Symptomatic and Functional Recovery:Does symptom severity affect the recovery of executive functioning in people with psychotic disorders?

Background: Recovery in psychotic disorder patients is a multidimensional concept that can include personal, symptomatic, societal and functional recovery. Here we define Functional Recovery (FR) as recovery or compensation after the loss or impairment of skills in different cognitive functions. Some of the most impaired cognitive functions in psychosis are the executive functions, whose impairment in people with a psychotic disorder can produce problems that are difficult to overcome, partly because treatment often focuses only on Symptomatic Recovery (SR). Although symptom severity may be a risk factor for longstanding impairments of executive functioning, the association is not always found. To date, there has been little research on the association between the 2. MethodThis study is part of the UP’S study, a longitudinal cohort study of patients with a psychotic disorder. The Behaviour Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used to measure FR at baseline and after 1 year. SR was measured using the Positive and Negative Symptom Scale-Remission (PANSS-R), also at baseline and 1 year? At both time points, correlations were computed as cross-sectional analyses. For the longitudinal analysis, the difference scores were used to calculate generalized linear models. Model selection was based on the Wald-Chi square test. Results323 people were included for the baseline assessment of the UP’S study, 163 of whom had completed the T1 follow-up measurement at the time of this study. We found a moderate association between PANSS-R baseline scores and BRIEF-A baseline scores (β=3.76). While there was also an association between the PANSS-R score at baseline and the BRIEF-A difference scores (β=1.67), we found no association between the PANSS-R difference scores and the BRIEF-A differences scores. ConclusionOur finding that less overall symptom severity was associated with 1 year improvement in executive functioning suggests that symptom severity could be a way of improving executive functioning over a year. However, as no link was found within the year between changes in symptoms and changes in executive functioning, it is possible that symptom severity does not have an immediate effect on executive functioning, but that its effect is delayed. This leaves scope for targeted interventions to improve executive functioning, and thus functional recovery

The association between executive functioning and personal recovery in people with psychotic disorders

Background Recovery in psychotic disorder patients is a multidimensional concept that can include personal, symptomatic, societal, and functional recovery. Little is known about the associations between personal recovery (PR) and functional recovery (FR). FR involves a person’s ability to recover or compensate for impaired cognition, such as executive functions, and the loss of skills. Method In this cross-sectional study (the UP’S study), we used measures of executive functioning and personal recovery to assess a cohort of people with a psychotic disorder. PR was measured using the Recovering Quality of Life (ReQOL) and Individual Recovery Outcomes (I.ROC). FR was assessed using two forms of assessment. The Behavioral Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used for self-rated executive functioning, and the Tower of London (TOL) for performance-based executive functioning. Regression models were calculated between executive functioning (BRIEF-A and TOL) and PR (ReQOL and I.ROC). Model selection was based on the Wald test. Results The study included data on 260 participants. While total scores of BRIEF-A had a small negative association with those of the ReQOL (β = −0.28, P > .001) and the I.ROC (β = −0.41, P > .001), TOL scores were not significantly associated with the ReQOL scores (β = 0.03, P = .76) and the I.ROC scores (β = 0.17, P = 0.17). Conclusion Self-reported EF, which measures the accomplishment of goal pursuit in real life was associated with PR. However, processing efficiency and cognitive control as measured by performance-based EF were not

The effectiveness of assertive community treatment for elderly patients with severe mental illness: A randomized controlled trial

Background: Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults.Methods: In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat.Results: Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables.Conclusions: These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully.Trial registration: NTR1620

Oxytocin moderates the association between testosterone-cortisol ratio and trustworthiness:A randomized placebo-controlled study

Oxytocin has been proposed to enhance feelings of trust, however, these findings have been difficult to replicate. Environmental or hormonal factors might influence this association. We studied whether oxytocin moderates the association between the testosterone-cortisol ratio, which is associated with risk taking behavior and aggression, and trustworthiness, while controlling for the general level of trust. A randomized double-blind placebo-controlled study with 53 healthy males was performed in which 32IU oxytocin (n = 27) or placebo (n = 26) was administered intranasally. Participants subsequently played the Trust Game in which they were allocated to the role of trustee. In the third phase of the Trust Game, we found a positive association between the testosterone-cortisol-ratio and the proportion of the amount that is returned to the investor (P=<0.01). However, administration of oxytocin reduced reciprocity in those with a high testosterone-cortisol ratio after reciprocity restoration (a significant interaction effect between administration of oxytocin and the testosterone-cortisol ratio in the third phase of the Trust Game, P = 0.015). The third phase of the Trust Game represents the restoration of reciprocity and trustworthiness, after this is violated in the second phase. Therefore, our data suggest that oxytocin might hinder the restoration of trustworthiness and diminish risk-taking behavior when trust is violated, especially in those who are hormonally prone to risk-taking behavior by a high testosterone-cortisol ratio

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008–2017) on 1194 outpatient emergencies involving children aged 6–18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient’s home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used

Personal Recovery in People With a Psychotic Disorder:A Systematic Review and Meta-Analysis of Associated Factors

Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions). Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests. Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = −0.44, 95%CI −0.50 to −0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48–0.63), meaning in life (r = 0.48, 95%CI 0.38–0.58) and empowerment (r = 0.53, 95%CI 0.42–0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43–0.65) and identity (r = 0.43, 95%CI 0.35–0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences. Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time

The role of adverse childhood experiences and mental health care use in psychological dysfunction of male multi-problem young adults

Adverse childhood experiences (ACEs) are associated with severe problems later in life. This study examines how eleven types of ACEs and mental health care use history are related to current psychological dysfunction among multi-problem young adults. A sample of 643 multi-problem young adult men (age 18-27) gave informed consent for us to collect retrospective regional psychiatric case register data and filled out questionnaires. ACEs were highly prevalent (mean 3.6, SD 2.0). Logistic regression analysis showed that compared with participants who experienced other ACEs, participants who experienced psychological problems in their family and grew up in a single-parent family were more likely to have used mental health care, and physically abused participants were less likely to have used mental health care. Linear regression analyses showed a dose-response relationship between ACEs and internalizing and externalizing problems. Linear regression analyses on the single ACE items showed that emotional abuse and emotional neglect were positively related to internalizing problems. Emotional and physical abuse and police contact of family members were positively related to externalizing problems. While multi-problem young adults experienced many ACEs, only a few ACEs were related to mental health care use in childhood and adolescence. Long-term negative effects of ACEs on psychological functioning were demonstrated; specifically, emotional abuse and emotional neglect showed detrimental consequences. Since emotional abuse and emotional neglect are not easily identified and often chronic, child health professionals should be sensitive to such problems

Від коваріацій до каузальності. Відкриття структур залежностей у даних

Проаналізовано сучасну методологію виводу каузальних моделей та структур систем імовірнісних залежностей із статистичних даних пасивних спостережень. Висвітлено можливості, проблеми, застереження та обмеження методів індуктивної ідентифікації каузальних відношень в апараті марковських властивостей та баєсових мереж. Виділено кілька ступенів каузальних моделей згідно з рівнем їх обґрунтованості та адекватності джерелу даних. Сформульовано статистичний паттерн, який зводить обґрунтування висновку про каузальний характер зв’язку двох змінних до тестування набору статистичних фактів (не)залежності.Проанализирована современная методология вывода каузальных моделей и структур систем вероятностных зависимостей из статистических данных пассивных наблюдений. Освещены возможности, проблемы, оговорки и ограничения методов индуктивной идентификации каузальных отношений в аппарате марковских свойств и байесовых сетей. Выделены несколько ступеней каузальных моделей согласно уровню их обоснованности и адекватности источнику данных. Сформулирован статистический паттерн, который сводит обоснование вывода о каузальном характере связи двух переменных к тестированию набора статистических фактов (не)зависимости.The current methodology of output casual models and structures of systems of probabilistic dependencies of stafistical data of passive observation is analysed. The problems, features, traps and limitations of the methods of the inductive identification of casual relation in the unit of marcov properties and bayesias nets are highlighted. Several stages of casual models according to the level of their validity and adequacy of the data source are emphasized. The statistical pattern, which brings the justification of a finding about casual nature of the connections between two variables to the test of a set of statistical facts of (in)dependency is formulated

Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial

Objective To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease