The clinical course and outcomes of first episode psychosis: A study of the acute, medium and long-term outcomes in a cohort rigorously treated in the early phase of illness

Psychiatr

The burden of care, quality of life and depression in relatives of patients with serious mental illness treated at Lentegeur Hospital

Background: The association between caregiver burden, quality of life and depression in patients with mental illness in a resource-limited setting is underresearched. Factors associated with caregiver burden may be amenable to intervention. Aim: To describe the level of caregiver burden and its association with quality of life and depression. Methods: The cross-sectional study was carried out in a psychiatric hospital in the Cape Flats, which is an urban area on the periphery of Cape Town. Data were collected from 104 caregivers of patients attending the outpatients service. Caregiver burden was measured using the Zarit Burden Interview questionnaire. The PHQ-9 questionnaire was to screen and measure severity of symptoms of depression. The WHOQOL-BREF was used to measure the subjective evaluation of the quality of life. Results: Most caregivers were female (76.92%), and caregivers were mild to moderately stressed (mean ZBS score 33.38 ± 21.59) and experienced moderate depression (mean PHQ-9 score). These effects were significantly associated with quality of life in psychological and social domains. Conclusion: Caring for patients with mental illness can lead to immense physical and psychological distress, leading to poor quality of life. Strategies that may reduce the burden of care may include improving the patients’ quality of life and addressing psychosocial support, and clinicians should consider screening for symptoms of depression in caregivers

Two neuroanatomical signatures in schizophrenia: Expression strengths over the first 2 years of treatment and their relationships to neurodevelopmental compromise and antipsychotic treatment

BACKGROUND AND HYPOTHESIS: Two machine learning derived neuroanatomical signatures were recently described. Signature 1 is associated with widespread grey matter volume reductions and signature 2 with larger basal ganglia and internal capsule volumes. We hypothesized that they represent the neurodevelopmental and treatment-responsive components of schizophrenia respectively. STUDY DESIGN: We assessed the expression strength trajectories of these signatures and evaluated their relationships with indicators of neurodevelopmental compromise and with antipsychotic treatment effects in 83 previously minimally treated individuals with a first episode of a schizophrenia spectrum disorder who received standardized treatment and underwent comprehensive clinical, cognitive and neuroimaging assessments over 24 months. Ninety-six matched healthy case-controls were included. STUDY RESULTS: Linear mixed effect repeated measures models indicated that the patients had stronger expression of signature 1 than controls that remained stable over time and was not related to treatment. Stronger signature 1 expression showed trend associations with lower educational attainment, poorer sensory integration, and worse cognitive performance for working memory, verbal learning and reasoning and problem solving. The most striking finding was that signature 2 expression was similar for patients and controls at baseline but increased significantly with treatment in the patients. Greater increase in signature 2 expression was associated with larger reductions in PANSS total score and increases in BMI and not associated with neurodevelopmental indices. CONCLUSIONS: These findings provide supporting evidence for two distinct neuroanatomical signatures representing the neurodevelopmental and treatment-responsive components of schizophrenia

Race trouble : experiences of black medical specialist trainees in South Africa

CITATION: Thackwell, N., et al. 2016. Race trouble: experiences of Black medical specialist trainees in South Africa. BMC International Health and Human Rights, 16:31, doi:10.1186/s12914-016-0108-9.The original publication is available at http://bmcinthealthhumrights.biomedcentral.comENGLISH SUMMARY : Background: This research aimed to identify and explore the experiences of Black registrars in their training in the Western Cape’s academic hospitals in order to identify structures, practices, attitudes and ideologies that may promote or impede the advancement of Black doctors into specialist medicine. This is justified by the requirement for universities to work towards monitoring and evaluating efforts to create non-discriminatory and inclusive training environments. Methods: This study employed qualitative research methods. Ten Black African medical specialists were interviewed about their training experiences in two university training hospitals in the Western Cape Province, South Africa. Interview data was collected using open-ended questions and coded and analysed using thematic and critical discursive analysis techniques. Results: Four experiential themes emerged from the interview data, they included: 1) experiences of everyday racism during work hours, 2) the physical and psychological effects of tokenism and an increased need to perform, 3) institutional racism as a result of inconsistent and unclear methods of promotion and clinical competence building, and 4) an organisational culture that was experienced as having a race and gender bias. Conclusion: This is a pilot study and there are limits on the generalizability of the data due to the small sample. What is clear from our participants, though, is the strong experiential component of finding it challenging to be a Black trainee in a White-dominated profession. We are undertaking further research to explore the issues raised in more detail.Publisher's versio

Sexual dysfunction in first-episode schizophrenia spectrum disorders

Sexual dysfunction (SD) is common in patients with schizophrenia. In this study, we examined the prevalence and correlates of SD in a sample of patients with first-episode schizophrenia spectrum disorders (FES) (n ​= ​77). Sexual functioning was examined using the Arizona Sexual Experiences Scale. Clinical measures of interest included the duration of untreated psychosis, psychopathology, depressive symptoms, functionality, and quality of life. Biochemical testing was also performed to measure prolactin, lipid profiles, and fasting glucose levels. In total, 27 (35%) patients met the criteria for SD, which was significantly more prevalent in females than in males (p ​= ​0.027). Higher depression scores, poorer social and occupational functioning, and lower high-density lipoprotein cholesterol levels predicted overall SD. Female sex, more pronounced global psychopathology, and poorer quality of life were also predictors of domain-specific SD, adjusting for the extent of antipsychotic exposure. In conclusion, SD has a high prevalence in patients with FES, particularly females. There is a need for a more nuanced understanding of SD in recent-onset schizophrenia, and to establish its relevance in terms of comorbid depressive symptoms and poor quality of life. SD may require specific attention and tailored treatment in females with FES

Instruments Measuring Blunted Affect in Schizophrenia: A Systematic Review

<div><p>Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions. The work of Abrams and Taylor and their development of the Rating Scale for Emotional Blunting in the late 1970’s was an early indicator that blunted affect could indeed be assessed reliably. Since then, several new instruments assessing negative symptoms with subscales measuring blunted affect have been developed. In light of this, we aim to provide researchers and clinicians with a systematic review of the different instruments used to assess blunted affect by providing a comparison of the type, characteristics, administration and psychometric properties of these instruments. Studies reporting on the psychometric properties of instruments assessing blunted affect in patients with schizophrenia were included. Reviews and case studies were excluded. We reviewed 30 full-text articles and included 15 articles and 10 instruments in this systematic review. On average the instruments take 15–30 minutes to administer. We found that blunted affect items common across all instruments assess: gestures, facial expressions and vocal expressions. The CAINS Self-report Expression Subscale, had a low internal consistency score. This suggests that this sub-scale does not reliably assess patients’ self-reported blunted affect symptoms and is likely due to the nature of blunted affect. Instruments correlated minimally with instruments measuring positive symptoms and more importantly with depression suggesting that the instruments distinguish between seemingly similar symptoms.</p></div

Divergent validity of subscales measuring blunted affect.

<p>Divergent validity estimates of negative symptom subscales measuring blunted affect.</p><p>Divergent validity of subscales measuring blunted affect.</p

Convergent validity of subscales measuring blunted affect.

<p>Convergent validity estimates of negative symptom instruments’ subscales measuring blunted affect.</p><p>Convergent validity of subscales measuring blunted affect.</p