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The structure of negative symptoms of schizophrenia is still a matter of controversy. Although a two-dimensional model (comprising the expressive deficit dimension and the motivation and pleasure dimension) has gained a large consensus, it has been questioned by recent investigations.
To investigate the latent structure of negative symptoms and its stability over time in people with schizophrenia using network analysis.
Negative symptoms were assessed in 612 people with schizophrenia using the Brief Negative Symptom Scale (BNSS) at baseline and at 4-year follow-up. A network invariance analysis was conducted to investigate changes in the network structure and strength of connections between the two time points.
The network analysis carried out at baseline and follow-up, supported by community detection analysis, indicated that the BNSS's items aggregate to form four or five distinct domains (avolition/asociality, anhedonia, blunted affect and alogia). The network invariance test indicated that the network structure remained unchanged over time (network invariance test score 0.13; P = 0.169), although its overall strength decreased (6.28 at baseline, 5.79 at follow-up; global strength invariance test score 0.48; P = 0.016).
The results lend support to a four- or five-factor model of negative symptoms and indicate overall stability over time. These data have implications for the study of pathophysiological mechanisms and the development of targeted treatments for negative symptoms.
Deficits in social cognition (SC) are significantly related to community functioning in schizophrenia (SZ). Few studies investigated longitudinal changes in SC and its impact on recovery. In the present study, we aimed: (a) to estimate the magnitude and clinical significance of SC change in outpatients with stable SZ who were assessed at baseline and after 4 years, (b) to identify predictors of reliable and clinically significant change (RCSC), and (c) to determine whether changes in SC over 4 years predicted patient recovery at follow-up.
The reliable change index was used to estimate the proportion of true change in SC, not attributable to measurement error. Stepwise multiple logistic regression models were used to identify the predictors of RCSC in a SC domain (The Awareness of Social Inference Test [TASIT]) and the effect of change in TASIT on recovery at follow-up.
In 548 participants, statistically significant improvements were found for the simple and paradoxical sarcasm of TASIT scale, and for the total score of section 2. The reliable change index was 9.8. A cut-off of 45 identified patients showing clinically significant change. Reliable change was achieved by 12.6% and RCSC by 8% of participants. Lower baseline TASIT sect. 2 score predicted reliable improvement on TASIT sect. 2. Improvement in TASIT sect. 2 scores predicted functional recovery, with a 10-point change predicting 40% increase in the probability of recovery.
The RCSC index provides a conservative way to assess the improvement in the ability to grasp sarcasm in SZ, and is associated with recovery.
Resilience is defined as the ability to modify thoughts to cope with stressful events. Patients with schizophrenia (SCZ) having higher resilience (HR) levels show less severe symptoms and better real-life functioning. However, the clinical factors contributing to determine resilience levels in patients remain unclear. Thus, based on psychological, historical, clinical and environmental variables, we built a supervised machine learning algorithm to classify patients with HR or lower resilience (LR).
SCZ from the Italian Network for Research on Psychoses (N = 598 in the Discovery sample, N = 298 in the Validation sample) underwent historical, clinical, psychological, environmental and resilience assessments. A Support Vector Machine algorithm (based on 85 variables extracted from the above-mentioned assessments) was built in the Discovery sample, and replicated in the Validation sample, to classify between HR and LR patients, within a nested, Leave-Site-Out Cross-Validation framework. We then investigated whether algorithm decision scores were associated with the cognitive and clinical characteristics of patients.
The algorithm classified patients as HR or LR with a Balanced Accuracy of 74.5% (p < 0.0001) in the Discovery sample, and 80.2% in the Validation sample. Higher self-esteem, larger social network and use of adaptive coping strategies were the variables most frequently chosen by the algorithm to generate decisions. Correlations between algorithm decision scores, socio-cognitive abilities, and symptom severity were significant (pFDR < 0.05).
We identified an accurate, meaningful and generalizable clinical-psychological signature associated with resilience in SCZ. This study delivers relevant information regarding psychological and clinical factors that non-pharmacological interventions could target in schizophrenia.
People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients’ body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes.
This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients’ physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected.
Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31–2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80–28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45–20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention.
The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.
Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals.
To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia.
The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures.
Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p = 0.010), attention (p = 0.011), verbal memory (p = 0.035), and social cognition (p = 0.001) domains, and an overall lower global cognitive composite score (p = 0.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p = 0.004), real-world interpersonal relationships (p < 0.001), and participation in community-living activities (p < 0.001).
These findings strengthen the notion that ASD symptoms may have a relevant impact on different aspects of the disease, crucial to the life of people with schizophrenia. Prominent ASD symptoms may characterize a specific subpopulation of individuals with SSD.
Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions.
Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression.
After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms.
In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem.
Serum protein distribution and concentration can be affected by different physiological and pathological conditions. The aim of this study was to evaluate the changes in the concentration of serum protein fractions and haptoglobin in clinically healthy dairy buffaloes during late pregnancy and early lactation. Blood and milk samples were collected from 30 buffaloes at around 7 d before expected calving (blood only) and 7, 30 and 50 d after calving. In serum samples, the total protein, haptoglobin, albumin, α1-, α2-, β1-, β2-, γ-globulins, and albumin/globulin ratio (A/G) values were evaluated. In milk, fat%, protein%, lactose%, somatic cell score (SCS) were assessed, along with milk yield (MY) and daily milk production (DMP). The peripartum period significantly influenced (P < 0.005) total protein, albumin, haptoglobin, α2-, β2- and γ-globulins (P < 0.005). Milk yield, DMP and fat% changed significantly throughout the monitoring period (P < 0.005). Milk yield and DMP were positively correlated with total protein, albumin, β2-globulins and A/G ratio, and negatively correlated with haptoglobin and α2-globulins. These results provide new knowledge about the serum protein electrophoretic pattern in Italian Mediterranean Buffaloes during the last phase of pregnancy and early stages of lactation.
Five turquoise samples, belonging to the XVII century historical collection of the Real Museo Mineralogico (University of Naples Federico II), were investigated by a multi-methodological approach based on powder X-ray diffraction, electron microprobe analysis in wavelength-dispersive spectroscopy mode, backscattered electron images from scanning electron microscopy in energy-dispersive spectroscopy mode, laser ablation inductively coupled plasma mass spectrometry, Fourier transform infrared and Raman spectroscopy.
The samples originate from Sinai (Egypt), Santa Fè S. Miguel (New Mexico), Saxony (Germany), Montebras Creuse (France) and Nishapur (Khorassan, Iran) and display different mineralogical compositions and various mineral associations. The study has shown the presence of: (1) four minerals of the turquoise group: turquoise, faustite, chalcosiderite and planerite; (2) other phosphates from different groups: wavellite, crandallite, goyazite, gorceixite, variscite, metavariscite, fluorapatite; and (3) other minerals: voltaite, adularia and quartz.
The present investigation is intended to show the mineralogical and geochemical variability of the samples with particular attention to the mineralogical parageneses, textural analyses and trace-element concentrations.
Cardiac progenitor cells (CPCs) are a promising candidate for cardiac regeneration, and the interaction between CPCs and their microenvironment can influence their regenerative response. Notch signaling plays a key role in cell fate decisions in the developing and adult heart. Here, we investigated the effect of three-dimensional (3D) spheroid culture, as a model of the 3D microenvironment, on Notch in fetal and adult human CPCs, under room air (20%) and physiological (5%) oxygen tension. Notch signaling is enhanced in 3D spheroids; spheroid culture under 5% O2 further increases Notch signaling enhancement, and might ultimately improve the regenerative potential of CPCs.
The primary aim of the present study was to determine the survival rates and identify predictors of disease duration in a cohort of Huntington's disease (HD) patients from Southern Italy.
All medical records of HD patients followed between 1977 and 2008 at the Department of Neurological Sciences of Federico II University in Naples were retrospectively reviewed and 135 patients were enrolled in the analysis. At the time of data collection, 41 patients were deceased (19 males and 22 females) with a mean ± SD age at death of 56.6 ± 14.9 years (range 18-83).
The median survival time was 20 years (95% CI: 18.3-21.7). Cox regression analysis showed that the number of CAG in the expanded allele (HR 1.09 for 1 point triplet increase, p=0.002) and age of onset (HR 1.05 for 1 point year increase, p=0.022) were independent and significant predictors of lower survival rates.
We believe that these findings are important for a better understanding of the natural history of the disease and may be relevant in designing future therapeutic trials.
The aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the “odd” PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C (“anxious”) PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.
The future space debris environment will be dominated by the production of fragments coming from massive fragmentations. In order to identify the most relevant parameters influencing the long term evolution of the environment and to assess the criticality of selected space objects in different regions of the circumterrestrial space, a large parametric study was performed. In this framework some indicators were produced to quantify and rank the relevance of selected fragmentations on the long term evolution of the space debris population. Based on the results of the fragmentation studies, a novel analytic index, the Criticality of Spacecraft Index, aimed at ranking the environmental criticality of abandoned objects in LEO, has been devised and tested on a sample population of orbiting objects.
Objective – Aim of the study was to investigate the psychometric properties of the Italian version of the Drug Attitude Inventory (DAI) by exploring its construct validity. Setting – 90 voluntary admitted patients with DSM III-R Schizophrenic (n.72) and Schizoaffective (n.18) disorders, age range between 18 and 50 years, treated with typical antipsychotics, able to participate in the study, were selected. Design – Exploratory factor analyses with alpha factoring and maximum–likelihood methods with Varimax Rotation were used to analyse DAI scores. Results – Extraction methods found 7 factors which explained 62.5% of the total variance. The first 2 factors could be labelled as “subjective response to treatment” construct and factors 3 to 7 as “attitude to medication” contruct. Conclusion – Although preliminarily, the Italian version of the DAI seems to maintain the original psychometric properties and it can be used easily to get a valid measurement of the patients' attitude to neuroleptic medication.
Aim and Method – The paper is a selective review of the literature on strategies and methods of cognitive remediation in schizophrenic disorders. It has been focused on the remediation of executive functions and the present hypotheses about the possibility of an improvement of the neurocognitive deficit through specific interventions. Results and Conclusions –People with Schizophrenic Disorders have some degree of cognitive deficit that often precede the clinical onset not secondary to the pathology characteristics persisting even when the positive symptoms have been resolved. The possibility that the neurocognitive deficits could be modified by psychological remediation with effects not exclusively confined to the cognitive domain has been nowadays accepted and numerous studies demonstrate that these interventions are effective and durable with a positive impact on social and working abilities, symptomatology and self-esteem.
Declaration of Interest
the authors declare that no economical support was obtained for this paper and no other kind of conflict of interest is present.
Objective - The aim of this study was to asses type and prevalence of Personality Disorders (PDs) and their patterns of comorbidity with Axis I disorders in a sample of psychiatric inpatients. Setting - The sample consisted of 300 subjects admitted to a psychiatric unit on a voluntary bases for an index episode. The study was conducted over a period of 12 months, from 1.11.1997 to 31.10.1998. Main outcome measures - The Italian version of SCID-II-PQ (Structured Clinical Interview for DSM-III-R personality disorders, with Personality Questionnaire-PQ- a self report questionnaire). Results - More than half the patients had at least one personality disorder. The mean of disorders per patient was 2.83±1.93 (±SD). The most prevalent Axis II disorders were Borderline PD (30.7%), Obsessive-compulsive PD (30.7%) and Avoidant PD (25.3%). Women were significantly more likely than men to meet criteria for Dependent PD and Avoidant PD. Man showed significantly more frequently than women Antisocial PD. Significant associations (p<0.05) were found for comorbidity of Mood Disorders and Avoidant PD, and for Psicoactive Use Disorders and Antisocial PD. Conclusions - Our study confirms the high prevalence of PDs in psychiatric inpatients and showes some interesting associations between Axis I and Axis II disorders. These results can't be generalized to outpatients because our clinical sample involved mainly severely ill inpatients, but they raise questions about the exact nature of PDs and of the relationship with Axis I disorders. Further research involving outpatients and general population is needed to examine factors that could affect development and course of Personality Disorders.
Objective - The aim of this study was to verify the construct validity of the Italian version of Parental Bonding Instrument (PBI) a questionnaire which estimates the parental style as reported by the son or daughter. Method - The questionnaire was administered to a group of 102 students (62 males and 40 females) attending University of L'Aquila and to a sample of 128 patients (76 males and 52 females) consecutively admitted to a psychiatric unit for an index episode. We compared the means of the two factors (care, protection) separately for each parent in the two groups using a t-test for indipendent samples. After having estimated the internal consistency of items of each scale by calculating Cronbach's coefficient α, a factor analysis was performed for students and patients to find the structural factors of the questionnaire; then, we conducted a confirmatory factor analysis of the PBI items, for the students only, to evaluate the fit of the real items to models proposed in the literature. Results - The Italian version of the Parental Bonding Instrument, demonstrated the ability to discriminate between patients and controls; it showed an high internal consistency. The factor analysis identified a two factors solution which accounted for 44.6% and 44.3% of the variance of the mother's and father's PBI scores respectively for the group of students and it identified two factors which accounted for 49.3% and 46.6% of the variance in the group of patients. Conclusions - The psychiatric patients showed a low «care»-high «protection » confirming an association between the «affectionless control» pattern and psychiatric disorders.
Nell'ultimo decennio la qualita della vita ha acquisito una sempre maggiore rilevanza come misura di esito sociale e clinico (Katschnig, 1997) dei disturbi mentali. Vi e un ampio consenso sul fatto che il costrutto della qualita della vita è multidimensionale e comprende la percezione che il paziente ha delle relazioni sociali, della propria salute fisica, della capacità di svolgere le attivita quotidiane domestiche e lavorative e del proprio benessere in generale (Patrick & Erickson, 1988). Mentre le misure di funzionamento si propongono di quantificare la compromissione in modo oggettivo, le misure della qualita della vita valutano la capacita del soggetto di trarre soddisfazione e piacere da varie attivita e richiedono una valutazione soggettiva. La definizione di qualita della vita del Quality of Life Group dell'Organizzazione
Aims — To describe patterns of experienced andanticipated discrimination in a sample of schizophrenic patients recruited in Italy in the context of the International Study of Discrimination and Stigma Outcomes (INDIGO). Methods — Cross-sectional survey on a sample of 50 people with clinical diagnosis of schizophrenia recruited in the Italian INDIGO sites of Verona and Brescia. The 41-item interview-based Discrimination and Stigma Scale (DISC-10), which assesses how experienced and anticipated discrimination affects the life of people with schizophrenia, was used. Results — The most frequently occurring areas of experienced discrimination were discrimination by family members (44%), making and keeping friends (33%), keeping (36%) and finding a job (34%), getting or keeping a driving licence (32%). Anticipated discrimination was common in applying for work, training or education (58%), lookingfor close relationships (50%) and doing something important (48%); 68% felt the need to conceal their diagnosis. Positive experiences were rare, and getting welfare benefits/disability pensions was the only area where participants reported being treated with advantage (34%) more commonly than with disadvantage (8%). Overall, experienced discrimination reported by Italian patients was in the intermediate position of the score range of all INDIGO sites, whereas anticipated discrimination was lower than that reported in the other countries. Conclusions — Interventions to reduce discrimination against people with schizophrenia may need to address both actual and anticipated discrimination. Targeted therapeutic strategies aiming to improve self-esteem of people with schizophrenia may be usefulto facilitate their social participation and full inclusion in the community.
Declaration of Interest: The authors declare they have not competing interests.
Negli ultimi anni il modello categoriale della psicosi e della schizofrenia in particolare, è stato riconsiderato a favore di una visione dimensionale. Questa assume che I sintomi psicotici differiscono in modo quantitativo dalle normali esperienze psichiche distribuendosi lungo un continuum che va dalla popolazione clinica affetta da schizofrenia ad individui con disturbo di personalità, fino alla popolazione generale che può mostrare esperienze simil psicotiche (Hanssen et al., 2003; Johns & Phil, 2005). Tale continuità fenomenologica è suggerita da studi che mostrano che le dimensioni del fenotipo della psicosi subclinica sono molto simili a quelle identificate nei disturbi clinici (Van Os et al. 2000; Van Os & Tamminga, 2007; Rossler et al., 2007). Sono state infatti riportate dimensioni positive e negative sia in ambito clinico che subclinico, mentre più incerta appare la presenza della dimensione disorganizzazione (Vollema & Hoijtink, 2000; van Os et al., 2002). Vari studi hanno riportato che i fenotipi clinico e non clinico condividono fattori di rischio, meccanismi psicologici ed i pattern epidemiologici (Sharpley & Peters,1999; Johns & van Os, 2001; van Os et al., 2001), fornendo un'ulteriore prova che l'espressione clinica e subclinica delle psicosi fanno parte dello stesso continuum.