| 1 | J Abnorm Psychol 2000 Nov 109: 792-6 |
|---|---|
| PMID | 11196006 |
| Title | Expressed emotion and attributions in the relatives of bipolar patients: an analysis of problem-solving interactions. |
| Abstract | Among the relatives of schizophrenic and depressed patients, high expressed emotion (EE) attitudes are associated with "controllability attributions" about the causes of patients' symptoms and problem behaviors. However, previous studies have judged EE attitudes and causal attributions from the same assessment measure, the Camberwell Family Interview (CFI; C. E. Vaughn & J. P. Leff, 1976). The authors examined causal attributions among relatives of 47 bipolar patients, as spontaneously expressed to patients in family problem-solving interactions during a postillness period. Relatives rated high EE during the patients' acute episode (based on the CFI) were more likely than relatives rated low EE to spontaneously attribute patients' symptoms and negative behaviors to personal and controllable factors during the postillness interactional assessment. Thus, the EE-attribution linkage extends to the relatives of bipolar patients evaluated during a family interaction task. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 2 | Schizophr. Res. 2000 Sep 45: 65-78 |
| PMID | 10978874 |
| Title | Is expressed emotion cause or effect in the mothers of schizophrenic young adults? |
| Abstract | The purpose of this study was to determine the most likely direction of influence between the symptom severity in schizophrenic young adults and the expressed emotion (EE) of their mothers. Specifically, the stability and cross-lagged effects of mothers' critical comments (CC) or emotional overinvolvement (EOI) and the severity of four symptom clusters were examined. Twenty-eight patients and their mothers were interviewed three times at 9 month intervals. Data were subjected to a form of structural equation modeling: cross-lagged panel analysis. Results suggest that maternal CCs and EOI both tend to be influenced by the patient's total symptom severity and are influenced significantly by negative symptoms, but not by positive symptoms. Also, the more severe the hostile-uncooperative symptoms in the patient, the more critical the mothers become over time. However, the greater the mother's EOI at time 1, the less severe the patient's hostile-uncooperative symptoms at time 3. The usual implication of the association between high EE and relapse, which was also found in this sample, is that high EE causes symptom exacerbation. The results of the current study suggest that CCs and EOI coded from the CFI do not reflect a noxious environment: rather, they appear to be more effect than cause. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 3 | Psychiatry Res 2000 Jul 94: 221-7 |
| PMID | 10889286 |
| Title | Evaluation of expressed emotion (EE) status in mood disorders in japan: inter-rater reliability and characteristics of EE. |
| Abstract | The reliability of expressed emotion (EE) ratings by the Camberwell Family Interview (CFI) and characteristics of EE were evaluated in families of patients with mood disorders in Japan. The subjects were 27 patients with mood disorders and 31 members of their families. The CFI was carried out with the family members. EE was rated by two raters independently, and the inter-rater reliability was evaluated according to Spearman's correlation coefficient by ranks and the kappa-value. The distribution of subscales of EE in these subjects was compared with that in families of patients with schizophrenia in Japan and families of patients with mood disorders abroad. Concerning critical comments (CC), hostility (H), and emotional over-involvement (EOI), which are important for EE rating, Spearman's correlation coefficient and the kappa-values were 0.4-0.8, and the reliability of EE ratings in mood disorders was not high. The proportion of positive agreement was particularly low in H and EOI. CCs were fewer in families of Japanese patients with mood disorders than in those with schizophrenia or families of American or European patients with mood disorders. Re-evaluation of the inter-rater reliability of EE ratings in mood disorders is needed. Expressed emotion was more suppressed in families of patients with mood disorders than in those of patients with schizophrenia. Expressed emotion was also more reserved in the Japanese subjects than in their Western counterparts. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 4 | Soc Psychiatry Psychiatr Epidemiol 2001 Oct 36: 486-92 |
| PMID | 11768846 |
| Title | Expressed emotion in staff-patient relationships: the professionals' and residents' perspectives. |
| Abstract | Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staff-patient dyad as measured by the concept of EE. EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS, residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders. Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI. The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 5 | Span J Psychol 2001 May 4: 65-71 |
| PMID | 11705344 |
| Title | Longitudinal study of the stability of expressed emotion in families of schizophrenic patients: a 9-month follow-up. |
| Abstract | The goal of this paper is to study attitude stability in schizophrenics' relatives, as reflected in the expressed emotion (EE) construct. For this purpose, the EE of 32 families of schizophrenic patients was assessed by means of the Camberwell Family Interview (CFI, Brown, Birley, & Wing, 1972; Vaughn & Leff, 1976b), both initially and at a 9-month follow-up. The results obtained indicate that EE is stable in fathers, whereas in mothers, high EE seems to be influenced by stressful situations, because, when assessed in crisis, EE was not stable, but in-between crises, it was. These results are discussed, as well as their relevance in family interventions aimed at reducing EE, where clinicians should take into account that mothers' EE may drop because of its instability, and not because of the intervention. On the other hand, clinicians should focus especially on fathers, because their high EE is constant, which is stressful to the patient during the follow-up. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 6 | Span J Psychol 2001 May 4: 65-71 |
| PMID | 11705344 |
| Title | Longitudinal study of the stability of expressed emotion in families of schizophrenic patients: a 9-month follow-up. |
| Abstract | The goal of this paper is to study attitude stability in schizophrenics' relatives, as reflected in the expressed emotion (EE) construct. For this purpose, the EE of 32 families of schizophrenic patients was assessed by means of the Camberwell Family Interview (CFI, Brown, Birley, & Wing, 1972; Vaughn & Leff, 1976b), both initially and at a 9-month follow-up. The results obtained indicate that EE is stable in fathers, whereas in mothers, high EE seems to be influenced by stressful situations, because, when assessed in crisis, EE was not stable, but in-between crises, it was. These results are discussed, as well as their relevance in family interventions aimed at reducing EE, where clinicians should take into account that mothers' EE may drop because of its instability, and not because of the intervention. On the other hand, clinicians should focus especially on fathers, because their high EE is constant, which is stressful to the patient during the follow-up. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 7 | Psychiatry Res 2002 Jul 110: 273-80 |
| PMID | 12127477 |
| Title | Family attitude scale: measurement of criticism in the relatives of patients with schizophrenia in Japan. |
| Abstract | Expressed emotion (EE) is traditionally measured with the Camberwell Family Interview (CFI), but the CFI requires considerable time for both execution and evaluation. As an alternative, we investigated the validity of the Family Attitude Scale (FAS), a questionnaire developed for the measurement of EE. The CFI, the FAS, the General Health Questionnaire (GHQ), and the Five-Minute Speech Sample (FMSS) were administered in 57 members of the families of 41 patients with acute episodes of schizophrenia. The relative sensitivity and specificity of EE assessment with the FAS compared with the criticism component of the CFI were 100% and 88.5%, respectively. EE assessment based on criticism as assessed with the FMSS compared with the CFI had a sensitivity of 40.0% and a specificity of 90.4%. The GHQ score tended to be higher in the high-scoring FAS group than in the low-scoring FAS group. The FAS showed excellent validity for the measurement of critical aspects of family attitudes, and the FAS score reflected the state of psychological health of the families. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 8 | Psychiatry Res 2002 Apr 109: 265-79 |
| PMID | 11959363 |
| Title | The Family Questionnaire: development and validation of a new self-report scale for assessing expressed emotion. |
| Abstract | The level of expressed emotion (EE) as assessed in the Camberwell Family Interview (CFI) has proved to be one of the best predictors of relapse in schizophrenia. The present study describes the development and validation of the Family Questionnaire (FQ), a brief self-report questionnaire measuring the EE status (criticism, emotional overinvolvement) of relatives of patients with schizophrenia. The FQ classifications in the initial sample of relatives (N=76) correlated significantly with the ratings in the CFI subcategories 'criticism' (78% correct classifications) and 'emotional overinvolvement' (71% correct classifications), as well as with the overall CFI EE ratings (74% correct classifications). A validation study in an independent second sample (N=79) yielded similar results. The overall correct classification rate of 74% remained unchanged. The FQ had better agreement with the CFI on emotional overinvolvement than did other short EE questionnaires. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 9 | Cult Med Psychiatry 2003 Mar 27: 95-106 |
| PMID | 12825786 |
| Title | The characteristics of expressed emotion among relatives of patients with schizophrenia in Chengdu, China. |
| Abstract | We used the Mandarin Chinese version of the Camberwell Family Interview (CFI) to measure the components of expressed emotion among relatives of schizophrenic patients in urban and rural areas of Chengdu, China. The reliability and validity of the Chinese version of the CFI was examined. Seventy-one patients and their key relatives were included in the study. The results showed that high interrater reliabilities were found for the Chinese version of CFI. The proportion of relatives in our sample rated as high-EE was 28.2%, and the Chengdu relatives expressed significantly fewer critical comments (CCs) and less emotional overinvolvement (EOI) than respondents in other similar studies in the West. Within the Chengdu sample, city dwellers were significantly more expressive than villagers expressing warmth, positive remarks, and EOI (p < 0.05). The results of this study could indicate the impact of cultural and ethnic differences and geographical location on EE. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 10 | Cult Med Psychiatry 2003 Mar 27: 95-106 |
| PMID | 12825786 |
| Title | The characteristics of expressed emotion among relatives of patients with schizophrenia in Chengdu, China. |
| Abstract | We used the Mandarin Chinese version of the Camberwell Family Interview (CFI) to measure the components of expressed emotion among relatives of schizophrenic patients in urban and rural areas of Chengdu, China. The reliability and validity of the Chinese version of the CFI was examined. Seventy-one patients and their key relatives were included in the study. The results showed that high interrater reliabilities were found for the Chinese version of CFI. The proportion of relatives in our sample rated as high-EE was 28.2%, and the Chengdu relatives expressed significantly fewer critical comments (CCs) and less emotional overinvolvement (EOI) than respondents in other similar studies in the West. Within the Chengdu sample, city dwellers were significantly more expressive than villagers expressing warmth, positive remarks, and EOI (p < 0.05). The results of this study could indicate the impact of cultural and ethnic differences and geographical location on EE. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 11 | Psychiatry Res 2003 Mar 117: 211-22 |
| PMID | 12686364 |
| Title | Determinants of expressed emotion in mothers of schizophrenia patients. |
| Abstract | Our objectives were to determine the extent to which symptoms in the schizophrenia patient and personality in the mother lead to a sense of subjective burden in the mother, and to explain variance in two components of Expressed Emotion. Data on symptom severity (PANSS), mothers' personality (NEO-PI), subjective burden (SBAS), and Expressed Emotion (CFI) were gathered from 41 schizophrenia outpatients and their mothers. Approximately one quarter of the variance in Critical Comments (CCs) and Emotional Overinvolvement (EOI) was explained using path analysis. Mothers' CCs were associated with more severe excitement in the patient, with lower Neuroticism, and greater burden in the mother. Higher EOI was explained by greater Conscientiousness and burden in the mother; patient depression had a weak indirect effect on maternal EOI. These results characterize the high EE mother as low in neuroticism and high in conscientiousness with a particular sensitivity to excitement and depression in the patient. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 12 | Soc Psychiatry Psychiatr Epidemiol 2004 Jul 39: 569-75 |
| PMID | 15243695 |
| Title | Mental health, burnout and job satisfaction among professionals in sheltered living in Flanders. A pilot study. |
| Abstract | Interest has been growing over the last few years in the working conditions of professionals who deal with clients with severe and chronic mental illnesses. In this study, the relationship between the affective climate, as measured by the construct of expressed emotion, and professionals' feelings of well-being and burnout was investigated. It was hypothesised that high expressed emotion (EE) (= a high amount of criticism, hostility or emotional overinvolvement) would be related to high burnout scores. Fifty-six professionals were interviewed about their schizophrenic clients who resided in sheltered-living houses in Flanders. EE was measured with two instruments, the Camberwell Family Interview (CFI) and the Perceived Criticism Scale (PCS). The professionals' characteristics were mental health (Symptom Checklist, SCL-90), job satisfaction (VEVAK), and burnout (a Dutch version of the Maslach Burnout Inventory, UBOS-C). Little indication was found for an association between EE and working conditions as measured with the CFI. For the PCS, a significant relationship was found between the resident version of the PCS and burnout. The professionals who were perceived by the residents as being very critical were less depersonalised and less emotionally exhausted than those who were not so perceived. High EE relationships can exist without feelings of stress and burnout. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 13 | J. Nerv. Ment. Dis. 2006 Jun 194: 391-6 |
| PMID | 16772854 |
| Title | Ethnicity, expressed emotion, and communication deviance in family members of patients with schizophrenia. |
| Abstract | This study examined the relationships among expressed emotion (EE), communication deviance (CD), and ethnicity in a sample of 57 white, Latino, and black relatives of patients with schizophrenia. A new method of assessing CD from the Five Minute Speech Sample was also developed and evaluated against an existing method (the Camberwell Family Interview; CFI). As hypothesized, high expressed emotion rated (from the CFI) was associated with higher levels of CD, and the Five Minute Speech Sample and CFI methods of assessing CD were concordant. CD statements made by white family members focused most on patient behaviors/symptoms that reflected a lack of independent functioning. CD statements of Latino and black relatives, however, focused most on patient behaviors that interfered with the family's interdependent functioning. Family members may have particular difficulty communicating coherently when discussing patients' inability to uphold important values and behaviors that are sanctioned by their ethnic background. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 14 | Psychiatry Res 2007 May 151: 107-13 |
| PMID | 17391775 |
| Title | Expressed emotion and interdependence in White and Latino/Hispanic family members of patients with schizophrenia. |
| Abstract | This study examined associations among ethnicity, expressed emotion (EE) and interdependence in a sample of 41 Latino/Hispanic and White family members of patients with schizophrenia. EE was assessed using both the Camberwell Family Interview (CFI) and the Five Minute Speech Sample (FMSS). These measures were found to be highly concordant for rating EE. However, the CFI appears to identify high EE more often than does the FMSS. Whites were designated as high EE significantly more often than were Latinos/Hispanics, regardless of assessment method. Using the interdependence subscale of the Self-Construal Scale, we found a strong trend for Latino/Hispanics to report a more interdependent self-construal than did Whites. However, contrary to expectations, interdependence was not found to mediate the relationship between ethnicity and EE. EE and interdependence may both play a role in the better course of illness observed for patients from traditional cultures. However, these two constructs may relate to patient functioning through different mechanisms. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 15 | Prog. Neuropsychopharmacol. Biol. Psychiatry 2009 Oct 33: 1113-8 |
| PMID | 19539682 |
| Title | The model of the relationships among the predictors of quality of life in chronic stage of schizophrenia. |
| Abstract | We attempted to formulate a model of quality of life (QoL) in chronic stage of schizophrenia with 72 patients by including key variables, i.e., psychopathology, insight, executive functioning, and side effects, proposed to be its significant predictors in previous studies. We applied the structural equation modelling (SEM) method to simultaneously test a number of possible hypotheses concerning the inter-relations among the predictors of QoL in schizophrenia patients by formulating possible models and examining their levels of fitness. Our most fit model (X(2)=2.106, df=4, P=0.716; CFI=1.000; TLI=1.213; RMSEA=0.000, LO=0.000, HI=0.132) showed that the severity of psychopathology not only directly causes poor QoL, but also by adversely affecting insight. On the other hand, executive function may not be affected significantly by psychopathology, but executive function still plays an important role in determining the QoL not only directly, but also indirectly by influencing self-evaluation of side-effects. Impaired insight and executive function caused by severe level of psychopathology contribute to an increased reporting of side-effects, resulting in cumulative dysfunction in daily life for patients with chronic schizophrenia. Our study illustrates that the complexity of the relationships among the predictors of QoL in chronic patients of schizophrenia should be considered when designing studies on QoL of this group. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 16 | Isr J Psychiatry Relat Sci 2011 -1 48: 74-81 |
| PMID | 22120441 |
| Title | Rates of expressed emotions in Pakistani relatives of patients with schizophrenia. |
| Abstract | Studies have reported substantial cross-cultural variations in rates of Expressed Emotions (EE) in relatives of patients with schizophrenia. As a first attempt from Pakistan, this study aimed to measure the components of EE among relatives of patients with schizophrenia in a different socio-cultural set-up. Thirty-two key family members were interviewed using the Camberwell Family Interview (CFI) and Five Minute Speech Sample (FMSS). Seventy-five percent of the family members appeared to be high EE with the majority rated so on the basis of hostility alone. Moreover, symptomatic behavior of the patient contributed more to the rating of relatives hostility. Pakistani relatives showed higher levels of emotional over-involvement and hostility as compared to many other cultures. In comparison to CFI, the FMSS showed lower sensitivity for identifying high EE relatives, thus it may not be very suitable to use on its own in Pakistan for cultural reasons. Lack of follow-up data and small sample size limit the scope of the study. Pakistani relatives appeared to be more hostile yet emotionally over-involved and warm toward their sick relatives as compared to the households reported in many previous studies. Psycho-educational programs need to be initiated for the concerned families to reduce their level of hostility. Outcome studies are also warranted in order to understand any link between high EE and relapse of schizophrenia in Pakistan. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 17 | Schizophr. Res. 2012 May 137: 246-50 |
| PMID | 22356801 |
| Title | Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. |
| Abstract | Although the developers of the Positive and Negative Syndrome Scale (PANSS) grouped items into three subscales, factor analyses indicate that a five-factor model better characterizes PANSS data. However, lack of consensus on which model to use limits the comparability of PANSS variables across studies. We counted "votes" from published factor analyses to derive consensus models. One of these combined superior fit in our Caucasian sample (n=458, CFI=.970), and in distinct Japanese sample (n=164, CFI=.964), relative to the original three-subscale model, with a sorting of items into factors that was highly consistent across the studies reviewed. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 18 | PLoS ONE 2012 -1 7: e47655 |
| PMID | 23144705 |
| Title | Neurocognition, insight and medication nonadherence in schizophrenia: a structural equation modeling approach. |
| Abstract | The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia. Cross-sectional study. Diagnosis of schizophrenia according to the DSM-IV-TR criteria. Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional 'Scale to assess Unawareness of Mental Disorder;' and nonadherence was measured using the multidimensional 'Medication Adherence Rating Scale.' Structural equation modeling (SEM) was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, 'awareness of positive symptoms' and 'negative symptoms', 'awareness of mental disorder' and nonadherence. One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed ?(2) = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1) neurocognition and 'awareness of symptoms,' (2) 'awareness of symptoms' and 'awareness of mental disorder' and (3) 'awareness of mental disorder' and nonadherence, mainly in the 'attitude toward taking medication' dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and 'awareness of mental disorder,' and 'awareness of symptoms' and nonadherence. Our findings support the hypothesis that neurocognition influences 'awareness of symptoms,' which must be integrated into a higher level of insight (i.e., the 'awareness of mental disorder') to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 19 | PLoS ONE 2013 -1 8: e79677 |
| PMID | 24205390 |
| Title | Toward meeting the needs of homeless people with schizophrenia: the validity of quality of life measurement. |
| Abstract | To provide new evidence regarding the suitability of using quality of life (QoL) measurements in homeless people with schizophrenia, we assess the acceptability and psychometric properties of a specific QoL instrument (S-QoL 18) in a population of homeless people with schizophrenia, and we compare their QoL levels with those observed in non-homeless people with schizophrenia. This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Two hundred and thirty-six homeless patients with schizophrenia were recruited over a 12 month-period. The S-QoL 18 was tested for construct validity, reliability, external validity and sensitivity to change. The QoL of the 236 homeless patients was compared with 236 French age- and sex-matched non-homeless patients with schizophrenia. The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA = 0.035, CFI = 0.95, GFI = 0.99 and SRMR = 0.015). Internal consistency, reliability and sensitivity to change were satisfactory. External validity was confirmed via correlations between S-QoL 18 dimension scores and SF-36, symptomatology and recovery scores. The percentage of missing data did not exceed 5%. Finally, homeless patients had significantly lower QoL levels than non-homeless patients with schizophrenia. These results demonstrate the satisfactory acceptability and psychometric properties of the S-QoL 18, suggesting the validity of QoL measurement among homeless patients with schizophrenia. Our study also reported that QoL levels in homeless patients with schizophrenia were dramatically low, highlighting the need for new policies to eradicate homelessness and tackle poverty. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 20 | PLoS ONE 2013 -1 8: e61115 |
| PMID | 23690922 |
| Title | Social functioning in Chinese college students with and without schizotypal personality traits: an exploratory study of the Chinese version of the First Episode Social Functioning Scale. |
| Abstract | The First Episode Social Functioning Scale (FESFS) was designed to measure social functioning of young individuals with schizophrenia. The aim of this study was to validate a Chinese version of the FESFS in a sample of young Chinese adults. The FESFS was translated to Chinese prior to being administered to 1576 college students. The factor structure, reliability, and validity of the scale were examined. Two items were deleted after item analysis and the internal consistency of the whole scale was .89. A six-factor structure was derived by exploratory factor analysis. The factors were interpersonal, family and friends, school, living skills, intimacy, and balance. Estimates of the structural equation model supported this structure, with Goodness of Fit Chi-Square ?(2)?=?1097.53 (p<0.0001), the root mean square error of approximation (RMSEA)?=?0.058, and the comparative fit index (CFI)?=?0.93. Scale validity was supported by significant correlations between social functioning factors scores and schizophrenia personality questionnaire (SPQ) scores. Individuals with schizotypal personality features presented poorer social functioning than those without schizotypal personality features. The Chinese revised version of the FESFS was found to have good psychometric properties and could be used in the future to examine social functioning in Chinese college students. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 21 | PLoS ONE 2013 -1 8: e61115 |
| PMID | 23690922 |
| Title | Social functioning in Chinese college students with and without schizotypal personality traits: an exploratory study of the Chinese version of the First Episode Social Functioning Scale. |
| Abstract | The First Episode Social Functioning Scale (FESFS) was designed to measure social functioning of young individuals with schizophrenia. The aim of this study was to validate a Chinese version of the FESFS in a sample of young Chinese adults. The FESFS was translated to Chinese prior to being administered to 1576 college students. The factor structure, reliability, and validity of the scale were examined. Two items were deleted after item analysis and the internal consistency of the whole scale was .89. A six-factor structure was derived by exploratory factor analysis. The factors were interpersonal, family and friends, school, living skills, intimacy, and balance. Estimates of the structural equation model supported this structure, with Goodness of Fit Chi-Square ?(2)?=?1097.53 (p<0.0001), the root mean square error of approximation (RMSEA)?=?0.058, and the comparative fit index (CFI)?=?0.93. Scale validity was supported by significant correlations between social functioning factors scores and schizophrenia personality questionnaire (SPQ) scores. Individuals with schizotypal personality features presented poorer social functioning than those without schizotypal personality features. The Chinese revised version of the FESFS was found to have good psychometric properties and could be used in the future to examine social functioning in Chinese college students. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 22 | Bipolar Disord 2013 Jun 15: 422-33 |
| PMID | 23656284 |
| Title | Confirmatory factor analysis reveals a latent cognitive structure common to bipolar disorder, schizophrenia, and normal controls. |
| Abstract | We sought to determine whether a single hypothesized latent factor structure would characterize cognitive functioning in three distinct groups. We assessed 576 adults (340 community controls, 126 adults with bipolar disorder, and 110 adults with schizophrenia) using 15 measures derived from nine cognitive tests. Confirmatory factor analysis (CFA) was conducted to examine the fit of a hypothesized six-factor model. The hypothesized factors included attention, psychomotor speed, verbal memory, visual memory, ideational fluency, and executive functioning. The six-factor model provided an excellent fit for all three groups [for community controls, root mean square error of approximation (RMSEA) <0.048 and comparative fit index (CFI) = 0.99; for adults with bipolar disorder, RMSEA = 0.071 and CFI = 0.99; and for adults with schizophrenia, RMSEA = 0.06 and CFI = 0.98]. Alternate models that combined fluency with processing speed or verbal and visual memory reduced the goodness of fit. Multi-group CFA results supported factor invariance across the three groups. Confirmatory factor analysis supported a single six-factor structure of cognitive functioning among patients with schizophrenia or bipolar disorder and community controls. While the three groups clearly differ in level of performance, they share a common underlying architecture of information processing abilities. These cognitive factors could provide useful targets for clinical trials of treatments that aim to enhance information processing in persons with neurological and neuropsychiatric disorders. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 23 | Schizophr. Res. 2013 May 146: 209-16 |
| PMID | 23522906 |
| Title | Sensory processing, neurocognition, and social cognition in schizophrenia: towards a cohesive cognitive model. |
| Abstract | schizophrenia research has identified deficits in neurocognition, social cognition, and sensory processing. Because a cohesive model of "disturbed cognitive machinery" is currently lacking, we built a conceptual model to integrate neurocognition, social cognition, and sensory processing. In a cross-sectional study, the cognitive performance of participants was measured. In accordance with the Schedules for Clinical Assessment in Neuropsychiatry, the participants were assigned to either the schizophrenia group or the non-schizophrenic psychosis group. Exclusion criteria included substance abuse, serious somatic/neurological illness, and perceptual handicap. The male/female ratio, educational level, and handedness did not differ significantly between the groups. The data were analyzed using structural equation modeling. Based upon the results of all possible pairwise models correlating neurocognition, social cognition, and sensory processing, three omnibus models were analyzed. A statistical analysis of a pairwise model-fit (?(2), CFI, and RMSEA statistics) revealed poor interrelatedness between sensory processing and neurocognition in schizophrenia patients compared with healthy control participants. The omnibus model that predicted disintegration between sensory processing and neurocognition was statistically confirmed as superior for the schizophrenia group (?(2)(53) of 56.62, p=0.341, RMSEA=0.04, CFI=0.95). In healthy participants, the model predicting maximal interrelatedness between sensory processing/neurocognition and neurocognition/social cognition gave the best fit (?(2)(52) of 53.74, p=0.408, RMSEA=0.03, CFI=0.97). The performance of the patients with non-schizophrenic psychosis fell between the schizophrenia patients and control participants. These findings suggest increasing separation between sensory processing and neurocognition along the continuum from mental health to schizophrenia. Our results support a conceptual model that posits disintegration between sensory processing of social stimuli and neurocognitive processing. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 24 | Schizophr. Res. 2013 May 146: 209-16 |
| PMID | 23522906 |
| Title | Sensory processing, neurocognition, and social cognition in schizophrenia: towards a cohesive cognitive model. |
| Abstract | schizophrenia research has identified deficits in neurocognition, social cognition, and sensory processing. Because a cohesive model of "disturbed cognitive machinery" is currently lacking, we built a conceptual model to integrate neurocognition, social cognition, and sensory processing. In a cross-sectional study, the cognitive performance of participants was measured. In accordance with the Schedules for Clinical Assessment in Neuropsychiatry, the participants were assigned to either the schizophrenia group or the non-schizophrenic psychosis group. Exclusion criteria included substance abuse, serious somatic/neurological illness, and perceptual handicap. The male/female ratio, educational level, and handedness did not differ significantly between the groups. The data were analyzed using structural equation modeling. Based upon the results of all possible pairwise models correlating neurocognition, social cognition, and sensory processing, three omnibus models were analyzed. A statistical analysis of a pairwise model-fit (?(2), CFI, and RMSEA statistics) revealed poor interrelatedness between sensory processing and neurocognition in schizophrenia patients compared with healthy control participants. The omnibus model that predicted disintegration between sensory processing and neurocognition was statistically confirmed as superior for the schizophrenia group (?(2)(53) of 56.62, p=0.341, RMSEA=0.04, CFI=0.95). In healthy participants, the model predicting maximal interrelatedness between sensory processing/neurocognition and neurocognition/social cognition gave the best fit (?(2)(52) of 53.74, p=0.408, RMSEA=0.03, CFI=0.97). The performance of the patients with non-schizophrenic psychosis fell between the schizophrenia patients and control participants. These findings suggest increasing separation between sensory processing and neurocognition along the continuum from mental health to schizophrenia. Our results support a conceptual model that posits disintegration between sensory processing of social stimuli and neurocognitive processing. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 25 | Schizophr. Res. 2013 Jan 143: 77-83 |
| PMID | 23201306 |
| Title | Cognition and the five-factor model of the positive and negative syndrome scale in schizophrenia. |
| Abstract | Different exploratory and confirmatory factorial analyses of the Positive and Negative Syndrome Scale (PANSS) have found a number of factors other than the original positive, negative, and general psychopathology. Based on a review of previous studies and using confirmatory factor analyses (CFA), Wallwork et al. (Schizophr Res 2012; 137: 246-250) have recently proposed a consensus five-factor structure of the PANSS. This solution includes a cognitive factor which could be a useful measure of cognition in schizophrenia. Our objectives were 1) to study the psychometric properties (factorial structure and reliability) of this consensus five-factor model of the PANSS, and 2) to study the relationship between executive performance assessed using the Wisconsin Card Sorting Test (WCST) and the proposed PANSS consensus cognitive factor (composed by items P2-N5-G11). This cross-sectional study included a final sample of 201 Spanish outpatients diagnosed with schizophrenia. For our first objective, CFA was performed and Cronbach's alphas of the five factors were calculated; for the second objective, sequential linear regression analyses were used. The results of the CFA showed acceptable fit indices (NNFI=0.94, CFI=0.95, RMSEA=0.08). Cronbach's alphas of the five factors were adequate. Regression analyses showed that this five-factor model of the PANSS explained more of the WCST variance than the classical three-factor model. Moreover, higher cognitive factor scores were associated with worse WCST performance. These results supporting its factorial structure and reliability provide robustness to this consensus PANSS five-factor model, and indicate some usefulness of the cognitive factor in the clinical assessment of schizophrenic patients. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 26 | Schizophr. Res. 2013 Jan 143: 77-83 |
| PMID | 23201306 |
| Title | Cognition and the five-factor model of the positive and negative syndrome scale in schizophrenia. |
| Abstract | Different exploratory and confirmatory factorial analyses of the Positive and Negative Syndrome Scale (PANSS) have found a number of factors other than the original positive, negative, and general psychopathology. Based on a review of previous studies and using confirmatory factor analyses (CFA), Wallwork et al. (Schizophr Res 2012; 137: 246-250) have recently proposed a consensus five-factor structure of the PANSS. This solution includes a cognitive factor which could be a useful measure of cognition in schizophrenia. Our objectives were 1) to study the psychometric properties (factorial structure and reliability) of this consensus five-factor model of the PANSS, and 2) to study the relationship between executive performance assessed using the Wisconsin Card Sorting Test (WCST) and the proposed PANSS consensus cognitive factor (composed by items P2-N5-G11). This cross-sectional study included a final sample of 201 Spanish outpatients diagnosed with schizophrenia. For our first objective, CFA was performed and Cronbach's alphas of the five factors were calculated; for the second objective, sequential linear regression analyses were used. The results of the CFA showed acceptable fit indices (NNFI=0.94, CFI=0.95, RMSEA=0.08). Cronbach's alphas of the five factors were adequate. Regression analyses showed that this five-factor model of the PANSS explained more of the WCST variance than the classical three-factor model. Moreover, higher cognitive factor scores were associated with worse WCST performance. These results supporting its factorial structure and reliability provide robustness to this consensus PANSS five-factor model, and indicate some usefulness of the cognitive factor in the clinical assessment of schizophrenic patients. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 27 | Psychol Assess 2014 Sep 26: 980-9 |
| PMID | 24796341 |
| Title | Psychometric evaluation of the Short Form 36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for patients with schizophrenia. |
| Abstract | Quality-of-life (QoL) instruments measure the overall health status of people with schizophrenia, for whom the activities of daily life are often difficult. However, information on the psychometric properties of scores from the Short Form 36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF), 2 commonly used generic QoL instruments in this population, is limited. Thus, we used a multitrait-multimethod analysis plus confirmatory factor analysis (CFA) to examine their psychometric properties. To test the reliability of their scores, we used methods of absolute reliability (standard error of measurement [SEM] and smallest real difference [SRD]) and relative reliability (i.e., intraclass correlation coefficient [ICC]). We recruited 100 patients with schizophrenia from a psychiatric hospital in southern Taiwan. All participants filled out the SF-36 and the WHOQOL-BREF at baseline and 2 weeks later. The participants' QoL scores were lower than those of the Taiwan general population (ps < .01), and CFA indicated that the constructs of QoL scores for the SF-36 (comparative fit index [CFI] = .918; incremental fit index [IFI] = .919; Tucker-Lewis index [TLI] = .885) and the WHOQOL-BREF (CFI = .967; IFI = .967; TLI = .900) were acceptable. The SEM and SRD analyses suggested that the total scores of the SF-36 (SEM% = 10.03%; SRD% = 27.80%) and of the WHOQOL-BREF (SEM% = 5.55%; SRD% = 15.40%) were reliable. Also, our results demonstrated that the WHOQOL-BREF scores were more reliable and valid than the SF-36 scores for assessing people with schizophrenia. The scores of both questionnaires were valid and reliable and detected different aspects of QOL in the population with schizophrenia. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 28 | Qual Life Res 2014 Nov 23: 2559-68 |
| PMID | 24756436 |
| Title | The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community. |
| Abstract | For people with schizophrenia living in the community and receiving outpatient care, the issues of stigma and discrimination and dearth of recovery-oriented services remain barriers to recovery and community integration. The experience of self-stigma and unmet recovery needs can occur regardless of symptom status or disease process, reducing life satisfaction and disrupting overall well-being. The present study examined the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life. Structural equation modeling and mediation analyses were conducted based on a community sample of 400 mental health consumers with schizophrenia spectrum disorders in Hong Kong. The model of self-stigma and unmet needs as mediators between symptom severity and subjective quality of life had good fit to the data (GFI = .93, CFI = .93, NNFI = .92, RMSEA = .06, ?(2)/df ratio = 2.62). A higher level of symptom severity was significantly associated with increased self-stigma (R (2) = .24) and a greater number of unmet needs (R (2) = .53). Self-stigma and unmet needs were in turn negatively related to subjective quality of life (R (2) = .45). It is essential that service providers and administrators make greater efforts to eliminate or reduce self-stigma and unmet recovery needs, which are associated with the betterment of the overall quality of life and long-term recovery. Both incorporating empowerment and advocacy-based interventions into recovery-oriented services and providing community-based, person-centered services to people based on personally defined needs are important directions for future recovery-oriented efforts. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 29 | Sci Rep 2015 -1 5: 11850 |
| PMID | 26136150 |
| Title | Re-visiting the nature and relationships between neurological signs and neurocognitive functions in first-episode schizophrenia: An invariance model across time. |
| Abstract | The present study examined different types of neurological signs in patients with first-episode schizophrenia and their relationships with neurocognitive functions. Both cross-sectional and longitudinal designs were adopted with the use of the abridged Cambridge Neurological Inventory which comprises items capturing motor coordination, sensory integration and disinhibition. A total of 157 patients with first-episode schizophrenia were assessed at baseline and 101 of them were re-assessed at six-month interval. A structural equation model (SEM) with invariance model across time was used for data analysis. The model fitted well with the data at baseline assessment, X^2(21)?= 21.78, p = 0.413, NFI = 0.95, NNFI = 1.00, CFI = 1.00, IFI = 1.00, RMSEA = 0.015. Subsequent SEM analysis with invariance model at six-month interval also demonstrated the same stable pattern across time and showed strong measurement invariance and structure invariance across time. Our findings suggest that neurological signs capture more or less the same construct captured by conventional neurocognitive tests in patients with schizophrenia. The measurement and structure of these relationships appear to be stable over time. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 30 | Schizophr. Res. 2015 Dec 169: 292-7 |
| PMID | 26522850 |
| Title | Psychometric properties of the recovery measurement in homeless people with severe mental illness. |
| Abstract | The Recovery Assessment Scale (RAS) is one of the most widely used measurements of recovery in mental health research. To date, no data have been available concerning the psychometric characteristics of the RAS in homeless people with severe mental illness. The aim of this study was to provide new data regarding the psychometric properties of the RAS in homeless people with schizophrenia and bipolar disorder. This multi-center study was conducted in 4 French cities. In addition to the RAS, data on sociodemographic information, disease severity using the Modified Colorado Symptom Index - MCSI, and the number of mental health comorbidities, care characteristics and quality of life (S-QoL-18) were collected. The RAS was tested for construct validity, reliability, external validity, sensitivity to change and acceptability. Six hundred fifty-eight homeless patients participated in this study. The five-factor structure was confirmed by confirmatory factor analysis (RMSEA = 0.043, CFI = 0.95, NFI = 0.94 and SRMR = 0.063). The internal item consistency (from 0.40 to 0.80) and reliability (Cronbach's alpha from 0.79 to 0.87) were satisfactory for all dimensions. External validity testing revealed that the dimension scores were correlated significantly with the MCSI and S-QoL 18 scores. Significant associations with age, disease severity, psychiatric comorbidities and care characteristics showed good discriminant validity. The percentage of missing data (< 14.4%) and sensitivity to change were satisfactory. Our study demonstrated the satisfactory acceptability and psychometric properties of the RAS, supporting its use as a mean of recovery measurement for homeless patients. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 31 | Mol. Psychiatry 2015 Nov 20: 1266-85 |
| PMID | 26283638 |
| Title | Understanding and predicting suicidality using a combined genomic and clinical risk assessment approach. |
| Abstract | Worldwide, one person dies every 40 seconds by suicide, a potentially preventable tragedy. A limiting step in our ability to intervene is the lack of objective, reliable predictors. We have previously provided proof of principle for the use of blood gene expression biomarkers to predict future hospitalizations due to suicidality, in male bipolar disorder participants. We now generalize the discovery, prioritization, validation, and testing of such markers across major psychiatric disorders (bipolar disorder, major depressive disorder, schizoaffective disorder, and schizophrenia) in male participants, to understand commonalities and differences. We used a powerful within-participant discovery approach to identify genes that change in expression between no suicidal ideation and high suicidal ideation states (n=37 participants out of a cohort of 217 psychiatric participants followed longitudinally). We then used a convergent functional genomics (CFG) approach with existing prior evidence in the field to prioritize the candidate biomarkers identified in the discovery step. Next, we validated the top biomarkers from the prioritization step for relevance to suicidal behavior, in a demographically matched cohort of suicide completers from the coroner's office (n=26). The biomarkers for suicidal ideation only are enriched for genes involved in neuronal connectivity and schizophrenia, the biomarkers also validated for suicidal behavior are enriched for genes involved in neuronal activity and mood. The 76 biomarkers that survived Bonferroni correction after validation for suicidal behavior map to biological pathways involved in immune and inflammatory response, mTOR signaling and growth factor regulation. mTOR signaling is necessary for the effects of the rapid-acting antidepressant agent ketamine, providing a novel biological rationale for its possible use in treating acute suicidality. Similarly, MAOB, a target of antidepressant inhibitors, was one of the increased biomarkers for suicidality. We also identified other potential therapeutic targets or biomarkers for drugs known to mitigate suicidality, such as omega-3 fatty acids, lithium and clozapine. Overall, 14% of the top candidate biomarkers also had evidence for involvement in psychological stress response, and 19% for involvement in programmed cell death/cellular suicide (apoptosis). It may be that in the face of adversity (stress), death mechanisms are turned on at a cellular (apoptosis) and organismal level. Finally, we tested the top increased and decreased biomarkers from the discovery for suicidal ideation (CADM1, CLIP4, DTNA, KIF2C), prioritization with CFG for prior evidence (SAT1, SKA2, SLC4A4), and validation for behavior in suicide completers (IL6, MBP, JUN, KLHDC3) steps in a completely independent test cohort of psychiatric participants for prediction of suicidal ideation (n=108), and in a future follow-up cohort of psychiatric participants (n=157) for prediction of psychiatric hospitalizations due to suicidality. The best individual biomarker across psychiatric diagnoses for predicting suicidal ideation was SLC4A4, with a receiver operating characteristic (ROC) area under the curve (AUC) of 72%. For bipolar disorder in particular, SLC4A4 predicted suicidal ideation with an AUC of 93%, and future hospitalizations with an AUC of 70%. SLC4A4 is involved in brain extracellular space pH regulation. Brain pH has been implicated in the pathophysiology of acute panic attacks. We also describe two new clinical information apps, one for affective state (simplified affective state scale, SASS) and one for suicide risk factors (Convergent Functional Information for Suicide, CFI-S), and how well they predict suicidal ideation across psychiatric diagnoses (AUC of 85% for SASS, AUC of 89% for CFI-S). We hypothesized a priori, based on our previous work, that the integration of the top biomarkers and the clinical information into a universal predictive measure (UP-Suicide) would show broad-spectrum predictive ability across psychiatric diagnoses. Indeed, the UP-Suicide was able to predict suicidal ideation across psychiatric diagnoses with an AUC of 92%. For bipolar disorder, it predicted suicidal ideation with an AUC of 98%, and future hospitalizations with an AUC of 94%. Of note, both types of tests we developed (blood biomarkers and clinical information apps) do not require asking the individual assessed if they have thoughts of suicide, as individuals who are truly suicidal often do not share that information with clinicians. We propose that the widespread use of such risk prediction tests as part of routine or targeted healthcare assessments will lead to early disease interception followed by preventive lifestyle modifications and proactive treatment. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 32 | Work 2015 -1 50: 629-36 |
| PMID | 24448016 |
| Title | Social cognition and work performance of persons with schizophrenia in a Chinese population. |
| Abstract | Social-cognitive deficits have a significant impact on the community and vocational functioning of persons with schizophrenia. This study aimed to explore the relationship between social-cognitive abilities and vocational functioning in a Chinese population. We recruited 30 outpatients with schizophrenia to participate. We administered the Chinese Social Cognition and Screening Questionnaire (C-SCSQ) to assess Theory of Mind (ToM), attributional bias, and neurocognition; the Facial Expression Identification Test (FEIT) to assess emotion perception (EP) ability, and the Chinese Work Personality Profile (CWPP) to assess work performance in a simulated work setting. ToM showed a significant negative correlation with attributional bias. The neurocognitive measure displayed a significant positive correlation with ToM and EP. The structural equation model was a good fit to the data (CFI=0.91, RMSEA=0.12), and showed that social-cognitive abilities had a significant impact (-0.41) on work performance. Of the four social-cognitive domains, ToM and paranoid attributional style (PAS) contributed significantly to variations in work performance. These results support the theory that social-cognitive abilities have an impact on work performance. ToM has a positive impact whereas PAS has an adverse effect. Persons with schizophrenia present specific deficits in their social-cognitive abilities, which have significant impact on their work performance and employability. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 33 | Mol. Psychiatry 2016 Jun 21: 768-85 |
| PMID | 27046645 |
| Title | Towards understanding and predicting suicidality in women: biomarkers and clinical risk assessment. |
| Abstract | Women are under-represented in research on suicidality to date. Although women have a lower rate of suicide completion than men, due in part to the less-violent methods used, they have a higher rate of suicide attempts. Our group has previously identified genomic (blood gene expression biomarkers) and clinical information (apps) predictors for suicidality in men. We now describe pilot studies in women. We used a powerful within-participant discovery approach to identify genes that change in expression between no suicidal ideation (no SI) and high suicidal ideation (high SI) states (n=12 participants out of a cohort of 51 women psychiatric participants followed longitudinally, with diagnoses of bipolar disorder, depression, schizoaffective disorder and schizophrenia). We then used a Convergent Functional Genomics (CFG) approach to prioritize the candidate biomarkers identified in the discovery step by using all the prior evidence in the field. Next, we validated for suicidal behavior the top-ranked biomarkers for SI, in a demographically matched cohort of women suicide completers from the coroner's office (n=6), by assessing which markers were stepwise changed from no SI to high SI to suicide completers. We then tested the 50 biomarkers that survived Bonferroni correction in the validation step, as well as top increased and decreased biomarkers from the discovery and prioritization steps, in a completely independent test cohort of women psychiatric disorder participants for prediction of SI (n=33) and in a future follow-up cohort of psychiatric disorder participants for prediction of psychiatric hospitalizations due to suicidality (n=24). Additionally, we examined how two clinical instruments in the form of apps, Convergent Functional Information for Suicidality (CFI-S) and Simplified Affective State Scale (SASS), previously tested in men, perform in women. The top CFI-S item distinguishing high SI from no SI states was the chronic stress of social isolation. We then showed how the clinical information apps combined with the 50 validated biomarkers into a broad predictor (UP-Suicide), our apriori primary end point, predicts suicidality in women. UP-Suicide had a receiver-operating characteristic (ROC) area under the curve (AUC) of 82% for predicting SI and an AUC of 78% for predicting future hospitalizations for suicidality. Some of the individual components of the UP-Suicide showed even better results. SASS had an AUC of 81% for predicting SI, CFI-S had an AUC of 84% and the combination of the two apps had an AUC of 87%. The top biomarker from our sequential discovery, prioritization and validation steps, BCL2, predicted future hospitalizations due to suicidality with an AUC of 89%, and the panel of 50 validated biomarkers (BioM-50) predicted future hospitalizations due to suicidality with an AUC of 94%. The best overall single blood biomarker for predictions was PIK3C3 with an AUC of 65% for SI and an AUC of 90% for future hospitalizations. Finally, we sought to understand the biology of the biomarkers. BCL2 and GSK3B, the top CFG scoring validated biomarkers, as well as PIK3C3, have anti-apoptotic and neurotrophic effects, are decreased in expression in suicidality and are known targets of the anti-suicidal mood stabilizer drug lithium, which increases their expression and/or activity. Circadian clock genes were overrepresented among the top markers. Notably, PER1, increased in expression in suicidality, had an AUC of 84% for predicting future hospitalizations, and CSNK1A1, decreased in expression, had an AUC of 96% for predicting future hospitalizations. Circadian clock abnormalities are related to mood disorder, and sleep abnormalities have been implicated in suicide. Docosahexaenoic acid signaling was one of the top biological pathways overrepresented in validated biomarkers, which is of interest given the potential therapeutic and prophylactic benefits of omega-3 fatty acids. Some of the top biomarkers from the current work in women showed co-directionality of change in expression with our previous work in men, whereas others had changes in opposite directions, underlying the issue of biological context and differences in suicidality between the two genders. With this study, we begin to shed much needed light in the area of female suicidality, identify useful objective predictors and help understand gender commonalities and differences. During the conduct of the study, one participant committed suicide. In retrospect, when the analyses were completed, her UP-Suicide risk prediction score was at the 100 percentile of all participants tested. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 34 | Schizophr. Res. 2016 Apr -1: -1 |
| PMID | 27041675 |
| Title | A confirmatory factor analysis of the MATRICS consensus cognitive battery in severe mental illness. |
| Abstract | A recent factor analysis of Measurement and Treatment Research to Improve Cognition in schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) data in a sample of schizophrenia-spectrum patients described a three factor model representing processing speed, attention/working memory, and learning; the social cognition measure was excluded from the analysis. The current analyses sought to replicate a three factor structure of the MCCB in a larger, more diagnostically diverse sample of participants. Confirmatory factor analyses were performed to evaluate the factor structure of the MCCB in 300 outpatients with severe mental illness (54.3% schizophrenia-spectrum diagnoses) who were participants in three studies of cognitive remediation. Exploratory analyses were conducted to evaluate the concurrent prediction of symptoms from MCCB factor scores. The three factor structure of the MCCB demonstrated stronger model fit (?(2)=14.53, p=0.75, SRMR=0.02, RMSEA=0.0, CFI=1.00, NNFI=1.01) than the unifactoral structure. Poorer cognitive performance across all three MCCB factors was significantly correlated with more severe overall and disorganization symptoms from the PANSS and BPRS, and less severe affective symptoms (e.g., depression, anxiety) in the overall sample. A three factor structure of the MCCB-composed of processing speed, attention/working memory, and learning-was replicated in a heterogeneous sample of persons with severe mental illness. Cognitive performance on the MCCB factors is associated with clinical symptoms. |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |
| 35 | Psychol Assess 2016 May 28: e88-e100 |
| PMID | 26619091 |
| Title | Cross-cultural validation of the Depression Anxiety Stress Scale-21 in China. |
| Abstract | The gap between the demand and delivery of mental health services in mainland China can be reduced by validating freely available and psychometrically sound psychological instruments. The present research examined the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21). Study 1 administered the DASS-21 to 1,815 Chinese college students and found internal consistency indices (Cronbach's alpha) of .83, .80, and .82 for the Depression, Anxiety, and Stress subscales, respectively, and .92 for the total DASS total. Test-retest reliability over a 6-month interval was .39 to .46 for each of the 3 subscales and .46 for the total DASS. Moderate convergent validity of the Depression and Anxiety subscales was demonstrated via significant correlations with the Chinese Beck Depression Inventory (r = .51 at Time 1 and r = .64 at Time 2) and the Chinese State-Trait Anxiety Inventory (r = .41), respectively. Confirmatory factor analyses supported the original 3-factor model with 1 minor change (nonnormed fit index [NNFI] = .964, comparative fit index [CFI] = .968, and root mean square error of approximation [RMSEA] = .079). Study 2 examined the clinical utility of the Chinese DASS-21 in 166 patients with schizophrenia and 90 matched healthy controls. Patients had higher Depression and Anxiety but not Stress subscale scores than healthy controls. A discriminant function composed of the linear combination of 3 subscale scores correctly discriminated 69.92% of participants, which again supported the potential clinical utility of the DASS in mainland China. Taken together, findings in these studies support the cross-cultural validity of the DASS-21 in China. (PsycINFO Database Record |
| SCZ Keywords | schizophrenia, schizophrenic, schizophrenics, schizotypal |