The importance of measuring psychosocial functioning in schizophrenia

BACKGROUND: Schizophrenia is among the most disabling of mental illnesses and frequently causes impaired functioning. We explore issues of definition and terminology, and the relationship between social functioning, cognition, and psychopathology considering relevant research findings. METHODS: The present article describes measures of social functioning and outlines their psychometric properties. It considers their usefulness in research and clinical settings. Treatment aims and objectives are explored in the context of cognitive and social functioning. Finally, we identify areas for developing research and refining the measurement of social functioning. RESULTS: The definition and measurement of social functioning in schizophrenia remains a complex and disputed area. The relationships between symptoms, cognitive functioning and social functioning are complex but we are beginning to understand them better. Scales for measuring functioning in clinical practice must be brief and sensitive to change and the Personal and Social Performance (PSP) scale may offer several advantages in these regards. Brief cognitive assessments focusing upon the domains most commonly affected in schizophrenia, such as verbal memory and executive functions, should be coadministered with measures of functioning. CONCLUSIONS: The use of validated scales for schizophrenia that are sensitive to change over the course of the illness and its treatment, should allow for a better understanding of patients' functional disabilities, enabling better and more comprehensive monitoring and evaluation of both pharmacological and non-pharmacological treatment strategies

Clinical implications of a staging model for bipolar disorders

A model of staging in the field of bipolar disorder (BD) should offer a means for clinicians to predict response to treatment and more general outcome measures, such as the level of functioning and autonomy. The present staging model emphasizes the assessment of patients in the interepisodic period and includes: latent phase: individuals who present mood and anxiety symptoms and increased risk for developing threshold BD; Stage I – patients with BD who present well established periods of euthymia and absence of overt psychiatric morbidity between episodes; Stage II – patients who present rapid cycling or current axis I or II comorbidities; Stage III – patients who present a clinically relevant pattern of cognitive and functioning deterioration, as well as altered biomarkers; and Stage IV – patients who are unable to live autonomously and present altered brain scans and biomarkers. Such a model implies a longitudinal appraisal of clinical variables, as well as assessment of neurocognition and biomarkers in the interepisodic period. Staging facilitates understanding of the mechanisms underlying progression of the disorder, assists in treatment planning and prognosis and, finally, underscores the imperative for early intervention

O impacto da história de sintomas psicóticos na função cognitiva de doentes bipolares eutímicos : comparação com doentes esquizofrênicos e controles saudáveis

Introducao: Cerca de dois tercos dos pacientes com Transtorno Bipolar (TB) apresentam sintomas psicoticos ao longo da vida. Objetivo: Comparar o desempenho neurocognitivo de quatro grupos: pacientes com TB, com e sem historico de sintomas psicoticos (HPS+ ou HPS-, respectivamente); pacientes esquizofrenicos; e grupo controle (GC) com individuos saudaveis. Metodos: Estudo transversal no qual 35 pacientes com esquizofrenia (EZ), 79 pacientes com TB na fase eutimica (44 HPS+ e 35 HPS-) e 50 GC foram submetidos a extensa avaliacao neuropsicologica. Resultados: Observou-se pior funcionamento neurocognitivo em pacientes com TB e com EZ quando comparados ao GC. Os dois grupos de pacientes TB nao diferiram em dados demograficos, clinicos ou variaveis neurocognitivas. Entretanto o grupo HPS+ teve mais sintomas negativos mensurados pela Positive and Negative Syndrome Scale (PANSS) e apresentou uma tendencia a pior performance nas funcoes executivas comparativamente aos pacientes HPS-. Alem disso ambos os grupos de pacientes TB tiveram melhor desempenho em todos testes neurocognitivos quando comparados aos pacientes com EZ. Conclusoes: A disfuncao neurocognitiva e mais marcada nos pacientes com EZ do que com TB, apesar de ser qualitativamente similar. Um historico de sintomas psicoticos no TB nao associou esta amostra de pacientes eutimicos a um maior prejuizo neurocognitivo. Assim sendo, o TB com sintomas psicoticos parece nao possuir um fenotipo neurocognitivo diferenciado.Background: About two-thirds of patients with bipolar disorder (BD) have a lifetime history of at least one psychotic symptom. Objective: To compare the neurocognitive performance of four groups: BD patients with and without a history of psychotic symptoms (BD HPS+ and BD HPS-, respectively); patients with schizophrenia (SZ); and healthy control (HC) subjects. Method: In this cross-sectional study, 35 stabilized patients with SZ, 79 euthymic (44 HPS+ and 35 HPS-) patients with BD, and 50 HC were administered a comprehensive battery of neuropsychological tests. Results: There was worse neurocognitive functioning in both BD and SZ patients compared to HC. Overall, data from both groups of BD patients did not differ on sociodemographic, clinical, or neurocognitive variables. However, BD HPS+ patients had significantly more negative symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS), and showed a trend toward worse performance on executive functions compared to BD HPS- patients. Moreover, both BD groups had better performance on all neurocognitive tests compared to SZ group. Conclusions: Neurocognitive dysfunction may be more marked in SZ than in BD, yet qualitatively similar. A history of past psychotic symptoms in BD was not associated with more severe cognitive impairment during euthymia. Therefore, BD with psychotic symptoms does not appear to be a distinct neurocognitive phenotype

Role of quetiapine beyond its clinical efficacy in bipolar disorder: From neuroprotection to the treatment of psychiatric disorders (Review)

In the 1650ss, after a century of increase, the population of England stopped growing. It was not to increase substantially again before 1750. Over the same interval, and not wholly coincidentally, scholars and theologians were trying to defend the orthodox account of how global population had increased since the Creation and must continue to do so, and the first political arithmeticians were trying to measure and analyse demographic change. This article seeks to throw fresh light on this many-sided discourse by examining William Petty’s attempt to write an account of the multiplication of mankind, and the reasons why he failed to complete it. It focuses particularly on Petty’s part in developing methods of measuring population density which highlighted the potential for future growth, and on the equally important demonstration by John Graunt that high and rising mortality in cities was hindering population growth in reality. As Petty’s cousin Robert Southwell pointed out, Graunt’s ‘rule of mortality’ was wholly incompatible with any coherent account of the future multiplication of mankind. At the end of this particular discourse, newly discovered facts about demography triumphed over the presuppositions of divinity

Apolipoprotein E genotype and Cognition in Bipolar Disorder

Apolipoprotein E (APOE) has been extensively studied as a risk factor for sporadic and late onset Alzheimer`s Disease (AD). APOE allele *3, the most frequent variant, is not associated to cognitive dysfunction (CD) or to increased AD risk. Differently, the *4 allele is a well-established risk factor for CD, while the *2 allele is associated with survival and longevity. CD is an important feature of Bipolar Disorder (BD) and recent data suggest that CD may be one of its endophenotypes, although controversial results exist. The aim of this research is to study the association of APOE genotype (APOE) and neurocognitive function in a sample of drug free young BD-type I patients. Sample consisted of 25 symptomatic BD (type I) patients (age 18-35 years old). They were submitted to an extensive neuropsychological evaluation and genotyped for APOE. Subjects with allele *2 presented better cognitive performance. The presence of allele *4 was associated with worse performance in a few executive tasks. APOE *3*3 was associated with overall severe dysfunction on cognitive performance. In young individuals with nontreated BD-type I, APOE may predict cognitive performance. Further and larger studies on APOE and cognition in BD are required to clarify whether APOE is a BD cognitive endophenotype