What factors should we modify to promote high functioning and prevent functional decline in people with schizophrenia?

BackgroundSince research in schizophrenia mainly focuses on deficits and risk factors, we need studies searching for high-functioning protective factors. Thus, our objective was to identify protective (PFs) and risk factors (RFs) separately associated with high (HF) and low functioning (LF) in patients with schizophrenia.MethodsWe collected information (sociodemographic, clinical, psychopathological, cognitive, and functional) from 212 outpatients with schizophrenia. Patients were classified according to their functional level (PSP) as HF (PSP > 70, n = 30) and LF (PSP ≤ 50, n = 95). Statistical analysis consisted of Chi-square test, Student’s t-test, and logistic regression.ResultsHF model: variance explained: 38.4–68.8%; PF: years of education (OR = 1.227). RFs: receiving a mental disability benefit (OR = 0.062) and scores on positive (OR = 0.719), negative-expression (OR = 0.711), and negative-experiential symptoms (OR = 0.822), and verbal learning (OR = 0.866). LF model: variance explained: 42.0–56.2%; PF: none; RFs: not working (OR = 6.900), number of antipsychotics (OR = 1.910), and scores on depressive (OR = 1.212) and negative-experiential symptoms (OR = 1.167).ConclusionWe identified specific protective and risk factors for high and low functioning in patients with schizophrenia and confirmed that high functioning factors are not necessarily the opposite of those associated with low functioning. Only negative experiential symptoms are a shared and inverse factor for high and low functioning. Mental health teams must be aware of protective and risk factors and try to enhance or reduce them, respectively, to help their patients improve or maintain their level of functioning

Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia

International audienceNegative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia.Los síntomas negativos pueden agruparse en 5 dominios: apatía/abulia, anhedonia, conductas asociales, afasia y aplanamiento afectivo. Existen pocas medidas validadas autocalificadas que evalúen estas 5 dimensiones. Por tanto, el objetivo de este estudio fue validar la herramienta Self-Evaluation of Negative Symptoms (SNS, Autoevaluación de síntomas negativos) en pacientes españoles esquizofrénicos.Material y métodos. Estudio transversal de validación en 104 pacientes esquizofrénicos externos, evaluados utilizando la versión española de las escalas siguientes: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale-Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) y la SNS.Resultados Respecto a la fiabilidad, la consistencia interna (α de Cronbach) fue de 0,915. En cuanto a validez convergente, el coeficiente de correlación de Pearson entre las puntuaciones totales de MAP-SR y SNS fue de 0,660 (p < 0,001). Para PANSS-N, la correlación fue de 0,437 (p < 0,005) y de 0,478 (p < 0,005) con CAINS-Total. Respecto a la validez divergente, el coeficiente de correlación de Pearson entre las puntuaciones SNS y PSP fue de r = –0,372 (p ≤ 0,001) y con las puntuaciones de SF-36 Physical and Mental Summary Component fueron de r = −0,213 (p = 0,066) y r = −0,144 (p = 0,219), respectivamente. En la validez discriminante, las puntuaciones totales de SNS fueron diferentes desde un punto de vista estadístico significativo, conforme a la gravedad de la sintomatología negativa calificada por la escala negativa CGI-SCH (p < 0,001).Conclusión. SNS es un instrumento fiable y válido para autocalificar los 5 dominios de los síntomas negativos en pacientes esquizofrénicos y parece adecuado para utilizarlo en la práctica clínica diaria como medida complementaria a la evaluación realizada por el clínico

Spanish Validation of the MAP-SR: Two Heads Better Than One for the Assessment of Negative Symptoms of Schizophrenia

Background: There is little research on self-reported negative symptomatology measures in schizophrenia. The aims of this study were to validate the Spanish version of the Motivation and Pleasure Scale-Self-Report (MAP-SR) and determine the concordance between patient-reported outcome measures for reflecting the severity of negative symptoms of schizophrenia and clinician-rated outcome measures. Method: A sample of 174 subjects who completed the MAP-SR and 104 who completed the Self-Evaluation of Negative Symptoms (SNS) were analyzed. The clinician-reported outcome measures (CROMs) were the Spanish versions of the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Positive and Negative Syndrome Scale (PANSS), while the patient-reported outcome measures (PROMs) were MAP-SR and SNS. Cronbachs a, bivariate analyses and Lins concordance correlation coefficient (CCC) were calculated. Results: The Spanish version of the MAP-SR demonstrated excellent reliability (Cronbachs =.923). Its correlation coefficients were higher with CAINS [CAINS-Total: r=.608, p<.005; CAINS-Motivation and Pleasure subscale(CAINS-MAP): r=.662, p<.005] than with PANSS negative scales [PANSS-Negative scale(PANSS-N): r=.393, p<.005; PANSS-Marder Negative Factor(PANSS-MNF): r=.478, p<.005]. Finally, concordance between clinician and patient ratings was low in all cases, varying from a CCC of 0.661 to .392. Conclusions: We found poor concordance between patient and clinician ratings, hence we believe that the two evaluations are not mutually exclusive but complementaryAntecedentes: existe poca investigación sobre autoinformes de evaluación de la sintomatología negativa en esquizofrenia. Los objetivos de este estudio son validar la versión española de la Escala-Autoinforme de Motivación y Placer (MAP-SR) y determinar la concordancia entre pruebas autoaplicadas y heteroaplicadas para los síntomas negativos de la esquizofrenia. Método: se analizaron los datos de una muestra de 174 personas que completaron la MAP-SR y 104 que completaron la Autoevaluación de los Síntomas Negativos (SNS). Mientras que como pruebas heteroaplicadas se aplicaron las versiones en español de la Entrevista Clínica de Evaluación de Síntomas Negativos (CAINS) y la Escala del Síndrome Positivo y Negativo de la Esquizofrenia (PANSS), como autoinformes se aplicaron la MAP-SR y SNS. Resultados: la versión en español de la MAP-SR ha mostrado excelente fiabilidad ( de Cronbachs=.923. Sus coeficientes de correlación han sido mayores con la CAINS [CAINS-Total: r=.608, p<.005; CAINS-subescala de Motivación y Placer (CAINS-MAP): r=.662, p<.005] que con las escalas negativas de la PANSS [PANSS-escala Negativa (PANSS-N): r=.393, p<.005; PANSS-Factor Negativo de Marder (PANSS-MNF): r=.478, p<.005]. La concordancia entre clínicos y pacientes fue baja en todos los casos, variando de un CCC de .661 a .392. Conclusiones: observamos pobre concordancia entre las puntuaciones de los pacientes y los clínicos, por lo que creemos que las evaluaciones de ambos no son mutuamente excluyentes, sino complementarias

Early psychological impact of the 2019 coronavirus disease (COVID-19) pandemic and lockdown in a large Spanish sample

Background: Epidemic outbreaks have significant impact on psychological well-being, increasing psychiatric morbidity among the population. We aimed to describe the early psychological impact of COVID-19 and its contributing factors in a large Spanish sample, globally and according to mental status (never mental disorder NMD, past mental disorder PMD, current mental disorder CMD). Methods: An online questionnaire was conducted between 19 and 26 March, five days after the official declaration of alarm and the lockdown order. Data included sociodemographic and clinical information and the DASS-21 and IES questionnaires. We analysed 21207 responses using the appropriate descriptive and univariate tests as well as binary logistic regression to identify psychological risk and protective factors. Results: We found a statistically significant gradient in the psychological impact experienced in five domains according to mental status, with the NMD group being the least affected and the CMD group being the most affected. In the three groups, the depressive response was the most prevalent (NMD=40.9%, PMD=51.9%, CMD=74.4%, F=1011.459, P<0.001). Risk factors were female sex and classification as a case in any psychological domain. Protective factors were younger age and ability to enjoy free time. Variables related to COVID-19 had almost no impact except for having COVID-19 symptoms, which was a risk factor for anxiety in all three groups. Conclusions: Our results can help develop coping strategies addressing modifiable risk and protective factors for each mental status for early implementation in future outbreaks