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The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships.
We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort.
Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained.
The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.
Longitudinal studies of the relationship between cognition and functioning in bipolar disorder are scarce, although cognition is thought to be a key determinant of functioning. The causal structure between cognition and psychosocial functioning in bipolar disorder is unknown.
We sought to examine the direction of causality between cognitive performance and functional outcome over 2 years in a large cohort of euthymic patients with bipolar disorder.
The sample consisted of 272 adults diagnosed with bipolar disorder who were euthymic at baseline, 12 and 24 months. All participants were recruited via the FondaMental Advanced Centers of Expertise in Bipolar Disorders. We used a battery of tests, assessing six domains of cognition at baseline and 24 months. Residual depressive symptoms and psychosocial functioning were measured at baseline and 12 and 24 months. The possible causal structure between cognition and psychosocial functioning was investigated with cross-lagged panel models with residual depressive symptoms as a covariate.
The analyses support a causal model in which cognition moderately predicts and is causally primary to functional outcome 1 year later, whereas psychosocial functioning does not predict later cognitive performance. Subthreshold depressive symptoms concurrently affected functioning at each time of measure.
Our results are compatible with an upward causal effect of cognition on functional outcome in euthymic patients with bipolar disorder. Neuropsychological assessment may help specify individual prognoses. Further studies are warranted to confirm this causal link and evaluate cognitive remediation, before or simultaneously with functional remediation, as an intervention to improve functional outcome.
Empathy and related concepts in health
Jean Decety, Department of Psychology, University of Chicago,
Philip L. Jackson, Department of Psychology, University of Laval, Canada,
Eric Brunet, Institute for Learning and Brain Sciences, University of Washington
Despite the plethora of definitions of empathy, most authors generally agree that it implies at least three different aspects: feeling what another person is feeling; knowing what another person is feeling; and having the intention to respond compassionately to another person's distress. Note that these aspects may be experienced independently from one another and constitute different levels of complexity ranging from empathic mimicry to sympathy. Moreover, regardless of the particular terminology used by different scholars, there is broad agreement that empathy involves three primary elements: (1) an affective response to another person, which often, but not always, entails sharing that person's emotional state; (2) a cognitive capacity to adopt the perspective of the other person; and (3) some monitoring and self-regulatory mechanisms that keep track of the origins of self and other feelings (e.g. Batson, 1991; Decety & Jackson, 2004; Ickes, 1997). The multidimensionality of the empathy construct makes it less amenable to traditional methods of study and investigation.
We propose in light of the current knowledge in neuropsychology and cognitive neuroscience a model of empathy that relies on four intertwined major functional components that dynamically interact to produce this intersubjective experience. The first component, affective sharing, is based on a perception-action coupling mechanism and resulting shared representations between self and other (Preston & de Waal, 2002). Self-other awareness constitutes the second component. Empathy requires that there is no confusion between self and other even though some temporary identification between the observer and its target may occur.
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