Cognitive predictors of psychosocial functioning outcome in schizophrenia: A follow-up study of subjects participating in a rehabilitation program
ABSTRACT The aims of this prospective study were to explore in subjects with psychosis participating in a rehabilitation program whether cognitive performances at baseline predicted (i) psychosocial functioning over a 15-16 month follow-up; (ii) improvement in psychosocial functioning over the rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performance in 55 subjects with schizophrenia spectrum disorders who completed a rehabilitation program. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. One subscale of the Client's Assessment of Strengths, Interests, and Goals (CASIG) provided a measure of subjective quality of life (QoL). Improvement was defined as a 15% or more increase in psychosocial scores between baseline and follow-up. Worse baseline sustained attention predicted better self-rated quality of life, and better baseline visual memory predicted better community functioning over the rehabilitation follow-up period, in particular, higher autonomy in activities of daily living, and less physical and psychiatric symptoms that could interfere with rehabilitation. Baseline cognitive performances predicted community functioning improvement during the follow-up period: visual memory predicted improvement in daily living autonomy and in social competence; sustained attention predicted improvement in behavioral problems (such as medication compliance, collaboration with treatment providers or impulse control) and social competence; planning performances predicted improvement in social competence. These cognitive functions could be specifically targeted in a rehabilitation program aimed at enhancing functioning in those particular dimensions.
- SourceAvailable from: Gustavo Silva
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- "In the last decade, a body of research has been examining the effects of physical activity (PA) for people with schizophrenia (Bradshaw, Lovell, Bee, & Campbell, 2010; Fogarty & Happell, 2005; Knöchel et al., 2012). The regular practice of PA promotes benefits, such as the reduction of weight, body mass index (BMI), waist circumference, cholesterol, triglycerides, negative symptoms, as well as increasing mental health, cognitive functioning, physical and social functioning (Acil, Dogan, & Dogan, 2008; Attux et al., 2011; Duraiswamy, Thirthalli, Nagendra, & Gangadhar, 2007; Methapatara & Srisurapanont, 2011; Pelletier, Nguyen, Bradley, Johnsen, & McKay, 2005; Poulin et al., 2007; Prouteau et al., 2005; Van Citters et al., 2010). "
ABSTRACT: Purpose The purpose of this study was to evaluate the effects of a 16-week group physical activity (PA) program on physical fitness and quality of life in outpatients with schizophrenia. Methods Nineteen outpatients with schizophrenia were divided into experimental (EG) (n=8; mean age 39±7 years) and control (CG) (n=11; mean age 40±6 years) groups. The EG underwent twice a week sessions of a group PA program for a period of 16-weeks. The participants completed a battery of tests at baseline and after 16-weeks, which included the assessment of body composition (dual-energy X-ray absorptiometry), functional exercise capacity (6MWT), physical activity levels (accelerometers), quality of life (WHOQOL-Brief), and anthropometric measures. During the program different strategies were implemented to ensure the participants’ adherence. Results The attendance to the program was 79.7%. In the EG a significant decrease was observed in hip circumference (p = 0.02); a significant increase occurred in moderate to vigorous physical activity (p = 0.05) and in the environment domain (WHOQOL-Brief) (p = 0.02). The improvement in environment domain scores was also associated with a decrease in sedentary behavior (r = -0.82, p = 0.01) in the EG. Conclusions The strategies used during the program promoted a high rate of attendance. PA may have a positive impact on the participants’ ability to perform activities of daily living. This study showed that a group PA program can be successfully implemented for outpatients with schizophrenia and can influence their quality of life and PA levels.Mental Health and Physical Activity 07/2014; 7(3). DOI:10.1016/j.mhpa.2014.07.002
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- "In our study, we did not find a direct relationship between neurocognition and QoL. Previous studies on this subject were not consistent , as some have found positive (Addington et al., 2005; Galletly et al., 1997), negative (Kurtz and Tolman, 2011; Narvaez et al., 2008; Prouteau et al., 2005) or the absence of, relationships (Aksaray et al., 2002; Brissos et al., 2008; Heslegrave et al., 1997). The correlation between memory performances and insight seems to confirm a recent study that identified memory acquisition as the only significant predictor of knowledge outcome involved in insight (Jahn et al., 2011). "
ABSTRACT: The aim of this study was to assess the impact of insight into illness on self-reported quality of life (QoL) for patients with schizophrenia. This cross-sectional study was conducted in the psychiatric department of a French public university teaching hospital. The data collected included socio-demographic information, clinical characteristics, medications, cognitive performance assessments, insight into illness, and the S-QoL 18. A multivariate analysis using multiple linear regressions was performed to determine variables potentially associated with QoL levels. One hundred and thirteen outpatients with stable schizophrenia were enrolled in our study. Significant associations were found between QoL and socio-demographic characteristics: a higher QoL was associated with marital status (in couple) and employment. Concerning insight into illness, lower QoL levels were associated with better awareness of the mental disorder, whereas higher QoL levels were associated with better awareness of positive and negative symptoms. Elementary neuropsychological measures were not statistically associated with QoL. Insight into illness, marital status and employment were the most important features associated with QoL, whereas there was no evidence that elementary neurocognition directly influenced QoL. The different facets of insight into illness should be considered to guide the development of specific interventions intended to improve QoL. Moreover, this study highlights the need for clinicians to pay more attention to the personal impact of schizophrenia, especially upon family life and work.Progress in Neuro-Psychopharmacology and Biological Psychiatry 03/2012; 36(2):271-6. DOI:10.1016/j.pnpbp.2011.10.008 · 4.03 Impact Factor
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- "These impairments have been shown to be associated with various impaired functional outcomes.4,5 The severity of cognitive impairment predicts poorer treatment adherence6,7 and increased relapse risk in first-episode patients.8 Furthermore, imaging studies have demonstrated relationships between cognitive deficits and structural or functional brain abnormalities.9–13 "
ABSTRACT: In light of the number of studies conducted to examine the treatment of cognitive impairment associated with schizophrenia (CIAS), we critically reviewed recent CIAS trials. Trials were identified through searches of the website "www.clinicaltrials.gov" using the terms "schizophrenia AND cognition," "schizophrenia AND neurocognition," "schizophrenia AND neurocognitive tests," "schizophrenia AND MATRICS," "schizophrenia AND MCCB," "schizophrenia AND BACS," "schizophrenia AND COGSTATE," and "schizophrenia AND CANTAB" and "first-episode schizophrenia AND cognition." The cutoff date was 20 April 2011. Included trials were conducted in people with schizophrenia, the effects on cognition were either a primary or secondary outcome, and the effect of a pharmacologically active substance was examined. Drug challenge, pharmacokinetic, pharmacodynamic, or prodrome of psychosis studies were excluded. We identified 118 trials, with 62% using an add-on parallel group design. The large majority of completed trials were underpowered to detect moderate effect sizes, had ≤8 weeks duration, and were performed in samples of participants with chronic stable schizophrenia. The ongoing add-on trials are longer, have larger sample sizes (with a number of them being adequately powered to detect moderate effect sizes), and are more likely to use a widely accepted standardized cognitive battery (eg, the MATRICS Consensus Cognitive Battery) and MATRICS guidelines. Ongoing studies performed in subjects with recent onset schizophrenia may help elucidate which subjects are most likely to show an effect in cognition. New insights into the demands of CIAS trial design and methodology may help increase the probability of identifying treatments with beneficial effect on cognitive impairment in schizophrenia.Schizophrenia Bulletin 11/2011; 39(2). DOI:10.1093/schbul/sbr153 · 8.61 Impact Factor