Związek postawy rodziny z płcią, nasileniem objawów i funkcjonowaniem społecznym osób chorujących na schizofrenię przez 20 lat : badanie prospektywne

Cel: Celem badania była ocena zależności pomiędzy postawą rodziny i płcią oraz klinicznymi i społecznymi wynikami leczenia w grupie 45 osób z diagnozą schizofrenii w okresie 20 lat chorowania. Metody: Dla oceny zmiennych klinicznych i społecznych użyto Kwestionariusza Anamnestycznego i Katamnestystycznego, skali BPRS i skali funkcjonowania społecznego wg DSM-III wymiar V, a do pomiaru postawy rodziny w czasie pierwszej hospitalizacji – CFI. W kolejnych punktach pomiarowych zastosowano 4-stopniową skalę kliniczną opartą na kategoriach CFI (ciepło i życzliwość, krytycyzm, wrogość, naduwikłanie emocjonalne), którą następnie analizowano jako dychotomiczną zmienną: postawa korzystna/ niekorzystna. Wyniki: Zaobserwowano istotną tendencję do poprawy postawy rodziny wraz z upływem lat chorowania. U chorujących kobiet zmiana postawy rodziny następowała szybciej niż w przypadku mężczyzn. Po 3 i 12 latach od pierwszej hospitalizacji niekorzystna postawa rodziny wiązała się z częstszymi nawrotami i rehospitalizacjami. Nasilenie objawów i poziom funkcjonowania społecznego nie miały związku z postawą rodziny w żadnym punkcie pomiarowym. Wnioski: W środowiskowym programie leczenia, w okresie 20 lat przebiegu schizofrenii, niekorzystna postawa rodziny uległa znaczącej poprawie zarówno wśród kobiet, jak i mężczyzn, lecz korzystne zmiany następowały szybciej w przypadku kobiet. W zależności od czasu przebiegu choroby wykazano związek pomiędzy niekorzystną postawą rodziny i częstszymi nawrotami oraz ponownymi hospitalizacjami, a także brak związku z nasileniem objawów i ogólnym poziomem funkcjonowania społecznego.Purpose: The aim of the study was to assess the relationship between the family attitude and clinical and social outcome measures in the group of 45 people diagnosed with schizophrenia during 20 years of illness. Methods: For the evaluation of clinical and social variables, the Anamnestic and Catamnestic Questionnaire, the BPRS scale and the scale of social functioning according to the DSM-III axis V were used. The family attitude during the first hospitalisation was measured with CFI. In subsequent measurement points, a 4-stage clinical scale based on the CFI categories (warmth and kindness, criticism, hostility, emotional overinvolvement) was used, which was then analysed as a dichotomous variable: favourable/unfavourable attitude. Results: A significant tendency to improve the family attitude within years of illness was observed. In women, the change in the family attitude was faster than in case of men. The unfavourable family attitude was associated with more frequent relapses and rehospitalisations after 3 and 12 years after the first hospitalisation. The severity of symptoms and the level of social functioning were not related to the family attitude at any measurement point. Conclusions: In the community treatment program, during the 20-year course of schizophrenia, the unfavourable family attitude improved among both women and men, but beneficial changes occurred faster in women. Depending on the time of disease, there was a relationship between the unfavourable family attitude and more frequent relapses, re-hospitalisations and lack of connection with the severity of symptoms and the general level of social functioning

On the relation of white matter brain abnormalities and the asociality symptoms in schizophrenia outpatients a DTI study

Recent MRI studies have shown that abnormal functional connections in schizophrenia coexist with subtle changes in the structure of axons in the brain. However, there is a discrepancy in the literature concerning the relationship between white matter abnormalities and the occurrence of negative psychopathological symptoms. In the present study, we investigate the relationship between the altered white matter structure and specific psychopathology symptoms, i.e., subscales of Positive and Negative Syndrome Scale (PANSS) and Brief Negative Symptoms Scale (BNSS) in a sample of schizophrenia outpatients. For investigation on white matter abnormalities in schizophrenia, the diffusion tensor imaging analysis of between-group differences in main diffusion parameters by tract-based spatial statistics was conducted on schizophrenia outpatients and healthy controls. Hence, the correlation of PANSS and BNSS psychopathology subscales in the clinical group with fractional anisotropy was analyzed in the 17 selected cortical regions of interest. Presented between-group results revealed widespread loss of white matter integrity located across the brain in schizophrenia outpatients. Results on the white matter relationship with psychopathology revealed the negative correlation between fractional anisotropy in the left orbital prefrontal cortex, right Heschl's gyrus, bilateral precuneus and posterior cingulate cortex and the severity of asociality, as assessed with the BNSS. In conclusion, the presented study confirms the previous evidence on the widespread white matter abnormalities in schizophrenia outpatients and indicates the existence of the subtle but specific association between fractional anisotropy in the fronto-temporo-parietal regions with the asociality. Recent MRI studies have shown that abnormal functional connections in schizophrenia coexist with subtle changes in the structure of axons in the brain. However, there is a discrepancy in the literature concerning the relationship between white matter abnormalities and the occurrence of negative psychopathological symptoms. In the present study, we investigate the relationship between the altered white matter structure and specific psychopathology symptoms, i.e., subscales of Positive and Negative Syndrome Scale (PANSS) and Brief Negative Symptoms Scale (BNSS) in a sample of schizophrenia outpatients. For investigation on white matter abnormalities in schizophrenia, the diffusion tensor imaging analysis of between-group differences in main diffusion parameters by tract-based spatial statistics was conducted on schizophrenia outpatients and healthy controls. Hence, the correlation of PANSS and BNSS psychopathology subscales in the clinical group with fractional anisotropy was analyzed in the 17 selected cortical regions of interest. Presented between-group results revealed widespread loss of white matter integrity located across the brain in schizophrenia outpatients. Results on the white matter relationship with psychopathology revealed the negative correlation between fractional anisotropy in the left orbital prefrontal cortex, right Heschl’s gyrus, bilateral precuneus and posterior cingulate cortex and the severity of asociality, as assessed with the BNSS. In conclusion, the presented study confirms the previous evidence on the widespread white matter abnormalities in schizophrenia outpatients and indicates the existence of the subtle but specific association between fractional anisotropy in the fronto-temporo-parietal regions with the asociality