Psychological morbidity is the main predictor of quality of life among caregivers of individuals in first-episode psychosis: data from a year-long longitudinal study in Brazil

Objective: To investigate quality of life (QoL) and QoL predictors among caregivers of individuals in first-episode psychosis (FEP). Methods: This longitudinal study investigated predictors of QoL in caregivers of 80 individuals in FEP over a 1-year follow-up period, measured using a single component extracted from the 36-item Short-Form Health Survey (SF-36). Results: Mediation analysis demonstrated that, at 1 year, high scores in the Self-Report Questionnaire (SRQ-20) were associated with high scores on the negative sub-scale of the Experience of Caregiving Inventory (ECI), which was also associated with low scores in the Essential Quality of Life (Essential QoL) component extracted from the SEF-36. Clinically, the resulting association indicates that depression and anxiety symptoms in caregivers at baseline are predictors of their 1-year quality of life, based on self-assessment of the caregiving experience. Conclusion: Supporting an individual in FEP can have a negative impact on QoL. Maintaining caregivers' mental health and subjective evaluation of the caregiving experience must be primary goals of FEP services. Complementary studies of FEP caregivers' QoL can support the design of personalized interventions in the near future.

Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder

Objectives: To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms. Methods: Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ). Results: Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8±68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6±23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia. Conclusions: This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients

Foi realizado estudo de corte transversal para estudar fatores associados às expectativas familiares com familiares ambulatoriais esquizofrênicos pela Classificaçäo Internacional de Doenças, 9ª ediçäo e que tivessem mais de 4 anos de duraçäo da doença foram incluídos no estudo. A expectativa familiar foi medida pela diferença dos escores da Escala de Ajustamento Katz (R2 e R3), que säo baseados nas expectativas dos familiares e no nível atual de desempenho das atividades socialmente esperadas (Escore de Discrepância). O ajustamento social foi medido através da Escala de Avaliaçäo Global (GAS) do DSM-III-R. As avaliaçöes dos desfechos clínicos foram realizadas independentemente, e a amostra foi constituída por 44 pacientes (25 homens e 19 mulheres). A média do Escore de Discrepância foi duas vezes maior para os homens do que para as mulheres (p<0,02), e houve uma associaçäo inversa entre o escore de discrepância, quando idade atual e idade de início da doença, e número de admissöes psiquiátricas foram controladas através de uma técnica de análise de regressäo múltipla. Houve interaçäo entre sexo e ajustamento social, uma relaçäo inversa entre ajustamento social e escore de discrepância mais pronunciada nos homens. Estes achados säo discutidos diante das associaçöes potenciais entre atmosfera familiar, gênero e ajustamento social dos pacientes esquizofrênicos e a necessidade de haver mais pesquisas nesta área, p. ex., descriçöes etnográficas das interaçöes entre pacientes e familiares no ambiente doméstico, particularmente, nos países menos desenvolvidos