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The aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.
Sixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4–6 years (T3), and 7–11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients’ psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.
Among them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.
Our results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.
The human body changes with age. How do these changes influence brain functions? the objective of this study was to analyze differences in cognitive status between elderly and middle age people.
Material and methods:
One hundred non-demented adults (29 M, 71 F) aged 46 - 88 years (mean 65.6; SD 11.0) living in rural regions of Poland entered the study. They were divided into two groups: people 40 - 65 years old (58,76; SD 5,74) and more than 65 years old (mean 73.8; SD 5.2). Dementia screening was performed using Mini Mental State Examination (MMSE). Cognitive functions were assessed by means of Stroop Test and Trail Making Test. Demographic, socioeconomic, clinical and lifestyle data were collected with the help of the semi-structure questionnaire. Data were collected by face to face interview.
The elderly group scored significantly worse on the cognitive tests, compared to the middle aged group. They had significantly worse results in MMSE, made significantly more mistakes in Stroop test part B, TMT part A and B. in the elderly the time needed to complete of both parts of Stroop test was significantly longer than in the younger group. Also there were significant correlation between the participants’ age and the time to complete the tests in each of these two groups.
Cognitive functions worsen with age which may be associated with the deterioration of the functioning of older people. the study is being continued in order to identify factors that may influence cognitive ageing.
Symptomatic remission is an important outcome of schizophrenia however its association with social functioning (SF) and quality of life (QoL) hasn't been fully recognized.
To assess SF and QoL in association with remission status according to Andreasen criteria.
This was a study of a group 64 patients hospitalized for the first time between 1998 - 2002. They were assessed 1 month following discharge (T. 1), 12 months later (T. 2), 4 – 6 years after T.1 (T. 3) and 7–11 years after T.1 (T. 4).
During the observation 17.2% were remitted (Group 1), 37.5% were remitted or non remitted (Group 2), and 45.3% were non remitted (Group 3). There were differences between the groups however SFS and QL didn't change.
Time 1 (mean)
Time 2 (mean)
Time 3 (mean)
Time 4 (mean)
Group 1 recovered n=11
Group 2 recovered/non-recovered n=24
Group 3 non-recovered n=29
[Table Social functioning and QoL]
Close association between remission status and SF and QoL suggests that remission status may be a good indicator for SF and QoL in schizophrenia.
Analysis of correlation between psychopathology and quality of life (QoL) of schizophrenic patients during 4-6 years after the first psychiatric hospitalisation.
Study population included 74 patients. They were assessed at fixed time-points: 1 month and 13 months after the hospitalisation and 4-6 years after the first examination (T1, T2 and T3, respectively). The following instruments were used to assess symptoms, objective and subjective QoL: PANSS (5-factors), Social Functioning Scale (SFS) and WHOQOL.
At T1, the mean PANSS score was 62.4. Significant deterioration was noticed in all groups of symptoms, with the exception of cognitive functions. The greatest deterioration was observed in the negative symptoms and depression/anxiety. At T1, the mean SFS score was 103.4, while mean overall subjective QoL scored 3.3. During the follow-up period, significant improvement of SFS was noticed, with no meaningful change in WHOQOL and concomitant exacerbation of symptoms. QOL was particularly compromised by negative symptoms and depression/anxiety.
Correlation between SFS and negative symptoms varied from -0.61 to -0.76, while those between SFS score and depression/anxiety - from -0.40 to -0.66. Correlation between subjective QoL and negative symptoms as well as depression/anxiety ranged from -0.31 (environment) to -0.64 (physical domain). To a large extent, symptoms were responsible for variance in both SFS and WHOQOL scores.
1) Clinical course of schizophrenia varied, depending on adopted criteria of evaluation.
2) Negative symptoms and depression/anxiety had a particularly deleterious influence on QoL. The role these symptoms varied, depending on time elapsed since the first hospitalisation.
Comparison of social functioning of first-admitted schizophrenic patients with healthy subjects and evaluation of the influence of several socio-demographic and clinical variables on social abilities of patients, 1 month (T1), 13 months after hospitalization (T2) and 4-6 years after T1 (T3).
A group of 74 schizophrenic patients: 46 male and 28 female; age 24.7 ± 6.7 and a control group of matched 52 male and 34 female subjects were enrolled. Social Functioning Scale (SFS), Positive and Negative Syndrome Scale (PANSS), Global Assessment Scale (GAS) and socio-demographic questionnaire were used.
In all examinations SFS scores in the patients (T1 - 103.4; T2- 104.4; T3- 107.0), were significantly lower than in the healthy controls - 117.0 (p< 0.001). In longitudinal analysis, a mild improvement was observed in T3 SFS score and in its three subscales (p< 0.05). In cross-sectional analysis, better social functioning was associated with female sex, longer education, activity before admission, and better functioning in the pre-admission period. In regression analyses SFS at T2 was predicted by PANSS (27% of the variance) and at T3 by PANSS and duration of psychotic symptoms (20% of the variance).
Social functioning in schizophrenia is disturbed from the onset of the disease and may be mildly improved in the intermediate follow-up. The duration of untreated illness and severity of symptoms after the first admission, are the independent significant determinants of social functioning in early course of schizophrenia.
Response and remission defined by cut-off values on the last observed depression severity score are commonly used as outcome criteria in clinical trials, but ignore the time course of symptomatic change and may lead to inefficient analyses. We explore alternative categorization of outcome by naturally occurring trajectories of symptom change.
Growth mixture models were applied to repeated measurements of depression severity in 807 participants with major depression treated for 12 weeks with escitalopram or nortriptyline in the part-randomized Genome-based Therapeutic Drugs for Depression study. Latent trajectory classes were validated as outcomes in drug efficacy comparison and pharmacogenetic analyses.
The final two-piece growth mixture model categorized participants into a majority (75%) following a gradual improvement trajectory and the remainder following a trajectory with rapid initial improvement. The rapid improvement trajectory was over-represented among nortriptyline-treated participants and showed an antidepressant-specific pattern of pharmacogenetic associations. In contrast, conventional response and remission favoured escitalopram and produced chance results in pharmacogenetic analyses. Controlling for drop-out reduced drug differences on response and remission but did not affect latent trajectory results.
Latent trajectory mixture models capture heterogeneity in the development of clinical response after the initiation of antidepressants and provide an outcome that is distinct from traditional endpoint measures. It differentiates between antidepressants with different modes of action and is robust against bias due to differential discontinuation.
TSH-suppressive therapy is widely used in treatment of thyroid differentiated carcinoma. A common consequence of therapy is subclinical hyperthyroidism which may cause dysfunction of cardiovascular system, metabolism and reduction of bone mass. Thyroid hormones are also involved in regulation of brain function. Therefore, thyroid dysfunctions are associated with frequent comorbid cognitive dysfunctions and depression.
The aim of our study was to assess the cognitive functions in patients treated with suppressive doses of levothyroxine due to thyroid papillary carcinoma.
Twenty three patients with subclinical hyperthyroidism in the course of substitutive treatment with levothyroxine due to total thyroidectomy and 131I therapy were involved in the study. The control group consisted of 13 healthy, euthyroid subjects.
A battery of neuropsychological tests was administered to assess: 1. Working memory and executive functions (the Wisconsin Card Sorting Test- WCST, The Controlled Oral Word Association Test-FAS), 2. Psychomotor speed (the Trial Making Test- TMT) 3. Attention (the Stroop test) and 4. Short term memory (the Digit Span test). Psychometric evaluation was made using 17 items the Hamilton Depression Rating Scale and Beck Depression Inventory.
Patients compared to control group performed poorer in WCST. They made significantly more perseverative errors. Patients were found to perform less well than controls in FAS and in TMT-B. The mean score of HDRS and BI (3,4 and 6,6 respectively) suggest that patients were not depressed during examination.
Our results suggest that suppressive treatment with levothyroxine may affect executive functions, working memory, psychomotor speed.