 5, IT–40127 Bologna, Italy, Tel. +39 051 209 1823, Fax +39 051 243 086, E-Mail elena.tomba @ unibo.it. Published online: September 16, 2010