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Scholte-Stalenhoef AN, Pijnenborg GHM, Hasson-Ohayon I, Boyette LL. Personality traits in psychotic illness and their clinical correlates: A systematic review. Schizophr Res 2023; 252:348-406. [PMID: 36804473 DOI: 10.1016/j.schres.2023.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 12/18/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023]
Abstract
This systematic review focuses on personality traits according to both the Five Factor Model and Cloninger Psychobiological Model in relation to treatment related outcome variables across all stages of clinical psychotic illness. Search of Pubmed and Psychinfo databases led to final inclusion of 65 studies, which were ranked on quality and analyzed according to the associations between personality and outcome. Main findings are that higher levels of Harm Avoidance and Neuroticism are associated with higher symptom levels, tendency towards passive coping, greater self-stigma, lower quality of life, and Harm Avoidance to higher suicidality. Higher levels of Extraversion and higher levels of Self-Directedness are associated with more preference for active coping, more intrinsic motivation and higher self-esteem. Higher Novelty Seeking is related to more substance use and aggression, in men specifically. On outcome of trauma, care consumption and duration of untreated illness no consistent associations with personality traits were found. Combined evidence from both personality models however reveals a consistent pattern of personality traits related to clinical outcome in psychotic disorder, which is discussed in a dimensional manner.
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Affiliation(s)
- Anne Neeltje Scholte-Stalenhoef
- Ziekenhuis Groep Twente, Department of Psychiatry, Almelo, the Netherlands; University of Groningen, Department of Psychology, Groningen, the Netherlands.
| | | | | | - Lindy-Lou Boyette
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, the Netherlands
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2
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Luther L, Hochheiser J, Wiesepape C, Lysaker PH. Negative Schizotypy Mediates the Relationship Between Metacognition and Social Functioning in a Nonclinical Sample. J Nerv Ment Dis 2023; 211:74-78. [PMID: 36596289 DOI: 10.1097/nmd.0000000000001585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Reduced metacognitive abilities-difficulty making sense of and understanding oneself and others-have been found to be key predictors of social functioning across a range of clinical and nonclinical groups. However, the exact processes through which metacognition impacts social functioning are unclear. This study examined whether subclinical negative symptoms mediated the relationship between metacognition and social functioning in a nonclinical sample of young adults (n = 98). Results demonstrated that lower metacognitive mastery was found to be uniquely associated with greater subclinical negative symptoms, whereas higher subclinical negative symptoms were associated with reduced social functioning. Further, the effects of lower metacognition on reduced social function were mediated by subclinical negative symptoms and not positive or disorganized subclinical symptoms. Results suggest that subclinical negative symptoms may link reductions in metacognition with social functioning in nonclinical samples. Training aimed at enhancing metacognition may support normative social functioning in the general population.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, Georgia
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Wong SCY, Chang WC, Hui CLM, Chan SKW, Lee EHM, Suen YN, Chen EYH. Relationship of subjective quality of life with symptomatology, neurocognition and psychosocial functioning in first-episode psychosis: a structural equation modelling approach. Eur Arch Psychiatry Clin Neurosci 2021; 271:1561-1569. [PMID: 34304302 DOI: 10.1007/s00406-021-01309-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Subjective quality of life (SQoL) represents an important outcome of psychotic disorders. However, determinants of SQoL and their complex inter-relationships in the early course of illness remain to be clarified. Association between neurocognitive impairment and SQoL in first-episode psychosis (FEP) is understudied. This study employed structural equation modeling (SEM) to examine relationships among SQoL, depressive, positive and negative symptoms, neurocognition, and psychosocial functioning in FEP patients. Three hundred and forty-seven patients aged 25-55 years presenting with FEP to early intervention program in Hong Kong were recruited. Assessment encompassing symptom profiles, psychosocial functioning and a battery of neurocognitive tests were conducted. SF-12 mental component summary scores were computed as the primary measure of SQoL. Our correlation analyses revealed differential relationships between negative symptom subdomains and SQoL, with amotivation, but not diminished expression, being related to SQoL. Final SEM model yielded a good model fit (comparative fix index = 0.94; root mean square error of approximation = 0.05; standardized root mean square residuals = 0.07) and demonstrated that depression, positive symptoms and psychosocial functioning were directly associated with SQoL, with depression showing the strongest effect. Amotivation, neurocognition and positive symptoms had an indirect effect on SQoL via the mediation of psychosocial functioning. This study affirms depression as a critical determinant of subjective mental wellbeing, and underscores an intermediary role of psychosocial functioning in linking amotivation, neurocognitive impairment and positive symptoms to SQoL in FEP patients. Depression and functional impairment thus constitute as crucial therapeutic targets for improvement of SQoL in the early illness stage.
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Affiliation(s)
- Sandra Chi Yiu Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong. .,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Christy Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
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Lysaker PH, Hasson-Ohayon I, Wiesepape C, Huling K, Musselman A, Lysaker JT. Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition. Front Psychol 2021; 12:723952. [PMID: 34721183 PMCID: PMC8552011 DOI: 10.3389/fpsyg.2021.723952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Many with psychosis experience substantial difficulties forming and maintaining social bonds leading to persistent social alienation and a lack of a sense of membership in a larger community. While it is clear that social impairments in psychosis cannot be fully explained by symptoms or other traditional features of psychosis, the antecedents of disturbances in social function remain poorly understood. One recent model has proposed that deficits in social cognition may be a root cause of social dysfunction. In this model social relationships become untenable among persons diagnosed with psychosis when deficits in social cognition result in inaccurate ideas of what others feel, think or desire. While there is evidence to support the influence of social cognition upon social function, there are substantial limitations to this point of view. Many with psychosis have social impairments but not significant deficits in social cognition. First person and clinical accounts of the phenomenology of psychosis also do not suggest that persons with psychosis commonly experience making mistakes when trying to understand others. They report instead that intersubjectivity, or the formation of an intimate shared understanding of thoughts and emotions with others, has become extraordinarily difficult. In this paper we explore how research in metacognition in psychosis can transcend these limitations and address some of the ways in which intersubjectivity and more broadly social function is compromised in psychosis. Specifically, research will be reviewed on the relationship between social cognitive abilities and social function in psychosis, including measurement strategies and limits to its explanatory power, in particular with regard to challenges to intersubjectivity. Next, we present research on the integrated model of metacognition in psychosis and its relation to social function. We then discuss how this model might go beyond social cognitive models of social dysfunction in psychosis by describing how compromises in intersubjectivity occur as metacognitive deficits leave persons without an integrated sense of others' purposes, relative positions in the world, possibilities and personal complexities. We suggest that while social cognitive deficits may leave persons with inaccurate ideas about others, metacognitive deficits leave persons ill equipped to make broader sense of the situations in which people interact and this is what leaves them without a holistic sense of the other and what makes it difficult to know others, share experiences, and sustain relationships. The potential of developing clinical interventions focused on metacognition for promoting social recovery will finally be explored.
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Affiliation(s)
- Paul H. Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | | | - Courtney Wiesepape
- Department of Psychology, Indiana State University, Terre Haute, IN, United States
| | - Kelsey Huling
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, United States
| | - Aubrie Musselman
- Department of Psychology, Indiana State University, Terre Haute, IN, United States
| | - John T. Lysaker
- Department of Philosophy, Emory University, Atlanta, GA, United States
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5
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Khalesi Z, Brook CA, Jetha MK, McNeely HE, Goldberg JO, Schmidt LA. Revisiting Shyness and Sociability in Schizophrenia: A Psychometric Examination of Measurement Invariance and Mean Level Differences. J Pers Assess 2021; 103:833-841. [PMID: 33759657 DOI: 10.1080/00223891.2021.1895183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although there is a long and rich empirical history of demonstrating differences on psychological self-report measures between people with schizophrenia and healthy controls, the question of whether both groups respond to psychological measures in the same way has gone largely unexplored. That is, is there measurement equivalence, or invariance, across the samples? To our knowledge, there have been no published studies on measurement equivalency in personality measures across groups diagnosed with and without schizophrenia. Here we examined the question of measurement invariance on two widely used questionnaires assessing temperament, the Cheek and Buss Shyness and Sociability Scales (CBSHY and CBSOC, respectively) between 147 stable adult outpatients with schizophrenia and 147 healthy age- and sex-matched controls. Results supported measurement invariance of the CBSHY and CBSOC across our clinical and non-clinical groups. These findings suggested that stable adult outpatients with schizophrenia and age- and sex-matched controls respond to the shyness and sociability items in the same way. We found that adults with schizophrenia reported higher levels of shyness and lower levels of sociability than healthy controls, consistent with prior studies. Findings are discussed concerning their relevance more broadly to self-report assessments of personality and psychological traits in clinical populations.
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Affiliation(s)
- Zahra Khalesi
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Christina A Brook
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Michelle K Jetha
- Department of Psychology, Cape Breton University, Sydney, Nova Scotia, Canada
| | - Heather E McNeely
- Department of Psychiatry & Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | - Joel O Goldberg
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Louis A Schmidt
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
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6
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Janowski K, Steuden S. The Temperament Risk Factor, Disease Severity, and Quality of Life in Patients with Psoriasis. Ann Dermatol 2020; 32:452-459. [PMID: 33911787 PMCID: PMC7875235 DOI: 10.5021/ad.2020.32.6.452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 03/21/2014] [Accepted: 05/02/2014] [Indexed: 11/08/2022] Open
Abstract
Background Psoriasis exerts a profound negative impact on health-related quality of life (QoL). Although the severity of psoriasis is one potential variable that contributes to decreased QoL, previous studies have shown only weak or no association between measures of psoriasis severity and QoL. We hypothesized that this relationship is moderated by temperament factors. Objective We aimed to verify whether the relationship between disease severity and QoL is moderated by a constellation of temperament traits (i.e., temperament risk factors) and whether this moderation takes place via cognitive-appraisal and coping processes. Methods One hundred fifty patients with psoriasis vulgaris participated in the study. Psoriasis severity was assessed by a standardized measure, the Psoriasis Area and Severity Index (PASI), and the patients also completed a battery of psychological questionnaires assessing QoL, temperament, disease-related cognitive appraisals, and coping strategies. Results A specific constellation of temperament traits was found to moderate the strength of the association between the PASI and QoL. This constellation of temperament traits was associated with certain disease-related cognitive appraisals (i.e., threat, obstacle/loss, harm, profit, value) and emotion-focused coping strategies (i.e., self-blame, avoidance, resignation, seeking social support, and seeking information). Conclusion The constellation of temperament traits is a crucial individual variable that strongly moderates the negative impact of psoriasis severity on QoL, potentially through the activation of non-adaptive cognitive appraisals and coping strategies in susceptible individuals.
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Affiliation(s)
- Konrad Janowski
- Institute of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Stanisława Steuden
- Department of Clinical Psychology, John Paul II Catholic University of Lublin, Lublin, Poland
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7
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Mamah D, Cloninger CR, Mutiso VN, Gitonga I, Tele A, Ndetei DM. Personality Traits as Markers of Psychosis Risk in Kenya: Assessment of Temperament and Character. ACTA ACUST UNITED AC 2020; 1:sgaa051. [PMID: 33215089 PMCID: PMC7656989 DOI: 10.1093/schizbullopen/sgaa051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Specific personality traits have been proposed as a schizophrenia-related endophenotype and confirmed in siblings at risk for psychosis. The relationship of temperament and character with psychosis has not been previously investigated in Africa. The study was conducted in Kenya, and involved participants at clinical high-risk (CHR) for psychosis (n = 268) and controls (n = 251), aged 15–25 years. CHR status was estimated using the Structured Interview of Psychosis-Risk Syndromes (SIPS) and the Washington Early Psychosis Center Affectivity and Psychosis (WERCAP) Screen. Student’s t-tests were used to assess group differences on the Temperament and Character Inventory (TCI). Neurocognitive functioning, stress severity, and substance use were correlated with the TCI, correcting for psychosis severity. CHR participants were more impulsive (ie, higher novelty seeking [NS]) and asocial (ie, lower reward dependence) than controls. They were also more schizotypal (ie, high self-transcendence [ST] and lower self-directedness [SD] and cooperativeness [CO] than controls). CO was related to logical reasoning, abstraction, and verbal memory. Stress severity correlated with high HA and schizotypal character traits. Lifetime tobacco use was related to NS, and lifetime marijuana use to high NS, low SD and high ST. Temperament and character of Kenyan CHR youth is similar to that observed in schizophrenia. Psychosis risk in Kenya is associated with impulsive, asocial, and schizotypal traits. CHR adolescents and young adults with schizophrenia-specific personality traits may be most at risk for developing a psychotic disorder and to require early intervention to improve outcomes.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO
| | - C Robert Cloninger
- Department of Psychiatry, Washington University Medical School, St. Louis, MO
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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8
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Bora E, Veznedaroglu B. Temperament and character dimensions of the relatives of schizophrenia patients and controls: The relationship between schizotypal features and personality. Eur Psychiatry 2020; 22:27-31. [PMID: 17129710 DOI: 10.1016/j.eurpsy.2006.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Revised: 07/25/2006] [Accepted: 07/26/2006] [Indexed: 10/23/2022] Open
Abstract
AbstractPurposePrevious findings indicated that schizophrenia patients might have a different personality structure from the general population on several dimensions of temperament and character. Some authors proposed that HA might be a marker of underlying genetic vulnerability to schizophrenia. Studies on high-risk subjects and first degree relatives of patients is essential to test the value of a measure as a marker of genetic vulnerability to a disease. Few studies tested the biopsychosocial model of personality on unaffected relatives of schizophrenia.Subjects and methodsWe compared the Temperament and Character (TCI) profiles of 94 first degree relatives of schizophrenia and 75 controls. We also investigated the relationship between schizotypy and TCI dimensions in the study sample.ResultsThe harm avoidance scores of the relatives of schizoprenia patients with schizotypal features were significantly higher. Self transcendence scores were also significantly higher among relatives with schizotypal features. In contrast, the relatives of the patients with schizophrenia who did not have schizotypal features had higher SD and C scores than the control group.Discussion and conclusionThis finding is consistent with the previous findings which suggested harm avoidance as a vulnerability indicator of schizophrenia. Some character features like self transcendence might be also associated with schizotypal features.
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Affiliation(s)
- Emre Bora
- Medical School of Ege University, Psychiatry Department, 35100 Izmir, Turkey.
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9
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Longitudinal evidence for a relation between depressive symptoms and quality of life in schizophrenia using structural equation modeling. Schizophr Res 2019; 208:82-89. [PMID: 31047723 DOI: 10.1016/j.schres.2019.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 02/28/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022]
Abstract
Patients diagnosed with schizophrenia often report a low quality of life (QoL). The purpose of this study was to investigate whether we could replicate a cross-sectional model by Alessandrini et al. (2016, n = 271) and whether this model predicts QoL later in life. This model showed strong associations between schizophrenia spectrum symptoms and depressive symptoms on QoL, but lacked follow-up assessment. This model was adapted in the current study and the robustness was investigated by using a longitudinal design in which the association between baseline variables (including IQ, depression, schizophrenia spectrum symptoms as well as social functioning) and QoL during 3-years of follow-up was investigated. We included patients with a non-affective psychotic disorder (n = 744) from a prospective naturalistic cohort-study. In the cross-sectional model, with good measure of fit, both depression as well as social functioning was associated with QoL (direct path coefficient -0.28 and 0.41, respectively). Additionally, the severity of schizophrenia spectrum symptoms was highly associated with social functioning (direct path coefficient -0.70). Importantly, the longitudinal model showed good measures of fit, which strengthens the validity of the initial model and highlights that depression prospectively affect QoL while schizophrenia spectrum symptoms prospectively influence QoL via social functioning. The negative, longitudinal impact of a depression on QoL highlights the need to focus on treatment of this co-morbidity.
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10
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Khalesi Z, Jetha MK, Poole KL, Goldberg JO, Van Lieshout RJ, Schmidt LA. Shyness, hormones, and quality of life among adults with schizophrenia. Int J Neurosci 2018; 129:470-480. [PMID: 30514136 DOI: 10.1080/00207454.2018.1543293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although individual differences in personality are known to influence quality of life in individuals with schizophrenia, relatively few studies have attempted to identify putative links underlying this relation. METHODS Here, we examined associations among temperamental shyness, hormones (ie baseline salivary cortisol and testosterone), and quality of life (QoL) measured in 42 stable outpatient adults with schizophrenia. RESULTS We found that baseline cortisol, but not testosterone, moderated the relation between shyness and QoL (ß = 1.09, p = 0.004). Among individuals with relatively low baseline cortisol, higher shyness was associated with lower Intrapsychic Foundations QoL. Individuals with relatively higher baseline cortisol reported similar QoL scores irrespective of level of shyness. CONCLUSION These preliminary results suggest that relatively lower baseline cortisol may be helpful to understanding the relation between temperament and Intrapsychic Foundations QoL in schizophrenia. The present findings are consistent with previous studies implicating relatively lower baseline cortisol levels in nonclinical samples of people who are shy and the negative downstream effects resulting from HPA axis dysregulation, and extends these prior findings to people with schizophrenia who are also shy.
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Affiliation(s)
- Zahra Khalesi
- a Department of Psychology, Neuroscience & Behaviour , McMaster University , Hamilton , Ontario , Canada
| | - Michelle K Jetha
- b Department of Psychology , Cape Breton University , Sydney , Nova Scotia , Canada
| | - Kristie L Poole
- a Department of Psychology, Neuroscience & Behaviour , McMaster University , Hamilton , Ontario , Canada
| | - Joel O Goldberg
- c Department of Psychology , York University , Toronto , Ontario , Canada
| | - Ryan J Van Lieshout
- d Department of Psychiatry & Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Louis A Schmidt
- a Department of Psychology, Neuroscience & Behaviour , McMaster University , Hamilton , Ontario , Canada
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11
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The Relationship of Motivation and Neurocognition with Functionality in Schizophrenia: A Meta-analytic Review. Community Ment Health J 2018; 54:1019-1049. [PMID: 29605875 DOI: 10.1007/s10597-018-0266-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/21/2018] [Indexed: 01/10/2023]
Abstract
The role that neurocognition plays in functionality in schizophrenia has been widely examined, although in recent years increasing attention has been paid to the influence of motivation instead. This study provides a review of the relationship of neurocognition and motivation with functionality in schizophrenia, taking into account objective/subjective functionality assessment, demographic variables, and the different terms used when referring to motivation. A search of electronic databases identified 34 studies that met the inclusion criteria for review. Correlation coefficients between motivation and functionality and between neurocognition and functionality were extracted. For a better understanding, potential moderator variables were also extracted. Meta-analysis showed that both motivation and neurocognition assessments were strongly associated with functioning, with correlations between motivation and functional outcomes being stronger. However, more than three-quarters of the variance in outcome remained unexplained by the moderating factors examined. The paper concludes with recommendations for clinical practice and future research.
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12
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McCarthy NS, Badcock JC, Clark ML, Knowles EEM, Cadby G, Melton PE, Morgan VA, Blangero J, Moses EK, Glahn DC, Jablensky A. Assessment of Cognition and Personality as Potential Endophenotypes in the Western Australian Family Study of Schizophrenia. Schizophr Bull 2018; 44:908-921. [PMID: 29040798 PMCID: PMC6007328 DOI: 10.1093/schbul/sbx141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Phenotypic heterogeneity is a major barrier to understanding the genetic architecture underlying schizophrenia. Incorporating endophenotypes is one way to reduce heterogeneity and facilitate more powerful genetic analysis. Candidate endophenotypes require systematic assessment against endophenotype criteria, and a ranking of their potential utility for genetic analysis. In this study we assess 20 cognitive and personality measures in a sample of 127 families with at least 2 cases of schizophrenia per family (n = 535) plus a set of 30 control families (n = 121) against 4 endophenotype criteria: (a) be associated with the illness but not be a part of its diagnosis, (b) be heritable, (c) co-segregate with the illness in families, and (d) be found in unaffected relatives at a higher rate than in the general population. The endophenotype ranking score (endophenotype ranking variable [ERV]) was used to rank candidate endophenotypes based on their heritability and genetic correlation with schizophrenia. Finally, we used factor analysis to explore latent factors underlying the cognitive and personality measures. Evidence for personality measures as endophenotypes was at least equivalent to that of the cognitive measures. Factor analysis indicated that personality and cognitive traits contribute to independent latent dimensions. The results suggest for this first time that a number of cognitive and personality measures are independent and informative endophenotypes. Use of these endophenotypes in genetic studies will likely improve power and facilitate novel aetiological insights.
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Affiliation(s)
- Nina S McCarthy
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
- Cooperative Research Centre for Mental Health, Carlton South, Australia
| | - Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
- Cooperative Research Centre for Mental Health, Carlton South, Australia
| | - Melanie L Clark
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Emma E M Knowles
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Phillip E Melton
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Vera A Morgan
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
- Neuropsychiatric Epidemiology Research Unit, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - John Blangero
- South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX
| | - Eric K Moses
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
| | - David C Glahn
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
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13
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The associations between quality of life and clinical symptoms in individuals with an at-risk mental state and first-episode psychosis. Psychiatry Res 2017; 254:54-59. [PMID: 28448805 DOI: 10.1016/j.psychres.2017.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 11/22/2022]
Abstract
Quality of life (QOL) is strongly associated with severity of clinical symptoms and is often compromised in patients with chronic or first-episode psychosis (FEP). However, it remains unclear whether baseline QOL in individuals with an at-risk mental state (ARMS) for psychosis is higher or lower than that in patients with FEP, or what specific clinical symptoms relate to a decreased QOL in individuals with ARMS and FEP. The World Health Organization's WHOQOL-BREF, an instrument assessing QOL, was administered to 104 individuals with ARMS and 53 with FEP. Clinical symptoms were assessed by the Positive and Negative Syndrome Scale and the Beck Depression Inventory-II. We compared the four domain scores of the WHOQOL-BREF between the two groups, and calculated Pearson correlations between each WHOQOL-BREF domain score and the clinical symptoms and compared these correlations between the groups. We observed significant correlations between poor QOL and severity of depressive symptoms in both the FEP and ARMS group. No between-group differences were found in any correlation coefficients between WHOQOL-BREF domains and clinical symptoms. Thus, depressive symptoms should be investigated as a key factor relating to poor QOL in both individuals with ARMS and those with FEP.
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Vrbova K, Prasko J, Ociskova M, Holubova M. Comorbidity of schizophrenia and social phobia - impact on quality of life, hope, and personality traits: a cross sectional study. Neuropsychiatr Dis Treat 2017; 13:2073-2083. [PMID: 28831256 PMCID: PMC5548278 DOI: 10.2147/ndt.s141749] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of the study was to explore whether the comorbidity of social phobia affects symptoms severity, positive and negative symptoms, self-stigma, hope, and quality of life in patients with schizophrenia spectrum disorders. METHODS This is a cross-sectional study in which all participants completed the Internalized Stigma of Mental Illness (ISMI) scale, Adult Dispositional Hope Scale (ADHS), Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Positive and Negative Syndrome Scale (PANSS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Temperament and Character Inventory - Revised (TCI-R), and the demographic questionnaire. The disorder severity was assessed both by a psychiatrist (Clinical Global Impression Severity - the objective version [objCGI-S] scale) and by the patients (Clinical Global Impression Severity - the subjective version [subjCGI-S] scale). The patients were in a stabilized state that did not require changes in the treatment. Diagnosis of schizophrenia, schizoaffective disorder, or delusional disorder was determined according to the International Classification of Diseases 10th Revision (ICD-10) research criteria. A structured interview by Mini International Neuropsychiatric Interview was used to confirm the diagnosis. RESULTS The study included 61 patients of both genders. Clinically, the patients with comorbid social phobia had the earlier onset of the illness, more severe current psychopathology, more intense anxiety (general and social), and higher severity of depressive symptoms. The patients with comorbid social phobia showed the significantly lower quality of life compared to the patients without this comorbidity. The patients with comorbid social phobia also had a statistically lower mean level of hope and experienced a higher rate of the self-stigma. They also exhibited higher average scores of personality trait harm avoidance (HA) and a lower score of personality trait self-directedness (SD). CONCLUSION The study demonstrated differences in demographic factors, the severity of the disorder, self-stigma, hope, HA, and SD between patients with schizophrenia spectrum disorders with and without comorbid social phobia.
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Affiliation(s)
- Kristyna Vrbova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic
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Wartelsteiner F, Mizuno Y, Frajo-Apor B, Kemmler G, Pardeller S, Sondermann C, Welte A, Fleischhacker WW, Uchida H, Hofer A. Quality of life in stabilized patients with schizophrenia is mainly associated with resilience and self-esteem. Acta Psychiatr Scand 2016; 134:360-7. [PMID: 27497263 DOI: 10.1111/acps.12628] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Improving quality of life (QoL) is an important objective in the treatment of schizophrenia. The aim of the current study was to examine to what extent resilience, self-esteem, hopelessness, and psychopathology are correlated with QoL. METHOD We recruited 52 out-patients diagnosed with schizophrenia according to DSM-IV criteria and 77 healthy control subjects from the general community. In patients, psychopathology was quantified by the Positive and Negative Syndrome Scale. The following scales were used in both patients and control subjects: the Berliner Lebensqualitätsprofil, the Resilience Scale, the Rosenberg Self-Esteem Scale, and the Beck Hopelessness Scale to assess QoL, resilience, self-esteem, and hopelessness respectively. RESULTS Patients with schizophrenia presented with significantly less QoL, resilience, self-esteem, and hope compared to healthy control subjects. In patients, QoL correlated moderately with resilience, self-esteem, and hopelessness and weakly with symptoms. With respect to the latter, particularly depression and positive symptoms were negatively correlated with QoL. CONCLUSION Our results highlight the complex nature of QoL in patients suffering from schizophrenia. They underscore that significant efforts are necessary to enhance resilience and self-esteem and to diminish hopelessness as well as affective and positive symptoms in patients with schizophrenia.
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Affiliation(s)
- F Wartelsteiner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Y Mizuno
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - B Frajo-Apor
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - G Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - S Pardeller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - C Sondermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - A Welte
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - W W Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - H Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - A Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria.
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Galderisi S, Rossi A, Rocca P, Bertolino A, Mucci A, Bucci P, Rucci P, Gibertoni D, Aguglia E, Amore M, Blasi G, Comparelli A, Di Giannantonio M, Goracci A, Marchesi C, Monteleone P, Montemagni C, Pinna F, Roncone R, Siracusano A, Stratta P, Torti MC, Vita A, Zeppegno P, Chieffi M, Maj M. Pathways to functional outcome in subjects with schizophrenia living in the community and their unaffected first-degree relatives. Schizophr Res 2016; 175:154-160. [PMID: 27209527 DOI: 10.1016/j.schres.2016.04.043] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022]
Abstract
RATIONALE Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives. METHODS The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both patients and SRs. RESULTS Interpersonal Relationships and Work Skills were the only functional domains impaired in both patients and SRs. For both domains, functional impairment in patients was found to predict impairment in unaffected relatives, suggesting the involvement of similar illness-related vulnerability factors. In both groups variables significantly associated with Interpersonal Relationships included Social Cognition, Neurocognition, Avolition, Resilience, Disorganization, Perceived Stigma and Gender, and those significantly associated with Work Skills included Social Cognition, Neurocognition and Disorganization. CONCLUSIONS Pathways to functional outcome for Interpersonal relationships and Work skills are similar between schizophrenia patients and their unaffected first-degree relatives. These findings validate, in the absence of confounders of clinical cohorts, structural models of determinants of functional outcome in people with schizophrenia.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Giuseppe Blasi
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Anna Comparelli
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience and Imaging, Chair of Psychiatry, G. d'Annunzio University, Chieti, Italy
| | - Arianna Goracci
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - Palmiero Monteleone
- Department of Medicine and Surgery, Chair of Psychiatry, University of Salerno, Salerno, Italy
| | - Cristiana Montemagni
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Rita Roncone
- Department of Life, Health and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Chair of Psychiatry, Tor Vergata University of Rome, Rome, Italy
| | - Paolo Stratta
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Maria Chiara Torti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, and Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
| | - Marcello Chieffi
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
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Galindo L, Pastoriza F, Bergé D, Mané A, Picado M, Bulbena A, Robledo P, Pérez V, Vilarroya O, Cloninger CR. Association between neurological soft signs, temperament and character in patients with schizophrenia and non-psychotic relatives. PeerJ 2016; 4:e1651. [PMID: 27168955 PMCID: PMC4860298 DOI: 10.7717/peerj.1651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/12/2016] [Indexed: 11/26/2022] Open
Abstract
The heritability of schizophrenia and most personality traits has been well established, but the role of personality in susceptibility to schizophrenia remains uncertain. The aim of this study was to test for an association between personality traits and Neurological Soft Signs (NSS), a well-known biological marker of schizophrenia, in non-psychotic relatives of patients with schizophrenia. For this purpose, we evaluated the NSS scale and personality measured by the Temperament and Character inventory (TCI-R) in three groups of subjects: 29 patients with schizophrenia, 24 unaffected relatives and 37 controls. The results showed that patients with schizophrenia were more asocial (higher harm avoidance and lower reward dependence), more perseverative (higher persistence), and more schizotypal (lower self-directedness and cooperativeness, higher self-transcendence). The unaffected relatives showed higher harm avoidance, lower self-directedness and cooperativeness than the healthy controls. Higher NSS scores and sub-scores were found in patients and non-psychotic relatives compared with the controls. Among all the patients, total NSS scores were positively correlated with harm avoidance but negatively correlated with novelty seeking and persistence. Total NSS were also correlated with low scores on self-directedness and cooperativeness, which are indicators of personality disorder. Our results show that susceptibility to NSS and to schizophrenia are both related to individual differences in the temperament and character features in non-psychotic relatives of patients with schizophrenia. High harm avoidance, low persistence, low self-directedness and low cooperativeness contribute to both the risk of NSS and schizophrenia. These findings highlight the value of using both assessments to study high risk populations.
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Affiliation(s)
- Liliana Galindo
- Neuropsychiatry and Addiction Institute, Parc de Salut Mar, Barcelona, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain; Red de Trastornos Adictivos, RETIC, Spain
| | - Francisco Pastoriza
- Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Daniel Bergé
- Neuropsychiatry and Addiction Institute, Parc de Salut Mar, Barcelona, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain; Neuropharmacology, Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Mané
- Neuropsychiatry and Addiction Institute, Parc de Salut Mar, Barcelona, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain
| | - Marisol Picado
- Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM) , Barcelona , Spain
| | - Antonio Bulbena
- Neuropsychiatry and Addiction Institute, Parc de Salut Mar, Barcelona, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain
| | - Patricia Robledo
- Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Neuropharmacology, Universitat Pompeu Fabra, Barcelona, Spain
| | - Victor Pérez
- Neuropsychiatry and Addiction Institute, Parc de Salut Mar, Barcelona, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain
| | - Oscar Vilarroya
- Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Claude Robert Cloninger
- Department of Psychiatry and Genetics, Washington University in St. Louis , Saint Louis, MO , United States
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Fernández-Mondragón S, Adan A. Personality in male patients with substance use disorder and/or severe mental illness. Psychiatry Res 2015; 228:488-94. [PMID: 26144586 DOI: 10.1016/j.psychres.2015.05.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/23/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
Dual diagnosis (DD) is the coexistence of a substance use disorder (SUD) and severe mental illness (SMI). The aim of this study is to determine for the first time if a specific personality pattern exists for DD patients compared to those who only have SUD or SMI. The sample was composed of 102 male, 34 patients in each group (DD, SUD and SMI). DD and SMI groups included 20 schizophrenic and 14 depressed patients respectively. Cloninger's TCI-R was administered together with a structured interview of sociodemographic and clinical characteristics. All the temperament dimensions and Self-directedness provided differences among groups. The DD and SUD showed significant higher scores in Novelty Seeking regarding SMI, whereas for Harm Avoidance the SUD subjects scored lower with respect to the DD and SMI group. Persistence was significant lower for the DD and SMI groups compared to the SUD patients. The DD obtained low significant scores in Reward Dependence in relation to the SUD and Self-directedness in relation to the SUD and SMI. Our data highlight the presence of a different personality profiles among DD, SUD and SMI disorders. Taking into account the patients' personality can benefit the clinical course and minimize the DD impact.
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Affiliation(s)
- Susana Fernández-Mondragón
- Department of Psychiatry and Clinical Psychobiology, School of Psychology, University of Barcelona, Barcelona, Spain
| | - Ana Adan
- Department of Psychiatry and Clinical Psychobiology, School of Psychology, University of Barcelona, Barcelona, Spain; Institute for Brain, Cognition and Behavior (IR3C), Barcelona, Spain.
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Peritogiannis V. Sensation/novelty seeking in psychotic disorders: A review of the literature. World J Psychiatry 2015; 5:79-87. [PMID: 25815257 PMCID: PMC4369552 DOI: 10.5498/wjp.v5.i1.79] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/31/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
The evaluation of personality traits is important for the better understanding of the person suffering from psychosis and for treatment individualization. However literature on patients’ personality and character in such disorders is limited. The aim of this review was to summarize the literature on sensation/novelty seeking (SNS), a trait which is biologically based and highly heritable and is associated with dopamine activity, and refers to a person’s tendency to seek varied, novel, complex, and intense sensations and experiences. A total of 38 studies were included in this review, involving 2808 patients and 2039 healthy controls. There is consistent evidence that this trait is independently associated with alcohol and substance abuse in patients with schizophrenia and related disorders. The estimation of SNS would help clinicians to identify patients at risk for abuse. There is also some evidence that higher SNS levels may relate to medication non-adherence and seem to increase the risk of patients’ aggressive and violent behavior, but studies are scarce. SNS was found not to be related to suicidality, whereas in the fields of patients’ quality of life and psychopathology results are contradictory, but most studies show no possible association. Several studies suggest that SNS is lower in psychotic patients compared to controls, whereas most yield no differences. The evidence for this trait as a potential endophenotype of schizophrenia is weak. SNS may be implicated in psychotic disorders’ course and prognosis in several ways and should be always inquired for. This trait can be reliably measured with the use of easily applicable self-rated instruments, and patients’ accounts could inform clinicians when planning management and delivering individualized treatment.
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Fresán A, León-Ortiz P, Robles-García R, Azcárraga M, Guizar D, Reyes-Madrigal F, Tovilla-Zárate CA, de la Fuente-Sandoval C. Personality features in ultra-high risk for psychosis: a comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R). J Psychiatr Res 2015; 61:168-73. [PMID: 25554622 DOI: 10.1016/j.jpsychires.2014.12.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/21/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023]
Abstract
Several variables have been identified as risk factors for conversion to overt psychosis in ultra-high risk for psychosis (UHR) individuals. Although almost two-thirds of them do not experience a transition to psychosis, they still exhibit functional disabilities. Other subjective developmental features may be useful for a more precise identification of individuals at UHR. Avoidant behaviors are consistently reported in schizophrenia and in UHR individuals and may be the reflection of a pattern of personality. Thus, personality features in UHR individuals deserves further research. The objective of the present study was to compare temperament and character dimensions between UHR individuals, patients with schizophrenia and healthy controls. One hundred participants (25 UHR individuals, 25 schizophrenia patients and 50 control subjects) where evaluated with the Temperament and Character Inventory-Revised (TCI-R). Univariate ANOVAs followed by Bonferroni tests were used. UHR individuals and schizophrenia patients exhibited higher levels of Harm Avoidance (HA) when compared to control subjects. For HA1 Anticipatory worry vs Uninhibited optimism and HA4 Fatigability & asthenia, UHR and schizophrenia groups showed similar scores and both groups were higher compared to control subjects. With respect to Cooperativeness (CO), UHR and schizophrenia reported lower scores than control subjects, in particular CO2 Empathy vs Social disinterest and CO3 Helpfulness vs unhelpfulness. This study replicates and extends the consideration of HA as a psychopathological related endophenotype and gives us further information of the possible role of personality features in the expression of some of the social dysfunctions observed both in prodromal subjects and schizophrenia patients.
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Affiliation(s)
- Ana Fresán
- Clinical Research Division, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - Pablo León-Ortiz
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Department of Education, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Rebeca Robles-García
- Epidemiological and Social Research Direction, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
| | - Mariana Azcárraga
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Diana Guizar
- Clinical Research Division, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - Francisco Reyes-Madrigal
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
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21
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Nitzburg GC, Malhotra AK, DeRosse P. The relationship between temperament and character and subclinical psychotic-like experiences in healthy adults. Eur Psychiatry 2014; 29:352-7. [PMID: 24439515 PMCID: PMC7852656 DOI: 10.1016/j.eurpsy.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/15/2013] [Accepted: 11/29/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Considerable data support phenomenological and temporal continuity between psychotic disorders and subclinical psychotic-like experiences (PLE's). Although numerous studies have found similar personality correlates for schizophrenia and schizotypal personality disorder patients, their unaffected first-degree relatives, and healthy adults characterized for schizotypal traits, no study has yet investigated personality correlates of PLE's measured by the Community Assessment of Psychic Experiences (CAPE). Our study sought to examine personality correlates of PLE's using the CAPE in healthy adults. METHOD The CAPE and temperament and character inventory (TCI) were administered to 415 healthy adults. Regressions examined links between TCI traits and overall PLE levels as well as positive and negative PLE's separately. RESULTS Consistent with past studies, lower self-directedness (SD) and reward dependence (RD) and higher self-transcendence (ST) and harm avoidance (HA) significantly predicted overall PLE levels. Higher ST and persistence (P) and lower SD significantly predicted higher levels of positive PLE's while lower SD and RD and higher HA, ST, and cooperativeness (C) predicted higher levels of negative PLE's. CONCLUSIONS Associations between TCI and PLE's using the CAPE are strikingly similar to past work in non-clinical and patient samples and provide additional support for phenomenological continuity between psychotic disorders and sub-syndromal psychotic symptoms.
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Affiliation(s)
- G C Nitzburg
- Division of Psychiatry Research, Division of the North Shore - Long Island Jewish Health System, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
| | - A K Malhotra
- Center for Translational Psychiatry, The Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Psychiatry Research, Division of the North Shore - Long Island Jewish Health System, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA; Hofstra North Shore - LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - P DeRosse
- Center for Translational Psychiatry, The Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Psychiatry Research, Division of the North Shore - Long Island Jewish Health System, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA
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Margetić BA, Jakovljević M, Furjan Z, Margetić B, Marsanić VB. Quality of life of key caregivers of schizophrenia patients and association with kinship. Cent Eur J Public Health 2014; 21:220-3. [PMID: 24592728 DOI: 10.21101/cejph.a3918] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Reports on the quality of life (QOL) of family caregivers of schizophrenia patients are uncommon. Relations of different degree of kinship to caregivers' QOL are unexplored, but may be relevant. The purpose of this study was to assess the subjective QOL of caregivers of stable outpatients with diagnosis of schizophrenia compared with controls, and to assess factors associated with QOL in this population. METHODS Responses of 138 schizophrenia outpatient' family caregivers to the Quality of Life, Enjoyment and Satisfaction Questionnaire (QLESQSF) were compared with those of a sex- and age-matched control group. Patients were assessed with the Positive and Negative Symptom Scale (PANSS) and the Global Assessment of Functioning (GAF) and data were collected for kinship relationship and hospitalization. RESULTS Group of caregivers had significantly lower QOL compared with controls (t=11.347; df=271; p=0.0001). Caregivers' QOL correlated significantly with their age and differed according to the degree of kinship and marriage status. ANCOVA, with age as covariate, performed to asses the differences in QOL according to kinship, showed that parents and own children had significantly lower QOL than patients' siblings who were also caregivers. CONCLUSION QOL of the schizophrenia patients' caregivers is lower in comparisons to controls. It depends on the degree of kinship and caregivers' age. Parents and own children have lower QOL than siblings. Psycho-educational intervention programmes should target specific needs of the family as a whole, depending also on their age and kinship relationship.
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Affiliation(s)
| | - Miro Jakovljević
- Department of Psychiatry, University Hospital Center, Zagreb, Croatia
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Song YY, Kang JI, Kim SJ, Lee MK, Lee E, An SK. Temperament and character in individuals at ultra-high risk for psychosis and with first-episode schizophrenia: associations with psychopathology, psychosocial functioning, and aspects of psychological health. Compr Psychiatry 2013; 54:1161-8. [PMID: 23831396 DOI: 10.1016/j.comppsych.2013.05.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/07/2013] [Accepted: 05/22/2013] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The psychobiological model of temperament and character indicates that personality traits are heritable and, during development, constantly influence one's susceptibility to schizophrenia. Our objective was to evaluate temperament and character in subjects at ultra-high risk (UHR) for psychosis and individuals with first-episode schizophrenia. METHODS UHR for psychosis subjects (n = 50), first-episode schizophrenia patients (n = 33), and normal controls (n = 120) were compared on temperament and character dimensions, and correlation analysis of each personality dimension with psychopathologies, global and social functioning, and self-esteem. General and social self-efficacy reports were conducted. UHR subjects were followed-up for 24 months and the baseline personality dimensions were compared between the converted and non-converted groups. RESULTS Both clinical groups showed abnormal personality traits in terms of temperament (higher harm avoidance, lower reward dependence and persistence) and character (lower self-directedness and cooperativeness). Psychosocial functioning and psychological health components were found to be correlated with some personality dimensions. The conversion rate of overt psychotic disorder was 25.0% at the 24-month follow-up. Baseline cooperativeness dimension was a significant predictive dimension for conversion into overt psychosis in the UHR group during the follow-up period. CONCLUSION Patients with first episode schizophrenia have a pervasively altered personality profile from normal controls. More importantly, this altered personality profile already emerged in putative prodromal, UHR individuals. The present findings indicate that certain personality traits can play a protective or vulnerable role in developing schizophrenia.
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Affiliation(s)
- Yun Young Song
- Department of Psychiatry, Yonsei University College of Medicine, Severance Mental Health Hospital, Gwangju-si, Gyeonggi-do, South Korea; Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Jetha MK, Goldberg JO, Schmidt LA. Temperament and its relation to social functioning in schizophrenia. Int J Soc Psychiatry 2013; 59:254-63. [PMID: 22271885 DOI: 10.1177/0020764011433639] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND We previously noted increased shyness in stable community outpatients with schizophrenia compared to healthy controls and that shyness may be a risk factor for social functioning impairment in this population (Goldberg & Schmidt, 2001). AIMS We attempted to replicate and extend these findings by comparing the use of a brief trait measure of shyness and sociability (SS; Cheek, 1983; Cheek & Buss, 1981) with the longer Temperament and Character Inventory (TCI; Cloninger, Przybeck, Svrakic, & Wetzel, 1994) used traditionally in work to measure personality dimensions in this population. METHODS A group of stable outpatients with schizophrenia (n = 41) and healthy controls (n = 41) matched on age and gender were compared on the SS and TCI measures. Patients were assessed on clinical symptoms using the Positive and Negative Symptom Scale (PANSS) and on social functioning measures using a Quality of Life Scale (QLS). RESULTS Patients reported significantly higher shyness, retrospective inhibition and harm avoidance, and lower novelty seeking, self-directedness and cooperativeness than healthy adults, replicating previous findings. Shyness and sociability were related to conceptually linked dimensional sub-scales of the TCI and were predictive of social functioning in the patient group. Importantly, scores on these measures were unrelated to symptom profiles and explained additional variance in social functioning beyond clinical symptoms. CONCLUSIONS These findings suggest that individual differences in trait shyness and sociability may influence social functioning in stable outpatients with schizophrenia. The results also support the use of the brief trait measures of shyness and sociability in this population.
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Affiliation(s)
- Michelle K Jetha
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada.
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Albayrak Y, Ekinci O, Cayköylü A. Temperament and character personality profile in relation to suicide attempts in patients with schizophrenia. Compr Psychiatry 2012; 53:1130-6. [PMID: 22682677 DOI: 10.1016/j.comppsych.2012.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Schizophrenia is associated with a significant risk of suicide, and suicide still remains one of the main causes of death in schizophrenic patients. Beside classic risk factors for suicidality, temperament and character traits have been researched and considered as risk factors for suicidal behavior in recent years. METHOD Subjects were 94 patients with schizophrenia who were under treatment. All patients were in a stable phase of the illness. Patients with lifetime suicide attempt (n = 46) and without suicidal attempt (n = 48) were compared with each other in terms of temperament and character traits by using the Temperament and Character Inventory. RESULTS Harm avoidance and persistence scores were higher in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. The scores of self-directedness and cooperativeness were lower in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. These 4 variables remained significant predictors of lifetime suicidal attempts in a logistic regression model. CONCLUSION To the best of our knowledge, the present study is the first that specifically compares schizophrenic patients with and without suicidal behavior by the Cloninger temperament and character model. Our data indicate that schizophrenic patients will show a greater risk for suicide according to certain personality configurations. However, to establish causal relationships between personality and suicidality in schizophrenia, longitudinal studies are warranted within a multifactorial interactive framework of biologic and clinical variables.
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Affiliation(s)
- Yakup Albayrak
- Department of Psychiatry, Kırklareli State Hospital, Kırklareli, Turkey
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Sim M, Kim JH, Yim SJ, Cho SJ, Kim SJ. Increase in harm avoidance by genetic loading of schizophrenia. Compr Psychiatry 2012; 53:372-8. [PMID: 21696715 DOI: 10.1016/j.comppsych.2011.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 05/05/2011] [Accepted: 05/09/2011] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Schizophrenia is highly familial neuropsychiatric disorder with heritability estimated at 60% to 90%. Even unaffected first-degree relatives of schizophrenia manifested some neuropsychologic abnormalities, neurologic soft sign, and morphologic anomalies. Because personality traits are under genetic influence and considerable heritability, we intended to evaluate temperament and character of first-degree relatives of schizophrenia and the influence of schizophrenia genetic loading on their temperament and character. METHODS Temperament and Character Inventory was completed by 97 first-degree relatives of schizophrenia or schizoaffective disorder, 48 schizophrenic probands (44 patients with schizophrenia and 4 patients with schizoaffective disorder), and 106 control subjects. Within first-degree relatives, parents who have additional probands with schizophrenia spectrum disorder in their ascendant or collateral pedigree and siblings who have offspring with schizophrenia spectrum disorder were defined as presumed carriers (n = 20). Group differences in Temperament and Character Inventory scores were compared using a mixed-model analysis of variance with family as a random effect and age as a covariate. RESULTS Harm avoidance (HA) scores increased in the order of control subjects, the first-degree relatives, and probands. Among the relatives, presumed carriers, but not presumed noncarriers, had higher HA compared with control subjects. In addition, probands showed significantly low reward dependence, low self-directedness, and low cooperativeness scores compared with the first-degree relatives and control subjects. Probands had also higher self-transcendence scores than the first-degree relatives and had lower persistence scores than control subjects. CONCLUSIONS Our findings that HA increases in proportion to the genetic loading of schizophrenia suggest that it may be a potential endophenotype of schizophrenia.
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Affiliation(s)
- Minyoung Sim
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
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Abbott GR, Byrne LK. Schizotypy and subjective well-being in university students. Psychiatry Res 2012; 196:154-6. [PMID: 22361445 DOI: 10.1016/j.psychres.2011.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 08/18/2011] [Accepted: 08/21/2011] [Indexed: 10/28/2022]
Abstract
One hundred and thirty-nine university students completed measures of schizotypy and subjective well-being (SWB). Inverse associations were found between schizotypy and SWB scores. These results provide evidence that diminished SWB is characteristic along the schizophrenia continuum. Further research is required to determine the mechanisms by which schizotypal individuals experience reduced life satisfaction.
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Affiliation(s)
- Gavin R Abbott
- School of Psychology, Deakin University, Burwood, Australia.
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Miettunen J, Raevuori A. A meta-analysis of temperament in axis I psychiatric disorders. Compr Psychiatry 2012; 53:152-66. [PMID: 21565334 DOI: 10.1016/j.comppsych.2011.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 03/06/2011] [Accepted: 03/12/2011] [Indexed: 12/20/2022] Open
Abstract
This article reports on a meta-analysis of Cloninger's temperament dimensions (novelty seeking, harm avoidance, reward dependence, and persistence) in individuals with lifetime psychiatric disorders compared with controls and on interdisorder comparisons between these disorders. Nine disorders from 75 studies were included in the meta-analyses. The most consistent feature was elevated harm avoidance: compared with the controls, harm avoidance was higher in all diagnostic groups studied except for those with alcohol use disorders. The increase in effect sizes in harm avoidance scores varied from a very large (d = 2.66) in social phobia to a small effect (effect size, d = 0.29) in alcohol use disorders. In other dimensions, differences between cases and controls were relatively small. However, in pairwise comparisons, notable differences also in other dimensions emerged: in novelty seeking, the lowest scores were in social phobia (d = -0.87) and the highest in bulimia nervosa (d = 0.33); in reward dependence, the lowest scores were in schizophrenia (d = -0.36) and the highest in social phobia (d = 0.12); and in persistence, the lowest scores were in social phobia (d = -0.30) and the highest in anorexia nervosa (d = 0.49). The provided data should be taken into account in the future studies on suggestive vulnerability markers for psychiatric morbidity.
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Affiliation(s)
- Jouko Miettunen
- Department of Psychiatry, University of Oulu, PO Box 5000, 90014 Oulu, Finland.
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Margetić BA, Jakovljević M, Ivanec D, Margetić B. Temperament, character, and quality of life in patients with schizophrenia and their first-degree relatives. Compr Psychiatry 2011; 52:425-30. [PMID: 21683179 DOI: 10.1016/j.comppsych.2010.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 08/23/2010] [Accepted: 08/30/2010] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to investigate the associations between the temperament, character dimensions, and quality of life (QOL) of patients with schizophrenia; their first-degree, nonaffected relatives; and healthy control subjects. One hundred twenty patients, the same number of first-degree relatives, and the same number of control subjects were assessed using the Temperament and Character Inventory and the Quality of Life Enjoyment and Satisfaction Questionnaire. Patients were also assessed using the Positive and Negative Syndrome Scale. Patients and relatives had a significantly lower QOL than control subjects, controlled for temperament and character dimensions. Patients scored significantly higher than control subjects in harm avoidance and self-transcendence and lower in novelty seeking and self-directedness. First-degree relatives had lower results for novelty seeking and scored higher on self-transcendence than control subjects. Harm avoidance, self-directedness, and self-transcendence were the dimensions of Temperament and Character Inventory shown to be the most significant predictors of QOL. Psychopathology and age were also significant predictors of QOL. Our understanding of an individual patient's QOL must include personality evaluation.
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Brenner K, St-Hilaire A, Liu A, Laplante DP, King S. Cortisol response and coping style predict quality of life in schizophrenia. Schizophr Res 2011; 128:23-9. [PMID: 21353766 DOI: 10.1016/j.schres.2011.01.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/20/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
Stress and coping have been found to be strongly associated with quality of life (QOL). Compared to community controls (CC), individuals diagnosed with schizophrenia (SZ) report a lower QOL. Lower QOL in SZ may be explained by patients' tendency to react differently to stress and to use less effective coping strategies than CC, but no studies to date have examined these possible associations. A main goal of this study, therefore, was to examine the roles of stress response and coping style in explaining QOL in SZ and CC, while controlling for potential confounds including personality. Subjects were 30 SZ patients and 29 matched controls who completed the Trier Social Stress Test (TSST). Salivary cortisol was used as an objective measure of stress response. Participants rated their coping strategies with the Brief COPE, judged their QOL with the Satisfaction with Life Scale, and rated their personality using the NEO-Five Factor Inventory. Results indicate that, even when confounds are controlled for, blunted cortisol response predicts better QOL in SZ patients. Additionally, results suggest that more frequent use of coping strategies is associated with better QOL but only in patients with blunted cortisol response; those who showed an increase in cortisol in response to the TSST have better QOL the lower their coping score. Possible explanations and clinical implications of these findings are discussed.
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Affiliation(s)
- Karene Brenner
- Université de Montréal, Département de Psychologie, 2900 Édouard-Montpetit Blvd., Montréal, QC, Canada H3T 1J4
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The effects of temperament and character on symptoms of depression in a chinese nonclinical population. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:198591. [PMID: 22028960 PMCID: PMC3199068 DOI: 10.1155/2011/198591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 07/01/2011] [Accepted: 07/31/2011] [Indexed: 11/24/2022]
Abstract
Objective. To examine the relations between personality traits and syndromes of depression in a nonclinical Chinese population. Method. We recruited 469 nonclinical participants in China. They completed the Chinese version temperament and character inventory (TCI) and self-rating depression scale (SDS). A structural equation model was used to rate the relation between seven TCI scales and the three SDS subscale scores (based on Shafer's meta-analysis of the SDS items factor analyses). This was based on the assumption that the three depression subscales would be predicted by the temperament and character subscales, whereas the character subscales would be predicted by the temperament subscales. Results. The positive symptoms scores were predicted by low self-directedness (SD), cooperativeness (C), reward dependence (RD), and persistence (P) as well as older age. The negative symptoms scores were predicted only by an older age. The somatic symptoms scores were predicted by high SD. Conclusion. Syndromes of depression are differentially associated with temperament and character patterns. It was mainly the positive symptoms scores that were predicted by the TCI scores. The effects of harm avoidance (HA) on the positive symptoms scores could be mediated by low SD and C.
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Relations of internalized stigma with temperament and character in patients with schizophrenia. Compr Psychiatry 2010; 51:603-6. [PMID: 20965307 DOI: 10.1016/j.comppsych.2010.02.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 02/10/2010] [Accepted: 02/14/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the associations between self-stigma and temperament and character dimensions. METHODS One hundred twenty outpatients with diagnosis of schizophrenia, established with Mini International Neuropsychiatric Interview were consecutively included in the study. Self-stigma was assessed with Internalized Stigma of Mental Illness (ISMI), personality dimensions with Temperament and Character Inventory, and psychopathology with Positive and Negative Symptom Scale. RESULTS The results showed that higher level of harm avoidance, lower self-directedness, and persistence correlated with ISMI and all its subscales. Self-transcendence correlated with ISMI subscales alienation, discrimination, and stigma resistance. Regression analyses controlling for psychopathology, age, length of illness, and number of hospitalizations revealed that higher level of harm avoidance and low self-directedness predicted internalized stigma. CONCLUSION The finding suggests that the experience of self-stigma is related to personality dimensions. Interpretations of these findings include the possibility that, irrespective of patients' psychopathology or functional characteristics, experience of self-stigma and its consequences might depend on personality dimensions. Further studies are needed.
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Cortés MJ, Valero J, Gutiérrez-Zotes JA, Hernández A, Moreno L, Jariod M, Martorell L, Vilella E, Labad A. Psychopathology and personality traits in psychotic patients and their first-degree relatives. Eur Psychiatry 2009; 24:476-82. [PMID: 19699061 DOI: 10.1016/j.eurpsy.2009.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 06/12/2009] [Accepted: 06/22/2009] [Indexed: 02/07/2023] Open
Abstract
Personality dimensions have been associated with symptoms dimensions in schizophrenic patients (SP). In this paper we study the relationships between symptoms of functional psychoses and personality dimensions in SP and their first-degree relatives (SR), in other psychotic patients (PP) and their first-degree relatives (PR), and in healthy controls in order to evaluate the possible clinical dimensionality of these disorders. Twenty-nine SP, 29 SR, 18 PP, 18 PR and 188 controls were assessed using the temperament and character inventory (TCI-R). Current symptoms were evaluated with positive and negative syndrome scale (PANSS) using the five-factor model described previously (positive [PF], negative [NF], disorganized [DF], excitement [EF] and anxiety/depression [ADF]). Our TCI-R results showed that patients had different personality dimensions from the control group, but in relatives, these scores were not different from controls. With regard to symptomatology, we highlight the relations observed between harm avoidance (HA) and PANSS NF, and between self-transcendence (ST) and PANSS PF. From a personality traits-genetic factors point of view, schizophrenia and other psychosis may be initially differentiated by temperamental traits such as HA. The so-called characterial traits like ST would be associated with the appearance of psychotic symptoms.
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Affiliation(s)
- M J Cortés
- Unitat de Psiquiatria i Psicologia Mèdica, Department Medicina i Cirurgia, Fac. Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/ Sant Llorenç 21, 43201 Reus, Spain
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Abstract
Studies of patients with schizophrenia or schizophrenia spectrum disorders and general population control groups consistently show differences regarding personality dimensions. However, the profile of personality dimensions in first-degree relatives of those patients is not well understood. We used Temperament and Character Inventory to explore personality dimensions in 61 clinically stable patients with schizophrenia or schizophrenia spectrum disorders, 59 of their first-degree relatives, and 64 healthy controls. Patients scored significantly higher than controls in harm avoidance and self-transcendence and lower in self-directedness and cooperativeness. First-degree relatives showed a tendency to lower novelty seeking and self-transcendence than controls. Interpretations of these findings include the possibility that lower novelty seeking and lower self-transcendence provide a protective influence in the relatives. Further studies are needed to go into this issue in greater depth.
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Abstract
This article reviews empirical studies of affective traits in individuals with schizophrenia spectrum disorders, population-based investigations of vulnerability to psychosis, and genetic and psychometric high-risk samples. The review focuses on studies that use self-report trait questionnaires to assess Negative Affectivity (NA) and Positive Affectivity (PA), which are conceptualized in contemporary models of personality as broad, temperamentally-based dispositions to experience corresponding emotional states. Individuals with schizophrenia report a pattern of stably elevated NA and low PA throughout the illness course. Among affected individuals, these traits are associated with variability in several clinically important features, including functional outcome, quality of life, and stress reactivity. Furthermore, evidence that elevated NA and low PA (particularly the facet of anhedonia) predict the development of psychosis and are detectable in high-risk samples suggests that these traits play a role in vulnerability to schizophrenia, though they are implicated in other forms of psychopathology as well. Results are discussed in terms of their implications for treatment, etiological models, and future research to advance the study of affective traits in schizophrenia and schizotypy.
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Affiliation(s)
- William P. Horan
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA 90095,To whom correspondence should be addressed; 300 UCLA Medical Plaza, Suite 2240, Los Angeles, CA 90095-6968, USA; tel: 310-206-8181, fax: 310-206-3651, e-mail:
| | - Jack J. Blanchard
- Department of Psychology, University of Maryland at College Park, College Park, MD 20742
| | - Lee Anna Clark
- Department of Psychology, University of Iowa, Iowa City, IA 52242
| | - Michael F. Green
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA 90095,VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073
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Smith MJ, Cloninger CR, Harms MP, Csernansky JG. Temperament and character as schizophrenia-related endophenotypes in non-psychotic siblings. Schizophr Res 2008; 104:198-205. [PMID: 18718739 PMCID: PMC2565802 DOI: 10.1016/j.schres.2008.06.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 06/27/2008] [Accepted: 06/29/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Quantitative endophenotypes are needed to better understand the pathogenesis of schizophrenia. The psychobiological model of temperament and character suggests that personality traits are heritable and regulated by brain systems influencing schizophrenia susceptibility. Thus, measures of temperament and character may serve as schizophrenia-related endophenotypes in individuals with schizophrenia and their non-psychotic siblings. METHODS Individuals with schizophrenia (n=35), their non-psychotic siblings (n=34), controls (n=63), and their siblings (n=56) participated in a study of the clinical, neurocognitive and neuromorphological characteristics of schizophrenia. A mixed-model approach assessed group differences on the Temperament and Character Inventory (TCI). Neurocognitive deficits and psychopathology were correlated with the TCI. Configurations of TCI domains were examined using a generalized linear model. RESULTS Individuals with schizophrenia and their non-psychotic siblings had higher harm avoidance than controls and their siblings. Individuals with schizophrenia had lower self-directedness and cooperativeness, and higher self-transcendence than their non-psychotic siblings, controls, and the siblings of controls. Neurocognition was not related to temperament and character in individuals with schizophrenia or either control group. In non-psychotic siblings, self-directedness and cooperativeness were correlated with working memory and crystallized IQ. CONCLUSION Evidence supports harm avoidance as a schizophrenia-related endophenotype. An increased risk of schizophrenia may be associated with asociality (configured as high harm avoidance and low reward dependence), schizotypy (configured as low self-directedness, low cooperativeness, and high self-transcendence), and neurocognitive deficits (poor executive functioning, working/episodic memory, attention, and low IQ). The non-psychotic siblings demonstrated features of a mature character profile including strong crystallized IQ, which may confer protection against psychopathology.
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Affiliation(s)
- Matthew J Smith
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL 60611, United States.
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Michalak EE, Murray G, Young AH, Lam RW. Burden of bipolar depression: impact of disorder and medications on quality of life. CNS Drugs 2008; 22:389-406. [PMID: 18399708 DOI: 10.2165/00023210-200822050-00003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Bipolar disorder is a complex, chronic psychiatric condition characterized by recurring episodes of depressive illness and mania or hypomania. Although the manic or hypomanic episodes define the disorder, recent research has shown that depressive symptoms predominate over manic symptoms in the majority of patients, and that bipolar depression accounts for much of the significant morbidity and mortality associated with bipolar disorder. Given these findings, there has been a recent upsurge of interest in furthering our understanding of the burden of depression in bipolar disorder. At the same time, increasing scientific attention is now being paid to expanding the measurement of outcome in bipolar disorder to encompass broader indicators of response, one of which is the assessment of quality of life (QOL). In this review, we provide a summary of the current knowledge about QOL in the depressive phase of bipolar disorder, and the effects of pharmacological treatment interventions for bipolar disorder upon QOL. It appears that QOL is poorer in bipolar disorder than in other mood disorders and anxiety disorders, but that schizophrenia might compromise QOL more severely than bipolar disorder. Existing data also suggest that, for patients with bipolar disorder, QOL is negatively associated with depression, both as a cross-sectional mood state and perhaps also as a feature of the patient's course. Despite its clinical and public health importance, bipolar depression has only recently started to receive the attention it warrants in clinical trials, and many important questions about its optimal pharmacological management remain to be answered. There is also a paucity of information about the impact of pharmacological interventions on QOL in bipolar depression. To our knowledge, only two clinical trials to date have specifically examined the impact of medications on QOL in patients with bipolar depression. A small number of other studies have examined the effects of depressive symptoms on QOL in patients who are experiencing manic or mixed episodes. Nonetheless, QOL appears to be a meaningful and important indicator of outcome and recovery in this patient population, and one that warrants further scientific interest and energy.
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Affiliation(s)
- Erin E Michalak
- Division of Mood Disorders, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
To inform psychiatric practice and research that enhances subjective quality of life (SQL) in diverse persons with schizophrenia, this study explored whether SQL differs in blacks and whites with varying educational attainment. Participants were interviewed upon discharge from 4 New York City psychiatric hospitals and after 3 months in community care (N = 264, mean age of 37 years, 61% male, 56% black). Linear regression equations predicted white and black SQL from educational attainment and control variables (ethnicity, age, functioning level, symptom severity). Educational accomplishment predicted lower SQL (F = 3.53, df = 4,227, p < 0.01), especially among whites (F = 5.87, df = 4,92, p < 0.001). However, the association was statistically insignificant in blacks who had SQL peaks and valleys with more years of school. Findings suggest that psychiatric care and research should account for educational and cultural variation in assessing and promoting SQL.
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Affiliation(s)
- Jonathan D Prince
- Rutgers, the State University of New Jersey, School of Social Work, New Brunswick, New Jersey 08901, USA.
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Krystal JH, D'Souza DC, Gallinat J, Driesen N, Abi-Dargham A, Petrakis I, Heinz A, Pearlson G. The vulnerability to alcohol and substance abuse in individuals diagnosed with schizophrenia. Neurotox Res 2007; 10:235-52. [PMID: 17197373 DOI: 10.1007/bf03033360] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Individuals with schizophrenia are at increased risk for developing substance abuse disorders. Here, we consider factors that might elevate their risk for substance abuse. The tendency among schizophrenic individuals to overvalue drug-like rewards and to devalue the potential negative consequences of substance abuse may be a contributing factor to their substance abuse risk. This bias, which may partly reflect the convergence of glutamatergic and dopaminergic input to the limbic striatum, also may contribute to disadvantageous decision-making and other impulsive behavior. This propensity to seek drug-like rewards is augmented by alterations in nicotinic cholinergic, GABAergic, glutamatergic, and cannabinnoid receptor function associated with schizophrenia that increase the abuse liability of low doses of nicotine, ethanol, and perhaps cannabis, and augment the dysphoric effects of higher doses of ethanol and cannabis. The distortions in reward processing and altered response to substances of abuse also increase the likelihood that individuals with schizophrenia will self-medicate their subjective distress with abused substances. The focus on distinctions between motivation and reward with respect to substance abuse risk by schizophrenic patients suggests a need for a reconsideration of the construct of "negative symptoms" for this dually-diagnosed patient group.
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Affiliation(s)
- John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Calvó de Padilla M, Padilla E, González Alemán G, Bourdieu M, Guerrero G, Strejilevich S, Escobar JI, Svrakic N, Cloninger CR, de Erausquin GA. Temperament traits associated with risk of schizophrenia in an indigenous population of Argentina. Schizophr Res 2006; 83:299-302. [PMID: 16480854 DOI: 10.1016/j.schres.2005.12.848] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 12/06/2005] [Indexed: 01/24/2023]
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