Victoria Villalta-Gil

Neurocognitive performance and negative symptoms: Are they equal in explaining disability in schizophrenia outpatients?

OBJECTIVE The aim of this study is to assess if cognitive variables and symptom dimensions can predict disability in a sample of outpatients with schizophrenia. METHOD A cross-sectional sample of 113 individuals with a diagnosis of schizophrenia (DSM-IV criteria) was selected from a computerized register of five Community Mental Health Centers. Patients were assessed by two trained psychologists, with a neuropsychological battery comprising measures for verbal memory, attention, operative memory and abstraction and flexibility functions. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); a socio-demographic and clinical questionnaire, comprising the Disability Assessment Scale (DAS), was also completed. Test scores were standardized (t scores) to performance of healthy controls. To assess the relationship between clinical and sociodemographic factors and disability and cognitive functioning Pearsons correlation coefficients were computed. In order to establish the predictive capacity of the cognitive, clinical and symptom variables on disability linear regression models were fitted. RESULTS Mean age of patients was 41.6 years and 68% were male. Higher ratings in the negative dimension were associated with more cognitive deficits. Association with the positive dimension was present but less strong. All disability areas, except for disability in occupational functioning, were partially explained by the negative dimension. Disability in family functioning was also partially explained by attention and number of admissions since onset. CONCLUSION Negative symptoms are the major source of disability of our sample and are also associated to cognitive functioning. The present findings suggest that further investigation on the mediators between clinical and social outcomes may help to design specific treatments to reduce disability.

Do needs, symptoms or disability of outpatients with schizophrenia influence family burden?

BackgroundMost needs of outpatients with schizophrenia are met by the family. This could cause high levels of family burden. The objective of this study is to assess the relationship between the patients’ needs and other clinical and disability variables and the level of family burden.MethodA total sample of 231 randomly selected outpatients with schizophrenia was evaluated with the Camberwell Assessment of Needs, Positive and Negative Syndrome Scale, Global Assessment of Functioning and Disability Assessment Scale. A total of 147 caregivers also answered the objective and subjective family burden questionnaire (ECFOS-II). Correlations between total number of needs and family burden, t tests between presence or absence of need for each domain of family burden and regression models between family burden and needs, symptoms, disability and sociodemographic variables were computed.ResultsThe number of patients’ needs was correlated with higher levels of family burden in daily life activities, disrupted behaviour and impact on caregiver’s daily routine. The patients’ needs most associated with family burden were daytime activities, drugs, benefits, self-care, alcohol, psychotic symptoms, money and looking after home. In a regression model, a higher number of needs, higher levels of psychopathology and disability, being male and older accounted for higher levels of family burden.ConclusionPatients with schizophrenia with more needs cause greater family burden but not more subjective concerns in family members. The presence of patients’ needs (daytime activities, alcohol and drug), severity of psychotic symptoms and disability are related to higher levels of family burden.

Reduced expression of SP1 and SP4 transcription factors in peripheral blood mononuclear cells in first-episode psychosis

Alterations of transcription factor specificity protein 4 (SP4) and 1 (SP1) have been linked to different neuropsychiatric diseases. Reduced SP4 and SP1 protein levels in the prefrontal cortex have been associated with bipolar disorder and schizophrenia, respectively, suggesting that both factors could be involved in the pathogenesis of disorders with psychotic features. The aim of this study was to investigate whether the reduction of SP1, SP4 and SP3 protein and mRNA expression in peripheral blood mononuclear cells in the early stages of psychosis may act as a potential biomarker of these disorders. A cross-sectional study of first-episode psychosis patients (n = 14) compared to gender- and age-matched healthy controls (n = 14) was designed. Patients were recruited through the adult mental health services of Parc Sanitari Sant Joan de Déu. Protein and gene expression levels of SP1, SP4 and SP3 were assessed in peripheral blood mononuclear cells of patients with first-episode psychosis and healthy control subjects. We report that protein levels of SP1 and SP4, but not SP3, are significantly reduced in patients compared to controls. In contrast, we did not observe any differences in expression levels for SP1, SP4 or SP3 genes between patient and control groups. In patients, SP4 protein levels were significantly associated with SP1 protein levels. No association was found, however, between protein and gene expression levels for each factor. Our study shows reduced SP1 and SP4 protein levels in first-episode psychosis in lymphocytes, suggesting that these transcription factors are potential peripheral biomarkers of psychotic spectrum disorders in the early stages.

Cognitive correlates of verbal memory and verbal fluency in schizophrenia, and differential effects of various clinical symptoms between male and female patients

BACKGROUND Impairment of higher cognitive functions in patients with schizophrenia might stem from perturbation of more basic functions, such as processing speed. Various clinical symptoms might affect cognitive efficiency as well. Notably, previous research has revealed the role of affective symptoms on memory performance in this population, and suggested sex-specific effects. METHOD We conducted a post-hoc analysis of an extensive neuropsychological study of 88 patients with schizophrenia. Regression analyses were conducted on verbal memory and verbal fluency data to investigate the contribution of semantic organisation and processing speed to performance. The role of negative and affective symptoms and of attention disorders in verbal memory and verbal fluency was investigated separately in male and female patients. RESULTS Semantic clustering contributed to verbal recall, and a measure of reading speed contributed to verbal recall as well as to phonological and semantic fluency. Negative symptoms affected verbal recall and verbal fluency in the male patients, whereas attention disorders affected these abilities in the female patients. Furthermore, depression affected verbal recall in women, whereas anxiety affected it in men. CONCLUSIONS These results confirm the association of processing speed with cognitive efficiency in patients with schizophrenia. They also confirm the previously observed sex-specific associations of depression and anxiety with memory performance in these patients, and suggest that negative symptoms and attention disorders likewise are related to cognitive efficiency differently in men and women.

Influence of age at onset on social functioning in outpatients with schizophrenia

Background and Objectives: There are different factors that have been found to predict disability in schizophrenia. The aim of our study is to evaluate the influence of age at onset on social functioning in schizophrenia in a large sample of schizophrenic outpatients controlling for gender. Methods: Two hundred and thirty-one subjects with schizophrenia (DSM-IV criteria) were randomly selected from a register that included all patients under treatment in five mental health care centers (MHCC) in Spain. Patients were evaluated with a sociodemographic and clinical questionnaire, and the Spanish version of the Living Skills Profile (LSP). Pearsons analyses were performed between age at onset and LSP, and an ANOVA analysis to compare three groups of age at onset (early, middle and late). Gender was introduced as a covariable. Results: Mean age at onset of the total sample was 23 (sd 7.35), with women having a later age at onset than men (women 24.6 (sd 9.1); men 22.2 (sd 5.9) (p<0.05)). The relation between age at onset and social functioning was only significant in the not interpersonal social behavior subscale (p<0.01). Early age at onset was positively related to social contact-communication (p<0.05), not interpersonal social behavior (p<0.05) and total LSP score (p<0.05). When including gender as a covariable, a significant relationship between age at onset and social functioning was found in most of the LSP subscales. Conclusions: Early onset of illness negatively influences psychosocial functioning, especially in the areas of communication, not interpersonal social behaviour and self-care. Female gender positively influences most aspects of social functioning.

Three-factor model of premorbid adjustment in a sample with chronic schizophrenia and first-episode psychosis

BACKGROUND The dimensionality of premorbid adjustment (PA) has been a debated issue, with attempts to determine whether PA is a unitary construct or composed of several independent domains characterized by a differential deterioration pattern and specific outcome correlates. AIMS This study examines the factorial structure of PA, as well as, the course and correlates of its domains. METHOD Retrospective study of 84 adult patients experiencing first-episode psychosis (FEP) (n=33) and individuals with schizophrenia (SCH) (n=51). All patients were evaluated with a comprehensive battery of instruments including clinical, functioning and neuropsychological variables. A principal component analysis accompanied by a varimax rotation method was used to examine the factor structure of the PAS-S scale. Paired t tests and Wilcoxon rank tests were used to assess the changes in PAS domains over time. Bivariate correlation analyses were performed to analyse the relationship between PAS factors and clinical, social and cognitive variables. RESULTS PA was better explained by three factors (71.65% of the variance): Academic PA, Social PA and Socio-sexual PA. The academic domain showed higher scores of PA from childhood. Social and clinical variables were more strongly related to Social PA and Socio-sexual PA domains, and the Academic PA domain was exclusively associated with cognitive variables. CONCLUSION This study supports previous evidence, emphasizing the validity of dividing PA into its sub-components. A differential deterioration pattern and specific correlates were observed in each PA domains, suggesting that impairments in each PA domain might predispose individuals to develop different expressions of psychotic dimensions.

Spanish validation of the Premorbid Adjustment Scale (PAS-S)

BACKGROUND The Premorbid Adjustment Scale (PAS) has been the most widely used scale to quantify premorbid status in schizophrenia, coming to be regarded as the gold standard of retrospective assessment instruments. AIMS To examine the psychometric properties of the Spanish version of the PAS (PAS-S). METHOD Retrospective study of 140 individuals experiencing a first episode of psychosis (n=77) and individuals who have schizophrenia (n=63), both adult and adolescent patients. Data were collected through a socio-demographic questionnaire and a battery of instruments which includes the following scales: PAS-S, PANSS, LSP, GAF and DAS-sv. The Cronbachs alpha was performed to assess the internal consistency of PAS-S. Pearsons correlations were performed to assess the convergent and discriminant validity. RESULTS The Cronbachs alpha of the PAS-S scale was 0.85. The correlation between social PAS-S and total PAS-S was 0.85 (p<0.001); while for academic PAS-S and total PAS-S it was 0.53 (p<0.001). Significant correlations were observed between all the scores of each age period evaluated across the PAS-S scale, with a significance value less than 0.001. There was a relationship between negative symptoms and social PAS-S (0.20, p<0.05) and total PAS-S (0.22, p<0.05), but not with academic PAS-S. However, there was a correlation between academic PAS-S and general subscale of the PANSS (0.19, p<0.05). Social PAS-S was related to disability measures (DAS-sv); and academic PAS-S showed discriminant validity with most of the variables of social functioning. PAS-S did not show association with the total LSP scale (discriminant validity). CONCLUSION The Spanish version of the Premorbid Adjustment Scale showed appropriate psychometric properties in patients experiencing a first episode of psychosis and who have a chronic evolution of the illness. Moreover, each domain of the PAS-S (social and academic premorbid functioning) showed a differential relationship to other characteristics such as psychotic symptoms, disability or social functioning after onset of illness.

Functional similarity of facial emotion processing between people with a first episode of psychosis and healthy subjects

BACKGROUND Neurofunctional and behavioral abnormalities in facial emotion processing (FEmoP) have been consistently found in schizophrenia patients, but studies assessing brain functioning in early phases are scarce and the variety of experimental paradigms in current literature make comparisons difficult. The present work focuses on assessing FEmoP in people experiencing a psychotic episode for the first time with different experimental paradigm approaches. METHODS Twenty-two patients with a first psychotic episode (FPe) (13 males) took part in a functional magnetic resonance imaging study (1.5T) examining neural responses to explicit and implicit processing of fearful and happy facial expressions presented at two different intensities: 50% and 100%. Their brain activation was compared to that of 31 healthy subjects (15 males). RESULTS Control subjects show differential patterns of brain activation regarding the task demands (implicit or explicit processing), the emotional content (happy or fear) and the intensities of the emotion (50% or 100%); such differences are not found in participants with a first psychotic episode (FPe). No interaction or group effects are seen between control and FPe participants with any of the emotional tasks assessed, although FPe subjects show worse behavioral performance. CONCLUSIONS No brain areas recruited for FEmoP emerge as significantly different between people with a FPe and healthy subjects, independently on the demands of the task, the emotion processed, or the intensity of the emotion; but FPe participants show a limited recruitment of differential brain regions that could be associated with poor emotional processing in the short term. Our results outline the need of investigating the underlying processes that lead FPe participants to worse FEmoP performance.

Validation of the Communication Skills Questionnaire (CSQ) in people with schizophrenia

This present study describes the validation of the Communication Skills Questionnaire (CSQ) in people with schizophrenia. A total of 125 clinically stable people in rehabilitation treatment who were diagnosed with schizophrenia were included. For convergent and discriminant validity the following tests were administered; the Gambrill and Richie (GR) Assertiveness Inventory, the Social Functioning Scale (SFS), Life Skills Profile (LSP), Clinical Global Impression scale for schizophrenia (CGI-S) and the Global Assessment of Functioning (GAF) scale. Internal consistency of the CSQ had a Cronbach׳s alpha of 0.96. Test-retest reliability showed coefficients between 0.60 and 0.70. Convergent validity showed significant relations at p<0.0001 for all instruments assessed. None of the subscales used for assessing discriminant validity showed a significant correlation with the CSQ except for the CGI-S depression subscale. The instrument shows good psychometric properties and demonstrates that it is a useful instrument for evaluating communication skills in people with schizophrenia.

Specificity proteins 1 and 4, hippocampal volume and first-episode psychosis

We assessed specificity protein 1 (SP1) and 4 (SP4) transcription factor levels in peripheral blood mononuclear cells and conducted a voxel-based morphometry analysis on brain structural magnetic resonance images from 11 patients with first-episode psychosis and 14 healthy controls. We found lower SP1 and SP4 levels in patients, which correlated positively with right hippocampal volume. These results extend previous evidence showing that such transcription factors may constitute a molecular pathway to the development of psychosis.