Psychiatric symptoms mediate the effects of neurological soft signs on functional outcomes in patients with chronic schizophrenia: A longitudinal path-analytic study

Neurological soft signs (NSS) in motor coordination and sequencing occur in schizophrenia patients and are an intrinsic sign of the underlying neural dysfunctions. The present longitudinal study explored the relationships among NSS, psychiatric symptoms, and functional outcomes in 151 Chinese patients with chronic schizophrenia across a 6-month period. The participants completed neurological assessments at baseline (Time 1), psychiatric interviews at Time 1 and 3-month follow-up (Time 2), and self-report measures on daily functioning at 6-month follow-up (Time 3). Two possible (combined and cascading) path models were examined on predicting the functional outcomes. Direct and indirect effects of Time 1 NSS on Time 3 functional outcomes via Time 2 psychiatric symptoms were evaluated using path analysis under bootstrapping. Motor coordination and sequencing NSS did not have significant direct effects on functional outcomes. Motor coordination NSS exerted significant and negative indirect effects on functional outcomes via psychiatric symptoms. These results contribute to a better understanding of the determinants of functional outcomes by showing significant indirect pathways from motor coordination NSS to functional outcomes via psychiatric symptoms. That motor sequencing NSS did not affect functional outcomes either directly or indirectly may be explained by their trait marking features.postprin

The psychophysiological effects of Tai-chi and exercise in residential Schizophrenic patients: a 3-arm randomized controlled trial

Background Patients with schizophrenia are characterized by high prevalence rates and chronicity that often leads to long-term institutionalization. Under the traditional medical model, treatment usually emphasizes the management of psychotic symptoms through medication, even though anti-psychotic drugs are associated with severe side effects, which can diminish patients’ physical and psychological well-being. Tai-chi, a mind-body exercise rooted in Eastern health philosophy, emphasizes the motor coordination and relaxation. With these potential benefits, a randomized controlled trial (RCT) is planned to investigate the effects of Tai-chi intervention on the cognitive and motor deficits characteristic of patients with schizophrenia. Methods/design A 3-arm RCT with waitlist control design will be used in this study. One hundred and fifty three participants will be randomized into (i) Tai-chi, (ii) exercise or (iii) waitlist control groups. Participants in both the Tai-chi and exercise groups will receive 12-weeks of specific intervention, in addition to the standard medication and care received by the waitlist control group. The exercise group will serve as a comparison, to delineate any unique benefits of Tai-chi that are independent of moderate aerobic exercise. All three groups will undergo three assessment phases: (i) at baseline, (ii) at 12 weeks (post-intervention), and (iii) at 24 weeks (maintenance). All participants will be assessed in terms of symptom management, motor coordination, memory, daily living function, and stress levels based on self-perceived responses and a physiological marker. Discussion Based on a promising pilot study conducted prior to this RCT, subjects in the Tai-chi intervention group are expected to be protected against deterioration of motor coordination and interpersonal functioning. They are also expected to have better symptoms management and lower stress level than the other treatment groups.published_or_final_versio

An examination of psychometric properties of the Chinese version of the Positive and Negative Syndrome Scale for schizophrenia

BACKGROUND: The Positive and Negative Syndrome Scale (PANSS) is commonly used for assessment of severity of schizophrenic symptoms. In view of the ambivalent results over the factor structure of the scale, the present study aimed to examine the psychometric properties of PANSS by examining the consensus five-factor model by Wallwork in Chinese schizophrenic patients. METHODS: Participants were 146 Chinese patients with schizophrenia (mean age = 54.0 years, SD = 8.5) who resided in a rehabilitation hostel. They completed the Chinese PANSS, which is a 20-item, 7-point scale of psychiatric symptoms with five proposed factors. The five-factor structure of the PANSS and its convergent validity was evaluated via exploratory structural equation modelling using weighted least square estimator in Mplus 7.2. RESULTS: The five-factor consensus model fitted the data significantly better than a four-factor model (Δχ2(16) = 64.4, p < .01). Overall, the five-factor model provided an excellent model fit (χ2(100) = 119.8, p = .09, CFI = .99, TLI = .99, RMSEA = .04, SRMR = .03). The five factors were weakly to moderately correlated (r = .20 - .57, p < .05) except for positive-negative (r = .04), negative-cognitive (r = .19), and depression-cognitive (r = .03). All of the five factors showed satisfactory reliability. DISCUSSIONS: These results supported the use of the five-factor consensus model derived by Wallwork for PANSS in the Chinese context. Future studies should apply the PANSS in the Chinese patients with schizophrenia for assessment of psychiatric symptoms

Tai-chi Exercises for Schizophrenia

e-Poster Poster Walk presentations: Schizophrenia 2Conference Theme: European Psychiatry Focusing on Body and MindBackground: The benefits of Tai-chi on relaxation, mental focus, motor coordination, balance, and stress reduction may help improve symptoms control and physical functioning in schizophrenic patients. The study aims at evaluating the effects of Tai-chi and developing this mind-body exercise in residential care of schizophrenia in long term. Method: The RCT included a pilot trial and an on-going 3-arm main study. A pilot trial with 30 participants randomly allocated into a 12-session (6-week) Tai-chi program and control group was conducted. Gross motor coordination, negative symptoms and functional disabilities were assessed at baseline, 1 week and 6 weeks post-intervention. Recruitment of 150 participants for the main study was conducted at the same hostel. They were randomly allocated into Tai-chi group, exercise group and wait-list control group. The study is still in progress and will be reported in the presentation. Results: For the pilot trial, participants in the control group showed marked deteriorations in the above areas throughout the study period. Tai-chi showed a protective effect from deteriorations in gross motor coordination (Z=-2.28; p=.023), and interpersonal functioning which could be sustainable for 6 weeks after the program (Z=-2.56; p=.01). Preliminary results of the main study will be presented in the conference. Conclusion: The pilot trial demonstrated the positive effects of Tai-chi on promoting movement coordination and alleviating functional disabilities. The group exercise format encourages socialization and interpersonal functioning. Tai-chi emphasizes movement rhythm and inner calmness which may further help symptoms control. The main study will confirm the results of the pilot trial

Psychometric validation of the consensus five-factor model of the Positive and Negative Syndrome Scale

Abstract: Background The Positive and Negative Syndrome Scale (PANSS) is widely used for clinical assessment of symptoms in schizophrenia. Instead of the traditional pyramidal model, recent literature supports the pentagonal model for the dimensionality of the PANSS. Aim The present study aimed to validate the consensus five-factor model of the PANSS and evaluate its convergent validity. Methods Participants were 146 Chinese chronic schizophrenic patients who completed diagnostic interviews and cognitive assessments. Exploratory structural equation modeling (ESEM) was performed to investigate the dimensionality of the PANSS. Covariates (age, sex, and education level) and concurrent outcomes (perceived stress, memory, daily living functions, and motor deficits) were added in the ESEM model. Results The results supported the consensus 5-factor underlying structure, which comprised 20 items categorized into positive, negative, excitement, depression, and cognitive factors with acceptable reliability (α = .69–.85) and strong factor loadings (λ = .41–.93). The five factors, especially the cognitive factor, showed evident convergent validity with the covariates and concurrent outcomes. Conclusion The results support the consensus five-factor structure of the PANSS as a robust measure of symptoms in schizophrenia. Future studies could explore the clinical and practical utility of the consensus five-factor model

Factors associating with Independent Daily Living of Adults with Schizophrenia in a Residential Rehabilitation Setting: Results from a Cross-Sectional Study

Objectives: The ability to live independently is an important aspect of rehabilitation of schizophrenia. This study aimed to explore the factors associating with independent daily living of adults with schizophrenia. Methods: Adopting a cross-sectional study design, 146 schizophrenic patients (80 men and 66 female, aged 24-69 years, mean age = 53.97 years) living in a residential care setting were interviewed. Variables measured included negative symptoms (measured by the Positive and Negative Symptoms Scale [PANSS]), self-perceived stress (measured by the Self-Perceived Stress Scale [PSS]), daily functioning (measured by the Bartha’s index of Activity of Daily Living [ADL]), and demographic data. Results: Results showed that level of ADL was negatively associated with age (β = –0.204, p ≤ 0.05) and perceived stress (β = –0.382, p ≤ 0.01); and positively associated with the dominance of positive symptoms (β = 2.17, p ≤ 0.05). Higher level of daily living functioning was associated with those who were of younger age, self-perceived as less stressful, and those who experienced predominantly positive symptoms. Conclusions: The ability to live independently is associated with younger, lower stress level, and the predominance of positive symptoms over negative symptoms. The findings might be due to the fact that negative symptoms are associated with cognitive deficient, which impairs tasks of independent daily living. Unlike positive symptoms, which can be easily managed by medication, management of negative symptoms requires timely psycho-social care. The findings imply the need for a paradigm shift in rehabilitation; whereas priority has to be given to management of negative symptom

Gender Difference in Schizophrenic Symptomatology and Subjective Stress of Chinese Adults with Schizophrenia in a Long-stay Residential Setting

Objectives: Males showed a higher risk of schizophrenia. This study aimed to explore the manifestation of schizophrenia between genders, focusing on schizophrenic symptomatology and perceived stress in Chinese adults with schizophrenia at long-term care residential setting. Results of the present study yield implications for effective health care strategies for this population. Methods: A total of 146 Chinese in-patients (80 males and 66 females), aged 24 to 69 (mean ± standard deviation [SD], 53.97 ± 8.54) years, participated in this crosssectional study. Independent sample t-tests were performed to explore potential gender differences in symptomatology and perceived stress. Schizophrenia symptomatology was indexed by positive and negative symptom, gender psychopathology subscales of the Positive and Negative Symptoms Scale (PANSS), while subjective stress was indicated by the Perceived Stress Scale (PSS). Results: Results indicated difference on measures of subjective stress (t(138) = –2.15, p ≤ 0.05), negative symptoms (t(138) = 4.82, p ≤ 0.01), and general psychopathology (t(138) = 3.55, p ≤ 0.01) between males and females. Males reported higher level of negative symptoms (mean ± SD, 21.12 ± 7.64) and general psychopathology (38.43 ± 14.43), but lower level of subjective stress (14.93 ± 6.67) when compared with females (15.38 ± 11.81; 38.43 ± 14.34; 17.35 ± 6.60). Conclusions: The present study replicated existing gender differences findings in schizophrenia. Males present more negative symptoms, while females reported higher prevalence of perceived stress. The study allows better understanding of illness presentation between the genders, which implies the need for developing gender-specific health care treatments in achieving better functioning outcome

Impact of Taichi on Independent Activities of Daily Living of Adults with Schizophrenia: Preliminary Results from a Randomized Controlled Trial

Background: The maintenance of instrumental daily functioning has long been recognised as the focus of psychosocial care for people with schizophrenia,1 and evidence of the efficacy of mind-body treatment methods was well-documented.2 The purpose of this study was to assess the impact of Taichi exercise, a Chinese form of mindbody exercise, on self-care ability of adults with chronic schizophrenia. Methods: A total of 57 adults, aged 24 to 66 years (mean, 52.51; standard deviation, 9.68 years), with chronic schizophrenia were invited to participate in a randomised controlled trial composing of Taichi Group (n = 29) and treatment-as-usual control group (n = 28). Independent living ability is indexed by the Chinese version of the Lawton’s Instrumental Activities of Daily Living (IADL). All participants were measured twice on 2 time-points: at baseline and immediate post-intervention. Results: Significant Time x Group effect on the measurement of instrumental daily living (F(1, 55)=4.21, p ≤ 0.05) was reported. Both Taichi and control group deteriorated across time (Taichi group: 3.69 vs. 3.28; control group: 3.93 vs. 2.11), yet the control group reported higher degree of deterioration. Conclusions: Although deterioration in instrumental self-care ability seemed irreversible for people with schizophrenia, findings of this study highlighted the buffering effect of Taichi exercise against deterioration of instrumental functioning. The findings leaned preliminary support to Taichi exercise as one of the possible psychosocial intervention strategies that might help preserving dignity in the residential healthcare setting