Altered Motor-Striatal Plasticity and Cortical Functioning in Patients with Schizophrenia

Patients with schizophrenia undergo changes in brain plasticity. In the present study, we characterized motor cortical-striatal plasticity in such patients. Compared with the potentiation following high-frequency repetitive transcranial magnetic stimulation in the control group, the patients demonstrated impaired plasticity of corticostriatal motor-evoked potentials recorded from hand muscles.Notably, the loss of cortical plasticity was correlated with impaired motor learning in a rotary pursuit task. Moreover,the loss of plasticity was correlated with the symptoms of schizophrenia. The results suggest that the progression of schizophrenia is accompanied by altered cortical plasticity and functioning.     

Predictors of Participation in Community Outpatient Psychosocial Rehabilitation in Schizophrenia

This study investigated demographic, clinical and neurocognitive factors predicting drop-out from an intensive, community outpatient psychosocial rehabilitation program for people with schizophrenia or schizoaffective disorder. One-hundred and twenty-seven outpatients with DSM-IV schizophrenia or schizoaffective disorder participated. Demographic variables of age, sex, education and race/ethnicity were recorded and formal symptom measures and a neurocognitive assessment consisting of measures of crystallized verbal ability, sustained visual vigilance, verbal learning, verbal fluency and problem-solving were administered at study entry. Thirty-seven percent of the sample dropped-out of the program. In a final multivariate model, younger age, and lower verbal fluency scores in clients with a history of a high number of hospitalizations predicted a greater likelihood of drop-out. The implications of these findings are discussed.     

Emotional Processing in Individuals with Substance Use Disorder and Posttraumatic Stress Disorder

Previous research has shown that individuals with substance use disorder (SUD) and posttraumatic stress disorder (PTSD) have emotional processing difficulties. However, no studies have specifically investigated the role of emotional processing in those with co-morbid SUD-PTSD. This study investigated whether there are more emotional processing abnormalities among patients with SUD-PTSD, than those with either a single diagnosis of PTSD or SUD. Emotional processing was assessed in three groups [1) SUD (without PTSD); 2) PTSD (without SUD); and 3) co-morbid SUD-PTSD] using the Emotional Processing Scale (EPS-25) and the International Affective Picture System (IAPS). Each of the three groups reported evidence of emotional processing dysfunction relative to the normal population. Within the SUD-PTSD group there was significant evidence that the additional impact of trauma increased emotional processing dysfunction but less evidence to suggest that substance use increased emotional processing dysfunction further. These findings call into question current United Kingdom guidelines for the treatment of co-morbid SUD-PTSD, which recommend that the drug or alcohol problem should be treated first.     

Symptom Severity and Personal Functioning Among Patients with Schizophrenia Discharged from Long-Term Hospital Care into the Community

Twenty recently deinstitutionalized residents of a 24-hour staffed community residential unit were assessed using measures of symptoms and functioning on two occasions one year apart. Overall inter-clinician agreements in ratings were good, but clinicians agreed more in their ratings of positive than of negative symptoms of schizophrenia. Levels of symptoms (measured with the Positive and Negative Syndrome Scale) and functioning (measured with the Multnomah Community Ability Scale) were similar to those of comparable groups of patients, and were moderately related, sharing approximately 50% of variance. For the whole group, mean measures of symptoms and functioning were generally unchanged at one year, with retest measures of symptoms more stable than measures of functioning.     

Substance Use Disorders in Schizophrenia��Clinical Implications of Comorbidity

Nearly half of the people suffering from schizophrenia also present with a lifetime history of substance use disorders (SUD), a rate that is much higher than the one seen among unaffected individuals. This phenomenon suggests that the factors influencing SUD risk in schizophrenia may be more numerous and/or complex than those modulating SUD risk in the general population. It is critically important to address this comorbidity because SUD in schizophrenic patients is associated with poorer clinical outcomes and contributes significantly to their morbidity and mortality.     

Parenting Styles and Psychiatric Profile of Parents of Adult Substance Use Disorder Patients: Cross-sectional Study

The purpose of this Lebanese, cross-sectional, multi-centric study is to examine the prevalence of psychiatric disorders among adult patients with substance use disorder and their parents along with the predominant parenting style. A total of 100 patients suffering from a substance use disorder, and their parents (N = 127) were administered the translated Arabic version of the MINI to diagnose lifetime psychiatric disorders. The Parental Authority Questionnaire (PAQ) in its translated validated Arabic version was filled by patients to detect the predominant parenting style. The least common parenting style reported was authoritative (25%). The parents’ prevalence of nicotine dependence, alcohol abuse and dependence, and illicit substance abuse and dependence were considerably higher than the general population. Mood and anxiety disorders were more prevalent among patients and their parents compared to the Lebanese general population. In the bivariate analysis, no significant association was found between the perceived parenting style (authoritative and non-authoritative) and parents’ economic (p = 0.545) and civil status (p = 0.231), patient’s gender (p = 0.390), birth order (p = 0.084), and parents’ and offspring psychiatric disorder. Hence, an underlying genetic and environmental mechanism could potentially explain our findings rather than a rearing problem; however, further studies with larger sample size are needed to confirm this hypothesis.

     

Using the Autism-Spectrum Quotient to Discriminate Autism Spectrum Disorder from ADHD in Adult Patients With and Without Comorbid Substance Use Disorder

It is unknown whether the Autism-spectrum quotient (AQ) can discriminate between Autism Spectrum Disorder (ASD) and Attention Deficit and Hyperactivity Disorder (ADHD) with or without comorbid Substance Use Disorder (SUD). ANOVA’s were used to analyse the mean AQ (sub)scores of 129 adults with ASD or ADHD. We applied receiver operating characteristic (ROC) computations to assess discriminant power. All but one of the mean AQ (sub)scores were significantly higher for adults with ASD compared to those with ADHD. The SUD status in general was not significantly associated with AQ (sub)scores. On the Social Skills subscale patients with ASD and comorbid SUD showed less impairment than those without SUD. The cut-off score 26 yielded 73% correct classifications. The clinical use of the AQ in differentiating between ASD and ADHD is limited.

Decisional Balance Regarding Substance Use Among Persons with Schizophrenia

State-of-the-science treatment of substanceabuse relies on decisional balance activities (weighingpros and cons of continued substance use) to enhancemotivation for change. Few data are available regarding the feasibility of these activities amongpersons dually diagnosed with schizophrenia andsubstance use disorder. To address this lacuna in theliterature, we completed focus groups with 21participants, all of whom had a schizophrenia-spectrumdiagnosis and lifetime substance abuse or dependence.These key informants discussed the pros and cons ofsubstance use as well as the pros and cons of quitting in response to a structured group interview.Our qualitative data indicate that persons living withschizophrenia can generate rich and diverse decisionalbalance information. We describe salient themes, contrast complementary perspectives (i.e., thepros of using and cons of quitting), and suggesttreatment implications based on thesefindings.     

Assessment of Psychosocial Functioning in a Large Cohort of Patients with Schizophrenia

Background

This study addresses the question of whether psychosocial functioning measured by the Personal and Social Performance (PSP) Scale is related to various psychopathological measures in a cohort of patients with schizophrenia.

Methods

The ‘Neuroleptic Strategy Study’ (NeSSy) performed at 14 German hospitals between 2010 and 2013 compared two treatment strategies instead of individual drugs. Secondary end-points were the two PSP scales as well as measures of quality of life (SF-36) and the Positive and Negative Syndrome Scale (PANSS).

Results

149 patients were randomised. There was no difference between the two treatment strategies (first-generation versus second-generation antipsychotics) with regard to the PSP. There were differences in doctors’ assessments regarding psychosocial functioning compared with patients’ own assessments. Furthermore, there were relationships between the PSP and quality of life, level of skills (ICF), and severity of disease (PANSS), level of sexual activities and poor well-being under antipsychotic medication but not with cognitive changes.

Conclusions

The findings on psychosocial functioning of patients with schizophrenia related to severity and skill level could be confirmed. Further findings were the correlation between psychosocial functioning and quality of life, well-being under treatment, and sexuality what emphasizes the substantial importance of a reduced psychosocial functioning.

     

Associations of Clozapine Use With Psychosocial Functioning and Quality of Life in Patients With Schizophrenia: A Community-Based Cross-Sectional Study

ObjectiveMore attempts have been made recently to improve psychosocial functioning and quality of life in patients with schizophrenia, due to their crucial role in long-term outcomes. Previous studies on the effects of clozapine on psychosocial functioning have been limited in terms of generalizability and application to clinical practice. This study examined the relationship of clozapine use with psychosocial functioning and quality of life in patients with schizophrenia in a real-world setting. MethodsData were obtained from a survey targeting community-dwelling patients with schizophrenia. The Behavior and Symptom Identification Scale (BASIS) and Satisfaction with Life Scale (SWLS) were administered to evaluate psychosocial functioning and quality of life, and patients were classified into Clozapine and Non-clozapine groups. Group differences were assessed using ANCOVA, with additional sensitivity analyses for participants on atypical antipsychotic medications only. ResultsOf 292 patients, the Clozapine group (n=34) had significantly better psychosocial functioning and quality of life than the Nonclozapine group (n=258), as demonstrated by their low BASIS score (F=4.651, df=1, 290, p=0.032) and high SWLS score (F=14.637, df=1, 290, p<0.001). Similar findings for psychosocial outcomes were observed in the analyses of the atypical antipsychotic subgroup (n=195). ConclusionFor optimal recovery in schizophrenia, restoration of impaired social functioning and enhanced satisfaction with life are essential. In this study, clozapine use was related to high levels of psychosocial functioning and quality of life in real-world settings. Further research on the causal relationship between clozapine use and psychosocial functioning is needed.     

Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders

There is a significant need for advanced understanding of treatment of co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Approximately half of individuals seeking SUD treatment meet criteria for current PTSD, and individuals with co-occurring PTSD-SUD tend to have poorer treatment outcomes compared with those without such comorbidity. However, there is not sufficient empirical evidence to determine a best course of treatment for these individuals. This paper provides a review of the literature relevant to the treatment of co-occurring PTSD-SUD. To date, treatment studies have focused primarily on non-exposure-based psychosocial treatments, exposure-based psychosocial treatments, and medication trials. The most promising outcome data thus far are for psychosocial treatments that incorporate an exposure therapy component; however, further research is needed, particularly as related to how best to implement these approaches in real-world treatment settings.     

Bulimia Nervosa and Substance Use Disorder: Similarities and Differences

The purpose of this study was to compare bulimia nervosa (BN) and substance use disorders (SUD) in cognitive-motivational terms. The cognitive orientation theory was used as a framework for testing the hypothesis that the commonality between BN and SUD consists of a similar motivational disposition for eating disorders, rather than for addiction, as was previously claimed. It was expected that BN and SUD patients would differ from controls but not from each other. The participants were 31 BN, 20 SUD, and 20 healthy controls. They were administered questionnaires for assessing anxiety, depression, addiction and the cognitive orientation for eating disorders. On most parameters BN and SUD scored higher than controls but did not differ from each other except in norm beliefs. Treatment of BN should consider the similarity of BN to SUD in the pathological tendency for eating disorders.     

Trauma and Posttraumatic Stress Disorder (PTSD) in Patients with Schizophrenia or Schizoaffective Disorder

Trauma and posttraumatic stress disorder (PTSD) have high prevalence among individuals with severe mental illness, such as schizophrenia or schizoaffective disorder. This study examined whether trauma and PTSD are under-detected in this population, and whether the cognitive theory of PTSD is applicable to these individuals. Traumatic experiences, PTSD symptoms and negative posttraumatic cognitions were directly measured with questionnaires, and compared to information obtained via chart-review. Results showed clear evidence of under-report of trauma and under-diagnosis of PTSD in patients’ charts. Furthermore, negative posttraumatic cognitions were positively related to PTSD symptom severity, supporting the cognitive model of PTSD. These findings underscore the importance of assessing trauma history as well as PTSD in the routine evaluation of patients with schizophrenia or schizoaffective disorder in outpatient clinical settings. Furthermore, the finding of negative posttraumatic cognitions suggests that the cognitive model of PTSD may be applicable to patients with schizophrenia or schizoaffective disorder.     

Psychoactive Substance Use and Problematic Internet Use as Predictors of Bullying and Cyberbullying Victimization

Research exploring the relationship between addictions and experiences of bullying suggests that problem behaviors may generally be associated with an increased risk of victimization. The aim of the present study was to examine the role of psychoactive substance use, excessive Internet use, and social support in both traditional offline bullying and online “cyberbullying” victimization in a nationally representative sample of adolescents (N = 6237; 51% male; M _age = 16.62 years, SD = 0.95). Results demonstrated that traditional bullying victimization was associated with cyberbullying victimization. Furthermore, psychoactive substance use and problematic Internet use predicted both traditional bullying and cyberbullying victimization. Finally, perceived social support was found to be an important protective factor against both traditional and cyberbullying victimization. However, psychoactive substance use and problematic Internet use accounted for only a small proportion of variance in victimization.     

Eating Disorder Behaviours and Substance Use in Women Attending Treatment for Substance Use Disorders: a Latent Class Analysis

International Journal of Mental Health and Addiction - Women with substance use disorders have a greater prevalence of eating disorders which can interfere with long-term recovery. In a sample of...