Interrelationships of long-term changes in recovery domains among patients with schizophrenia spectrum disorders: a six-year follow-up study.

ABSTRACTIntroductionPatients with schizophrenia spectrum disorders (SSD) improve in several outcome domains over the course of illness, but to different degrees. In this meta‐analysis, we investigated whether longitudinal changes in different outcome domains are associated with each other and which factors moderate these changes over time.MethodsOur protocol was preregistered in PROSPERO (CRD42024504253). We included 109 studies, identified through searches in PsycInfo, PubMed, CINAHL, and Cochrane up until November 2023, investigating longitudinal changes in at least two outcome domains (symptoms, social functioning, cognition or personal recovery) for patients with SSD with at least 1 year follow‐up. We calculated Pearson correlation coefficients for associations of changes between outcome domains. Potential moderating effects of demographic, clinical, social, or study characteristics were explored. Quality assessment was executed using the QUIPS tool.ResultsWe found substantial positive associations between changes in symptoms, social functioning, and cognition. Especially, changes in negative symptoms and overall social functioning were associated with changes in several outcome domains. Changes in personal recovery were only associated with changes in symptoms. We found more substantial improvements in combinations of outcomes for patients with a shorter illness duration, females, a lower percentage of patients diagnosed with schizophrenia, and patients receiving treatment focused on targeted outcomes.ConclusionsSymptoms, social functioning, and cognition often concurrently improve and may boost each other. This suggests that an integrated approach targeting several outcome domains jointly boosts long‐term improvement. However, changes in personal recovery seem to occur separately from other outcome domains. Therefore, targeted attention for personal recovery is needed.Trial Registration: PROSPERO: CRD42024504253

Heterogeneity in Schizophrenia Spectrum Disorders: Studies on Functional, Affective, and Metabolic Outcomes This dissertation aimed to explore the heterogeneity in schizophrenia spectrum disorders (SSD) by examining long-term clinical and subjective outcomes in older adults and by investigating the role of depressive symptomatology in relation to metabolic risk. Part 1: Long-term Course of Remission and Quality of Life in Older Adults with SSD With an aging population, the number of older individuals with SSD is increasing. Their care needs often differ from those of younger patients. A better understanding of the long-term course of SSD in later life is therefore essential. Contrary to earlier beliefs that schizophrenia inevitably leads to a dementia-like state, more recent evidence suggests a more diverse and sometimes favorable course in older patients. Symptomatic remission, defined as a state of low symptom severity, has become a useful clinical concept. However, recovery must also include the patient’s perspective, especially in terms of subjective quality of life (SQoL). Using data from the SOUL study, we analyzed 77 patients aged 60+ over a 5-year period. We found that 26% of patients improved in terms of symptomatic remission, while 23% remained stable in remission. Key predictors of a favorable course were lower baseline positive symptoms and having a partner. In a separate analysis of 75 patients from the same cohort, we examined changes in SQoL using the Manchester Short Assessment of Quality of Life (MANSA). About 36% showed clinically relevant improvement, while 20% experienced a decline. Factor analysis revealed three SQoL domains: ‘personal circumstances,’ ‘daily life,’ and ‘social relations,’ with the first two showing notable improvement. Older age predicted more change, whereas a higher baseline SQoL score predicted stability. These findings suggest that improvement in both clinical and subjective outcomes is achievable even at later ages. Part 2: Depressive Symptom Profiles and Metabolic Syndrome in SSD People with SSD have higher mortality rates and shorter life expectancy, partly due to somatic conditions like cardiovascular disease, obesity, and diabetes. Recent studies suggest a link between depressive symptoms and metabolic syndrome (MetS), especially symptoms related to energy dysregulation. We compared depressive symptom profiles in 449 individuals with SSD, 816 with depressive disorders (DD), and 417 healthy controls (aged 18–50). Somatic/vegetative symptoms were more similar between SSD and DD groups than cognitive/mood symptoms. Among SSD patients, depressive symptom severity was associated with male gender, lower social functioning, use of benzodiazepines, and higher positive symptom burden. In a second study of 513 individuals with SSD, we examined the relationship between energy-related depressive symptoms (e.g., hypersomnia, hyperphagia, fatigue) and MetS. A third of the sample met criteria for MetS. Energy-related symptoms—but not melancholic symptoms—were significantly associated with both the presence and severity of MetS. Notably, hypersomnia showed the strongest link. Conclusion This dissertation underscores the heterogeneity in SSD, both in long-term outcomes and comorbid conditions. Older individuals with SSD can experience improvements in remission and quality of life, especially with social support. Additionally, specific depressive symptom patterns—particularly energy-related symptoms—may help identify patients at greater metabolic risk, supporting the need for integrated care approaches that address both mental and physical health.

Background:Chronic skin diseases like psoriasis affect a patient’s physical, psychological, and social functioning as well as well-being, and the lockdown acted as a cofactor in further worsening the quality of life in psoriasis patients.Objective:The objective of the study is to assess the effect of lockdown on the health, lifestyle, and mental well-being of psoriasis patients.Methods:A cross-sectional study was done using an online questionnaire shared through messenger applications to the patients of chronic plaque psoriasis who registered in the psoriasis clinic between August 2020 and December 2020. Data regarding demographics, psoriasis, lifestyle changes, mental status, financial loss, and problems faced during lockdown were collected.Results:Our study included 181 completed questionnaires. The mean age was 37.7 (SD 13.9) years, and 124 (68.5%) were males. Sixty-five (35.9%) patients reported worsening of their psoriasis during the lockdown. Ordinal regression analysis revealed male sex had a higher proportion of worsening of psoriasis (OR 2.56, 95% CI 1.29–5.08, P < 0.007). Duration of illness <6 months (OR 0.14, 95% CI 0.02–0.98, P < 0.04) and feeling relaxed (OR 0.14, 95% CI 0.03–0.56, P < 0.005) were negatively associated with disease worsening.Conclusion:The findings of our study reveal the impact of coronavirus disease 2019 (COVID-19) lockdown on the life of people with psoriasis. A substantial number of patients had a flare of psoriasis during the lockdown. A shorter duration of illness and relaxed mental status was negatively associated with disease worsening. Individuals with financial loss felt anxious or depressed.

Quality of life in anxiety disorders: Its relation to work and social functioning and dysfunctional cognitions: An exploratory study from India

Retinal structural alterations in chronic versus first episode schizophrenia spectrum disorders

IntroductionMood disorders, including anxiety and depression, are prevalent among patients with chronic kidney disease (CKD) who are on hemodialysis. Anxiety and\\or depressive symptoms among those patients have been associated with early initiation of dialysis and adverse outcome.AimThe aim is to investigate the prevalence and factors associated with anxiety and depression among Saudi patients with CKD who are on hemodialysis.MethodsThis is a cross-sectional study. A total of 122 patients with CKD and on hemodialysis at King Fahad Hospital in Al-Madinah, Saudi Arabia, were included in the study during the period from November 2017 to August 2018. Data were collected using the Hospital Anxiety and Depression Scale questionnaire. Sociodemographic information, duration of illness, and duration of hemodialysis were determined.ResultsOf the 122 CKD patients, 24.6% had depression and 19.7% had anxiety symptoms. Anxiety symptoms were more prevalent among females than males (P = 0.04). Older age was significantly associated with depression (P = 0.003). Patients’ depression and anxiety symptoms were insignificantly associated with their education level, employment status, duration of illness, and duration of hemodialysis.ConclusionAnxiety and depression are prevalent among CKD patients, particularly among females and older patients. Thus, this study suggests establishing a screening program to determine patients who are at risk of developing anxiety and depression. In addition, management to prevent the occurrence of depression and anxiety and improve patients’ quality of life must be implemented.

Chapter 18 - Promoting Psychosocial Functioning and Recovery in Schizophrenia Spectrum and Other Psychotic Disorders

Social interactive functions such as facial emotion recognition and smell identification have been shown to differ between women and men. However, little is known about how these differences are mirrored in patients with schizophrenia and how these abilities interact with each other and with other clinical variables in patients vs. healthy controls. Standardized instruments were used to assess facial emotion recognition [Facially Expressed Emotion Labelling (FEEL)] and smell identification [University of Pennsylvania Smell Identification Test (UPSIT)] in 51 patients with schizophrenia spectrum disorders and 79 healthy controls; furthermore, working memory functions and clinical variables were assessed. In both the univariate and the multivariate results, illness showed a significant influence on UPSIT and FEEL. The inclusion of age and working memory in the MANOVA resulted in a differential effect with sex and working memory as remaining significant factors. Duration of illness was correlated with both emotion recognition and smell identification in men only, whereas immediate general psychopathology and negative symptoms were associated with emotion recognition only in women. Being affected by schizophrenia spectrum disorder impacts one's ability to correctly recognize facial affects and identify odors. Converging evidence suggests a link between the investigated basic and social cognitive abilities in patients with schizophrenia spectrum disorders with a strong contribution of working memory and differential effects of modulators in women vs. men.

Background and Objectives: Identify the factors affecting quality of life (QOL) is one of the major goals for improving the Health-Related Quality of Life (HR-QOL) in patients suffering from Congestive Heart Failure (CHF). Considering the fact that there are few published studies in this regard in Iran, as a developing country, this research was designed to determine the HR-QOL in Iranian CHF patients and its related factors. Methods and Materials: In this cross-sectional study, random sampling was used to select 1840 female CHF patients. After obtaining informed consent, patients’ demographic and disease-related data (using a researcher-made questionnaire which assessed eight dimensions including role-physical, physical functioning, bodily pain, general health, vitality, role-emotional, social functioning and mental health), and the HR-QOL data (using the SF-36 questionnaire) were assessed and analyzed with SPSS version 15. Results: A high proportion of the participants had an unfavorable HR-QOL in physical functioning (44.56%), rolephysical (49.55%), role-emotional (59.83%), mental health (54.50%), and general health (53.36%) dimensions and a relatively favorable HR-QOL in social functioning (50.57%), vitality (49.26%), and body pain dimensions (52.55%). A significant relationship was found between the HR-QOL and the employment status, level of education, being cared for at home, functional capacity, disease duration, frequency of medical encounter and hospitalization, duration of hypertension and concurrent CHF, presence of edema, presence of disease symptoms and morbidities, intensity of fatigue at the study time and previous months, and the type of medications. Conclusion: According to the results, QOL in CHF patients was unfavorable in the scales of general health, role-emotional, and mental health.

Childhood temperament is associated with distress, anxiety and reduced quality of life in schizophrenia spectrum disorders

BackgroundThe aim of this study was to evaluate the self-reported perceived quality of life (QoL) in female to male (FTM) and male to female (MTF) transgenders and compare it with a general population sample, and to find possible determinants that likely contribute to their QoL.MethodsParticipants were 71 trandgenders participating in the communities of Isfahan and Fars provinces, Iran, including 30 MTF and 41 FTM, and 142 gender- and age-matched controls. Persian version of the Short Form 36-Item Questionnaire was used to evaluate self-reported QoL, which measures QoL across eight domains.ResultsCompared to control group, the QoL of transgenders in the most dimensions of the SF-36 questionnaire was lower. MTF had a lower QoL than FTM for the subscale physical functioning (p = 0.044). There was a significant relationship between education and subscales of emotional well-being (p = 0.048) and social function (p = 0.008); economic status and physical function subscale (p = 0.003); employment status and physical function (p = 0.012) and social function subscales (p = 0.003). Compared to male controls, MTF transgenders had lower physical functioning (P < 0.001), role limitation due to physical health (P = 0.015), vitality (P = 0.023), social functioning (P < 0.001) and pain score (P = 0.044) and no significant differences between female controls and FTM transgenders were seen.ConclusionTransgenders have lower physical and mental QoL, FTM transgender has better QoL than MTF transgender. Employment, education, province of residence and economic status as well as therapeutic intervention is associated with transgender’s QoL.

The limbic and neocortical contribution of α-synuclein, tau, and amyloid β to disease duration in dementia with Lewy bodies

The article analyzes the physical and psychological components of the quality of life (QOL) in patients with diabetic polyneuropathy (DP) on the background of type I and II diabetes mellitus (DM) with comorbidity. Has been demonstrated the prevalence of more frequent multimorbidity in this nosology and its effect on patients’ QOL. QOL is recognized as an integral part of a comprehensive analysis of new methods of diagnosis, treatment, prevention, quality of treatment and medical assistance [2]. With the highest frequency in DM detect sensory or sensorimotor forms of distal symmetrical DP. However, there are motor symptoms in DM, including cranial neuropathy and Bruns-Garland syndrome (diabetic amyotrophy) [3], which interfere with the satisfactory functioning of patients. The purpose of our work was to assess the extent of physical and mental functioning of people with DP on the background of multimorbidity. Materials and methods. We examined 92 patients with DP on the background of type I and II DM, aged from 19 to 69 years, which were divided into 2 groups: from DP on the background of type 1 DM (group I) and type II (group II). We distinguished such subgroups: DP on the background of type I DM and concomitant cardiovascular pathology (CVP) (group A), DP on the background of type II DM and concomitant CVP (group B), DP on the background of type I DM and gastroenterological pathology (GEP) (group C), DP on the background of type II DM and GEP (group D), DP on the background of type I DM and pathology of the thyroid gland (thyroid) (group E), DP on the background of type II DM and thyroid pathology (group F). Patients underwent clinical and neurological examination, laboratory tests and ultrasound examination of the abdominal cavity and thyroid gland, electromyography (EMG). Static calculation was done in MS Excel 2003. Results and discussion. In groups A and B with the highest frequency among CVP was arterial hypertension - 91% vs 97% and coronary heart disease - 27% vs 41%. In group C - chronic hepatitis (40%), chronic cholecystitis (40%), chronic pancreatitis (40%), chronic gastroduodenitis (40%). In people of group D, gallstone disease was diagnosed more often than in other pathologies (43%). The leading place in group E was occupied by autoimmune thyroiditis (29%), idiopathic hypothyroidism (29%), thyrotoxicosis (29%), in group F - nodular goiter (57%). The longest duration of DM was observed in group A - 24.54 ± 2.46 years, the smallest in group D - 7.14 ± 1.01 years. Diabetic foot syndrome was diagnosed in patients of groups A and B in 14%, group C - in 2%. In patients of group I, the indicators of QOL were higher than in group II. The highest indicators were of groups I and II in the domains social (SF) and physical functioning (PF) - 66.75 ± 2.41; 65.5 ± 3.23 and 63.39 ± 3.54; 61.42 ± 3.88. In group A, the level of QOL was slightly higher than in group B, in particular in the domains of mental health (MH) - 53.09 ± 3.12, bodily pain (BP) - 50.90 ± 4.05. In addition, the manifestations of DP in such group of individuals (group A) were manifested by the absence or mild pain, which causes in people of this group higher rate of QOL. QOL in patients of group C was higher than in group D, in particular, the indicators of physical functioning (PF) - 68.75 ± 5.88, social functioning (SF) - 65.62 ± 5.35, role emotional (RE) - 58.33 ± 18.75, mental health (MH) - 54 ± 5.36. In group D, the data were high in the domains of social functioning (SF) 60.71 ± 16.0 and physical functioning (PF) 57.14 ± 8.37. In the examined patients of group F the level of QOL was higher than in group E, it was, in the domains of physical functioning (PF) - 76.42 ± 7.99, bodily pain (BP) - 61.28 ± 11.18, general health (GH) - 60.85 ± 7.33. Physical health (PH) was low in all groups, but slightly higher in group F (47.90 ± 3.45). The mental health (MH) was low in all groups of patients, slightly higher in group C (47.89 ± 3.59). Conclusions. The level of QOL in persons with DP on the background of type I and II DM with multimorbidity was generally not high. Patients in group D showed the lowest levels of QOL, they also had a level of glycated hemoglobin much higher than in other groups. In group F, the data of QOL were higher, because people with DP on the background of type I DM (group E) had a higher frequency of concomitant thyroid damage, the manifestations of which significantly complicate the course of the underlying disease and reduce levels of functioning. Often manifestations of diabetic foot occur in the onset of DP, when the fibers responsible for sensitivity were damaged, which causes the appearance of the neuropathic component of pain, so in persons of group B the lowest among all groups was the level of QOL in the domain of pain intensity. In addition, it was convenient to monitor the results of treatment by conducting a QOL survey several times a year. Careful analysis of QOL in all areas of functioning in patients with DP allowed detecting early mental disorders and timely start treatment, including psychotherapy sessions. Keywords: quality of life, diabetic polyneuropathy, comorbidity, diabetic foot.

276 Background: CCA is associated with poor prognosis and reduced QoL. In the phase 2 FIGHT-202 study (NCT02924376) of the selective oral FGFR1–3 inhibitor pemigatinib, 35.5% and 46.7% of pts with previously treated advanced CCA and FGFR2 fusions/rearrangements (RE) had a complete or partial response (CR/PR) and stable disease (SD), respectively; 14.9% had progressive disease (PD) [Abou-Alfa et al., Lancet Oncology 2020;21:671-684]. QoL was an exploratory endpoint. Methods: Pts received pemigatinib 13.5 mg once daily (21-day cycle; 2 weeks on, 1 week off). QoL was assessed longitudinally by best overall response (BOR) per RECIST with the EORTC-QLQ-C30 and the biliary tract cancer-specific EORTC-QLQ-BIL21 questionnaires. QoL scores and longitudinal changes from baseline (BL) were analyzed using descriptive statistics. Treatment-related changes in QoL were a priori expected to be evident by cycle 6 day 1 (week 16). Results: Of 107 pts with FGFR2 RE, 100 (93%) were evaluable for QoL, including36, 48, and 15 with CR/PR, SD, and PD, respectively. From BL to week 16, QLQ-C30 overall health status was maintained in pts with CR/PR and SD and worsened in pts with PD (Table). Emotional functioning remained stable and similar in pts with CR/PR and SD but worsened in pts with PD. All subgroups showed decline in role and social functioning. Pts with CR/PR and SD experienced decreases in QLQ-BIL21 pain and anxiety; all subgroups showed increases in QLQ-BIL21 treatment side effects. Conclusions: In these pts with advanced CCA, those with an SD as BOR had a similar pattern of changes in QoL as those with CR/PR to pemigatinib. Changes in QoL were directionally more favorable in pts with CR/PR or SD than pts with PD. Clinical trial information: NCT02924376. [Table: see text]

Background : Lengthening life expectancy of population worldwide has led to rapid growth of the elderly population. This change indicates good development progress. However, it also poses quality of life concern among the elderly. Since the elderly have limitation in many ways, their quality of life decreases, often requiring self-confidence, family support, as well as community awareness, to improve their quality of life. Quality of life is affected by physical, psychological, social and environmental conditions. This study aimed to determine the effects of self efficacy, education, employment status, income, family support, social capital, and residential status on the quality of life of the elderly. Subjects dan M et hod : This was an analytic observational study using cross-sectional design. The study was conducted in 6 villages, in Sidorejo sub-district, Salatiga, Central Java, from March to April 2017. A total sample of 150 elderlies aged between 60 to 74 years old were selected for this study by stratified random sampling. The exogenous variables were education, social capital and residential status. The endogenous variables were family support, self efficacy, employment status, income, and the quality of life. The data were collected by a set of questionnaire and analyzed by path analysis. Results : The quality of life of the elderly was directly affected by income (b=0.06; SE= 1.16; p=0.005), family support (b=0.14; SE=0.22; p=0.003), and self efficacy (b=0.79; SE= 0.11;Â p<0.001). Family support was affected by residence status (b=0.54; SE=0.88; p<0,001), income (b=0.21; SE=0.40; p<0.001), and social capital (b=0.41; SE=0.02; p<0.001). Self efficacy was affected by family support (b=0.54; SE=0.10; p<0.001), and social capital (b=0.40; SE=0.04; p<0.001). Employment status was affected by education (b=0.16; SE=0.09; p=0.043). Income was influenced by education (b= 0.71; SE= 0.06; p<0.001). Conclusion : The quality of life of the elderly is directly affected by income, family support, and self efficacy. The quality of life is indirectly affected by education, employment status, social capital, and residential status. K eywords : quality of life, influencing factor, elderly, path analysis Correspondence :Â Kadarwati. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta, Central Java. Email: kadarwati297@gmail.com. Mobile: +6285728953956. Journal of Epidemiology and Public Health (2017), 2(1):Â 58-69 https://doi.org/10.26911/jepublichealth.2017.02.01.06 Â