Background: The present study evaluated two psychometric instruments derived from the objective measurement of adult ADHD using the Quantified Behavior Test Plus. The instruments were examined in ADHD versus a clinical group with overlapping symptoms including borderline personality disorder and bipolar II disorder, and another clinical group with participants assessed for but disconfirmed a diagnosis of ADHD as well as adult normative participants.
Methods: The Quantified Behavior Test Plus includes Continuous Performance Testing and a Motion Tracking System with parameters related to attention and activity operationalized as the cardinal symptoms of ADHD and then summarized into a Weighed Core Symptoms scale with ten cut-points ranging from 0 to 100. A categorical predictor variable called Prediction of ADHD was used to examine the levels of sensitivity and specificity for the Quantified Behavior Test Plus with regard to ADHD.
Results: The Weighed Core Symptoms scale separated ADHD and normative participants from each other as well as from the two clinical reference groups. The scale reported highest levels of core symptoms in the ADHD group and the lowest level of core symptoms in the normative group. Analyses with Prediction of ADHD yielded 85 % specificity for the normative group, 87 % sensitivity for the ADHD group, 36 % sensitivity for the bipolar II and borderline group and 41 % sensitivity for the group with a disconfirmed diagnosis of ADHD.
Conclusions: The Weighed Core Symptoms scale facilitated objective assessment of adult ADHD insofar that the ADHD group presented more core symptoms than the other two clinical groups and the normative group. Sensitivity for the Quantified Behavior Test Plus was lower in complex clinical groups with Bipolar II disorder, Borderline disorder and in patients with a disconfirmed diagnosis of ADHD. The psychometric instruments may be further evaluated with regard to well-documented and effective treatment programs for ADHD core symptoms.
Neurocognitive variability exists within the schizophrenia spectrum disorder (SSD) population, with subgroups performing at the same level as healthy samples Here we study the relationship between different levels of neurocognitive responding and real-world functioning. The participants were 291 SSD patients and 302 healthy controls that were assessed with a comprehensive neurocognitive battery. In addition, the patients were assessed with the Specific Level of Functioning Scale (SLOF). The results showed that the mean neurocognitive test responses of the SSD group were significantly below that of the control group. However, there was considerable overlap between the cognitive scores of the two groups, with as many as 24% of the patients performing above the mean healthy score for some domains. Moreover, the patients with the highest level of neurocognitive functioning reached the highest levels of practical and work-related functioning outcome skills. There was no significant relationship between neurocognitive and social function skills. The large differences in cognitive performance and their associations with functional outcome within the patient group are rarely addressed in clinical practice, but indicate a clear need for individualized treatment of SSD. Early identification of cognitive risk factors for poor real-life functional outcome is necessary in order to alert the clinical and rehabilitation services about patients in need of extra care.
Cognitive impairment is an established feature of schizophrenia. From a cross-sectional perspective, studies have revealed associations between cognition and remission. Few studies have examined this relationship longitudinally. Here we examine which cognitive domains might be related to long-term remission and symptomatic severity. The present study followed 173 outpatients with schizophrenia for five years, divided into groups based on long-term remission status and symptomatic severity, assessed with the Positive and Negative Syndrome Scale. Cognitive functioning was assessed at baseline, with tests of vigilance, executive functions, processing speed, memory and learning, working memory, and premorbid functioning. Cognitive domains related to long-term remission status were executive functions, working memory, and premorbid functioning. The most prominent cognitive differences were found between the group in stable remission with minimal symptoms, and the non-remission group, the first group demonstrating better cognitive functioning. The study highlights the role of premorbid functioning as a cognitive feature in the prediction of long-term remission. It also indicates the possibility of viewing specific cognitive domains as markers for clinical outcome, highlighting the value of early assessment of cognition. In summary, a certain cognitive profile, in coexistence with long-term non-remission, suggests poorer outcome. Hence, this group is in need of increased support.
Achieving symptomatic remission, as defined by the Remission in Schizophrenia Working Group, is intended tobe a meaningful outcome for individuals with schizophrenia, resulting in enhanced well-being. Cross-sectionalstudies have reported an association between symptomatic remission and subjective quality of life (QoL). Longitudinal studies aimed at examining this association have showed mixed results. The aim of this study was toexplore the relationship between symptomatic remission and subjective QoL, both cross-sectionally andlongitudinally. The study comprised data from what were at most 386 patients with schizophrenia, of whom 122–140 werefollowed over a period of four years. Based on cross-sectional remission status and longitudinal remissionpattern, differences in subjective QoL were explored. Remission status was assessed using the Positive andNegative Syndrome Scale (PANSS), and subjective QoL using the Short Form-36 Health Survey (SF-36). Both the cross-sectional and the longitudinal approach showed that patients in symptomatic remission hadsignificantly higher subjective QoL. Patients who were in non-remission at baseline, but who achieved remissionat follow-up, also had significantly higher subjective QoL at follow-up compared with baseline. The results from the study show a clear association between symptomatic remission and subjective QoL. However, achieving symptomatic remission does not appear to be a guarantee of sustained subjective QoL, andonly continued stable remission appears to result in such an outcome.
A decade has passed since the standardized remission criteria of schizophrenia spectrum disorders-the Andreasen Criteria-were defined. Over 2000 studies have been published, but only a few describe symptomatic remission over time. In this prospective study we followed patients for 3 and 5 years, respectively. The aim was to investigate how different symptoms affect the occurrence of remission and how the remission cut-off level affects remission sustainability. The participants were patients diagnosed with schizophrenia spectrum disorders (DSM-IV). First, the importance of each core symptom for remission was examined using the Positive and Negative Syndrome Scale (n = 274). Second, we investigated which items affect patients to either go in and out of remission or never achieve remission (n = 154). Third, we investigated how the sustainability of remission is affected by a cut-off set to 2 (minimal) and 3 (mild) points, respectively (n = 154). All core symptoms affected the occurence of remission, to a higher or lesser extent. Delusions and Hallucinatory behavior contributed the strongest to fluctuation between remission and non-remission, while the contribution of Mannerism and posturing was very marginal. Negative symptoms were enhanced when remission was never achieved. Moreover, the study found that remission duration was significantly longer for the cut-off score 2 rather than 3. The study shows that, over time, remission criteria discriminate between being stable, unstable, or never in remission. Patients with only a minimal occurrence of symptom intensity exhibit a significantly longer remission duration compared to patients with mild symptom intensity, indicating that the treatment goal should be minimal symptom intensity.
Dysfunctional affectivity is common in schizophrenia spectrum disorders (SSD), and may influence quality of life, illness progression and treatment effects. This study describes Positive (PA) and Negative (NA) affect and their relationship to demographic and clinical variables in 135 individuals with SSD. Affect dimensions were assessed by the Positive and Negative Affect Schedule (PANAS). Stepwise regression analyses with affects as dependent variables and demographic and clinical factors as independent variables were performed. Relative to healthy norms, the participants exhibited lower PA and a similar NA level. The PA score was not influenced by demographic or clinical variables. The NA score was predicted by a combination of male gender, single status, and items of general psychopathology from the Positive and Negative Syndrome Scale (PANSS). There was no relation between affects and classical schizophrenia symptoms. In conclusion, the SSD patients exhibited abnormally low PA. The affect level was not influenced by psychosis symptom severity, indicating that the PANAS is a relatively unbiased rating tool of affective responding in SSD. Finally, male gender, single status and general distress were modestly related to NA.
Purpose Neurocognitive outcomes are frequently used as indicators of real-world functioning in schizophrenia spectrum disorders (SSD). These test results may be influenced by individual differences, such as affective dispositions. Here we investigate the relationship between positive and negative affect and neuropsychological test scores in a large, mixed-gender, population based group of participants without co-morbid substance abuse. Materials and methods We assessed 129 male and female SSD patients with the Positive and Negative Affect Schedule (PANAS) and a comprehensive neuropsychological test battery. Results and conclusions The neuropsychological test scores were mainly predicted by age and gender, with small contributions from negative psychosis symptoms. There was a statistically significant relationship between Positive Affect and processing speed and between Negative Affect and verbal memory and executive function. However, the level of neurocognitive function variance explained by these affects was only 5%. Thus, the neurocognitive test results were not associated with trait affect in any clinically significant manner. This adds to previous findings of no relationship between affective dispositions and psychosis symptom variables in our participants. We suggest that affective traits constitute an independent dimension that may influence well-being, coping, and real-life outcome in SSD patients directly, and not through neurocognitive function.
Individuals with schizophrenia spectrum disorders (SSD) have significantly lower life-expectancy than healthy people. Previously, we have identified baseline neurocognitive function in general and verbal memory and executive function in particular as related to mortality nearly two decades later. In this study, we aim to replicate these findings with a larger and age-matched sample. The patient group consisted of 252 individuals, 44 of whom were deceased and 206 alive. Neurocognition was assessed with a comprehensive battery. Results showed that the deceased group, compared to the living group, had significantly more severe neurocognitive deficits across nearly all domains. There were no differences in sex, remission status, psychosis symptoms, or function level between the groups. Immediate verbal memory and executive function were the strongest predictors of survival status. These results were nearly identical to our previous studies, and we conclude that baseline neurocognitive function is an important predictor for mortality in SSD. Clinicians should be mindful of this relationship in patients with significant cognitive deficits.
Patients with schizophrenia have significantly greater mortality rates than the general population, with an estimated reduced lifespan of 10–20 years. We previously reported on a link between impairment in cognition and premature death in a prospective 20-year study. Patients who had died prematurely showed neurocognitive impairment in nine different cognitive tests compared to those who did not. Based on those findings, in this study the surviving patients in the cohort were divided into three different groups based on neurocognitive impairment and compared on symptom severity including remission status, RAND-36, weight and BMI at onset of illness and baseline of the study, and medical/physical symptomatology (i.e., blood pressure, symptom awareness, vertigo and orthostatic symptoms). Differences were most prominent between the cognitively unimpaired and severely cognitively impaired (SCI) groups, with remission, negative symptoms, general symptoms and PANSS total scores differing. For SF-36 (RAND) Physical functioning and Role limitations due to physical health subscales the SCI were worst. The findings indicate that greater impairments in cognitive ability during the illness are associated with several potential indicators of risk for early mortality. Together these factors may be of guidance for establishing an algorithm to detect patients at risk of premature death early in their illness.
Background: Patients with schizophrenia have about 20 years shorter lifetime expectancy compared to healthy population. Among these patients, cognitive performance is a predictor of early death while illness severity, as expressed in both symptom activity and remission status, has no relation with length of life. Vital signs, such as blood pressure and heart rate, weight including BMI, and spontaneously reported symptoms did neither indicate an increased risk for early death. This work focus on whether self-rated physical condition and activities, in contrast to vital signs and perceived symptoms, could be related to cognitive performance and length of life.Methods: From the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS) study, 310 participants were categorized into 4 groups from their cognitive performance at baseline: good cognitive function (GCF), n = 114, impaired cognitive function (ICF), n = 90, and severely impaired cognitive function (SICF), n = 45. The fourth group was patients who had passed away during the study time, n = 61. Patients’ perceived physical condition was assessed at baseline using the SF-36, which included 10 questions about everyday physical activities. The 4 groups were compared using ANOVAs and post hoc analyzes.Results: Patients who had deceased reported, on average 9.5 years before their death, a significantly (P < .001) more impaired physical condition compared to the GCF group and the ICF group (P = .028) but did not show any difference compared with the SICF group (P = .424). An item analysis showed that especially physical activities, such as walking a distance or climbing the stairs, were impaired. When only alive patients’ physical status vs cognitive performance were analyzed, the GCP were more physical fit than the ICF (P = .018) and SICF (P = .011), but there were no difference between ICF and SICF.Conclusion: In contrast to vital signs and perceived symptoms of illness, patient reported differences in physical fitness corresponded to differences in their cognitive ability. It has earlier been argued that physical performance is an underappreciated variable for improving ADLs. This study indicates that patents’ physical performance may, several years in advance, offer important information about increased risk of an early death.
People with schizophrenia often demonstrate an impaired ability to assess and report aspects of their everyday functioning, and the aim of this study is to investigate how patients' self-rating ability regarding functional performance relates to neurocognitive performance and real-world functional performance. A total of 222 outpatients with a schizophrenia spectrum disorder participated in this study. They were divided into groups based on their self-rating ability (determined using self-rating questions) and their observed functional capacity (the UCSD Performance-Based Skills Assessment-Brief, UPSA-B). The results showed that patients with impaired functional capacity perform at a similar cognitive level, regardless of their self-rating ability. When comparing patients with unimpaired function to those with impaired function, we found differences in two cognitive domains; premorbid functioning and executive functioning. The results also reveal that clinicians seem to have greater difficulty assessing patients who over-estimate their functioning. Consequently, when clinicians assessed the patients with the Specific Levels of Functioning Scale (SLOF) no significant differences were found between the group with unimpaired function and the group of overestimators. Patients who overestimate their functioning risk receiving inadequate treatment and support.
The needs of people with schizophrenia are great, and having extensive knowledge of this patient group is crucial for providing the right support. The aim of this study was to investigate, over 4 years, the importance of repeated assessments by patients with schizophrenia and by professionals. Data were collected from evidence-based assessment scales, interviews, and visual self-assessment scales. The data processing used descriptive statistics, correlation and regression analyses. The results showed that the relationships between several of the patients’ self-rating assessments were stronger at the 4-year follow-up than at baseline. In parallel, the concordance rate between patient assessments and case manager assessments increased. The conclusions drawn are that through repeated assessments the patients’ ability to assess their own situation improved over time and that case managers became better at understanding their patients’ situation. This, in turn, provides a safer basis for assessments and further treatment interventions, which may lead to more patients achieving remission, which can lead to less risk for hospitalization and too early death.