Rebecca E. Daly

Associations of High Sensitivity C-Reactive Protein Levels in Schizophrenia and Comparison Groups

Schizophrenia is characterized by physical (mainly metabolic and cardiovascular) comorbidity and shortened lifespan. High sensitivity C-reactive protein (hs-CRP), an inflammatory marker of hepatic origin linked to metabolic and cardiovascular diseases and mortality in the general population, has been reported to be elevated in people with schizophrenia. However, the relationship of hs-CRP to psychiatric and medical risk factors, after controlling for potentially confounding variables such as smoking, is not well established in schizophrenia. We assessed hs-CRP levels along with various demographic, psychiatric, and metabolic measures in 88 clinically stable outpatients with schizophrenia or schizoaffective disorder and 71 age epoch-matched comparison subjects with no history of a major psychiatric illness. hs-CRP levels were significantly higher in individuals with schizophrenia than in comparison subjects. Higher hs-CRP levels in the schizophrenia group were associated with female gender, more severe negative symptoms, greater medical comorbidity, and worse metabolic risk factors including BMI, fasting glucose, and hemoglobin A1c levels. hs-CRP was not related to age, race, education, smoking status, antipsychotic dosage, or cognitive impairment. Longitudinal studies are needed to investigate the relationship between hs-CRP and long-term health outcomes including metabolic syndrome, cardiovascular disease, and mortality in schizophrenia.

Tri-ethnic variations of co-morbid substance and alcohol use disorders in schizophrenia

OBJECTIVES This study examined the differential prevalence of substance and alcohol use disorders among European Americans, African Americans, and Latinos with schizophrenia (n = 6424) who received public mental health services in San Diego County during fiscal year 2002-2003. METHODS Data were obtained from the public mental health database used by the San Diego County Mental Health System. Chi-Square analyses and stepwise logistic regression analyses were used to examine differences regarding the prevalence of substance and alcohol use among clients with schizophrenia and schizoaffective disorder, and to analyze the sociodemographic variables associated with this co-morbidity. RESULTS Significant differences in the prevalence of diagnosed co-morbidity were found across the ethnic groups. Rates of co-morbid diagnosis among African Americans (25%) were significantly higher than those among European Americans (22%) and Latinos (19%). Logistic regression results revealed ethnicity was a significant predictor of co-morbid substance and alcohol use, as was being homeless and male. Among Latinos, language preference was also a significant predictor. Latinos who denoted English as their primary language were 1.7 times more likely to be diagnosed with co-morbid substance or alcohol use disorders than Latinos who denoted Spanish. CONCLUSIONS Among people with schizophrenia, there were significant differences in prevalence rates and predictors of diagnosed co-morbid substance and alcohol use disorders. Future research is needed to examine the relationship among language preference, level of acculturation, and subsequent diagnosing barriers for Latinos. Among African Americans, the reasons behind increased co-morbidity rates need to be examined, and homelessness should be carefully addressed among all three ethnic groups.

Summer Research Training for Medical Students: Impact on Research Self‐Efficacy

There is a well‐documented shortage of physician researchers, and numerous training programs have been launched to facilitate development of new physician scientists. Short‐term research training programs are the most practical form of research exposure for most medical students, and the summer between their first and second years of medical school is generally the longest period they can devote solely to research. The goal of short‐term training programs is to whet the students’ appetite for research and spark their interest in the field. Relatively little research has been done to test the effectiveness of short‐term research training programs. In an effort to examine short‐term effects of three different NIH‐funded summer research training programs for medical students, we assessed the trainees’ (N = 75) research self‐efficacy prior to and after the programs using an 11‐item scale. These hands‐on training programs combined experiential, didactic, and mentoring elements. The students demonstrated a significant increase in their self‐efficacy for research. Trainees’ gender, ranking of their school, type of research, and specific content of research project did not predict improvement. Effect sizes for different types of items on the scale varied, with the largest gain seen in research methodology and communication of study findings.

Life satisfaction and its correlates among older cancer survivors: critical role of psychosocial factors

Dear Editor,IntroductionImprovements in early detection and treatment of cancerhave resulted in a growing number of aging cancer survi-vors. Currently, 60% of the 10 million cancer survivors inthe USA are older than 65 years [1]. Yet, research hasbeen scarce on mental health outcomes, especially satis-faction with life (SWL), in older cancer survivors (OCSs)[2]. A number of existing studies in this arena are limitedby a focus on a single cancer type such as breast cancer,small sample sizes, inclusion of people with very recentlydiagnosed cancer, and a lack of age-matched healthycomparison subjects (HCs) [1–3]. There are also prevalentassumptions that limit progress in our understanding ofpsychological well-being in this population, for example,that positive emotions are absent, dangerous, delusional,or trivial among people with life-threatening illnesses[4]. Studiessuggestthat OCSsfare muchworse physicallythan HCs as a result of adverse interactions among cancer,its treatment, aging, and comorbidity [1–3]. Findings onmental function suggest that OCSs have worse psycholog-ical functioning than HCs [1], experience age-associateddecline in health-related quality of life [5], and have loweroptimism about life expectancy than HCs [3]. Other find-ings are mixed, with some studies reporting similar de-pression scores and cognitive function between OCSsand HCs [3], whereas others report increased depressionwith age but no association between age and SWL inOCSs [2]. Conversely, OCSs have reported resilient socialwell-being, spirituality, and personal growth with aging[6]. Notably, only a few reports have employedstandardized instruments for assessing positive psychoso-cialresourcessuchas SWL,resilience,optimism,personalmastery, and spirituality [2].Thus,understandingSWLanditspsychosocialcorrelatesamong OCSs remains an important but understudied areawith high public health significance. Such research wouldbe of value in developing interventions to increase SWL.The present study compared SWL, as well as health-related physical, cognitive, and psychosocial functioninginOCSs,withthatindemographicallymatchedHCsfroma community-based sample. As several studies havereported worse physical and psychological function inOCSs than among HCs [1], we hypothesized that OCSswould perform worse in all spheres of functioningcompared with HCs. We also examined the correlates ofSWL in the two groups.Materials and methodsParticipantsCancer survivors and HCs were recruited from a largemulticohortlongitudinal,community-basedsampleofolderadults whohad beenselected using random digit dialing, inthe Successful AGing Evaluation (SAGE) study. TheSAGEdataincludestandardizedmeasuresofphysical,cog-nitive,andpsychosocialfunctioningfromatelephoneinter-view and a mail-in survey completed by 1006 participantsbetween the ages of 50 and 99 years [7]. Two hundredandnineteenSAGEparticipantsreportedhavingadiagnosisof cancer (excluding skin cancer). They were comparedwith 219 age-, gender-, and education-matched HCs fromthe same sample, who did not report a history of cancer.

Association of Learning Styles with Research Self‐Efficacy: Study of Short‐Term Research Training Program for Medical Students

With a growing need for developing future physician scientists, identifying characteristics of medical students who are likely to benefit from research training programs is important. This study assessed if specific learning styles of medical students, participating in federally funded short‐term research training programs, were associated with research self‐efficacy, a potential predictor of research career success.

A new scale for assessing wisdom based on common domains and a neurobiological model: The San Diego Wisdom Scale (SD-WISE)

Wisdom is an ancient concept that has gained new interest among clinical researchers as a complex trait relevant to well-being and healthy aging. As the empirical data regarding wisdom have grown, several measures have been used to assess an individuals level of wisdom. However, none of these measures has been based on a construct of wisdom with neurobiological underpinnings. We sought to develop a new scale, the San Diego Wisdom Scale (SD-WISE), which builds upon recent gains in the understanding of psychological and neurobiological models of the trait. Data were collected from 524 community-dwelling adults age 25-104 years as part of a structured multi-cohort study of adult lifespan. Participants were administered the SD-WISE along with two existing measures of wisdom that have been shown to have good psychometric properties. Factor analyses confirmed the hypothesized measurement model. SD-WISE total scores were reliable, demonstrated convergent and discriminant validity, and correlated, as hypothesized, negatively with emotional distress, but positively with well-being. However, the magnitudes of these associations were small, suggesting that the SD-WISE is not just a global measure of mental state. The results support the reliability and validity of SD-WISE scores. Study limitations are discussed. The SD-WISE, with good psychometric properties, a brief administration time, and a measurement model that is consistent with commonly cited content domains of wisdom based on a putative neurobiological model, may be useful in clinical practice as well as in bio-psycho-social research, especially investigations into the neurobiology of wisdom and experimental interventions to enhance wisdom.

Differences in gut microbiome composition between persons with chronic schizophrenia and healthy comparison subjects

Intestinal microbiome and gut-brain axis have been receiving increasing attention for their role in the regulation of brain/behavior and possible biological basis of psychiatric disorders. Several recent clinical studies have linked the microbiome with neuropsychiatric conditions, although the literature on schizophrenia is quite limited. This study investigated gut microbiome composition in 50 individuals, including 25 persons with chronic schizophrenia and 25 demographically-matched non-psychiatric comparison subjects (NCs). Stool samples were collected and assayed using 16S rRNA sequencing of the V4 region. Examination of unweighted UniFrac and Bray-Curtis dissimilarity revealed significant community-level separation in microbiome composition between the two subject groups. At the phylum level, Proteobacteria were found to be relatively decreased in schizophrenia subjects compared to NCs. At the genus level, Anaerococcus was relatively increased in schizophrenia while Haemophilus, Sutterella, and Clostridium were decreased. Within individuals with schizophrenia, abundance of Ruminococcaceae was correlated with lower severity of negative symptoms; Bacteroides was associated with worse depressive symptoms; and Coprococcus was related to greater risk for developing coronary heart disease. Our findings provide evidence of altered gut microbial composition in persons with chronic schizophrenia and suggest a need for larger and longitudinal studies of microbiome in schizophrenia.