Funcionamiento social y cognitivo en pacientes con esquizofrenia / Social and cognitive functioning in patients with schizophrenia

La presente investigación corresponde a un estudio no experimental, transversal y correlacional, cuyo objetivo fue identificar si existe relación entre funcionamiento social (FS) y cognitivo (FC) en pacientes con esquizofrenia, mediante la evaluación del funcionamiento social (SFS) y deterioro cognitivo (MoCA y SCIP-S) en una muestra de 12 pacientes (11 hombres y 1 mujer) entre los 22 y 70 años, de Medellín (Colombia), mediante muestreo no probabilístico por conveniencia. Se encontró que más de la mitad (n = 7) presenta un nivel superior de FS y casi el total de la muestra presenta deterioro cognitivo. Al correlacionar FS y FC se encontró que sólo SFS y MoCA se relacionan significativamente, mientras que la SCIP-S no presenta relación con SFS ni con MoCA. Aunque estos hallazgos no pueden ser concluyentes ni generalizables debido a limitaciones metodológicas, pueden ser usados como antecedente para futuros estudios.

A non-experimental, cross-sectional and correlational study was made, whose objective was to identify if there is a relationship between social functioning (SF) and cognitive functioning (CF) in patients with schizophrenia, through the evaluation of social functioning (SFS) and cognitive impairment (MoCA and SCIPS) in a sample of 12 patients (11 men and 1 woman) between 22 and 70 years old, from Medellín (Colombia), selected by non-probabilistic sampling for convenience. It was found that more than half of the participants (n = 7) present a higher level of SF and almost the total of the sample presents cognitive impairment. When correlating SF and CF it was found that only SFS and MoCA are significantly related, whereas SCIP-S has no relation with SFS or with MoCA. Although these findings cannot be conclusive or generalizable due to methodological limitations, they can be used as a background for future studies.

Effectiveness of behavioral family therapy in people with schizophrenia: a randomized, controlled clinical trial / Efectividad de la terapia familiar conductual en personas con esquizofrenia. Un ensayo clínico controlado aleatorizado

Abstract Objective To evaluate the effectiveness of FBT in comparison with usual care in people with schizophrenia treated at an outpatient psychiatric department of a public hospital in Chile. Method Quantitative study, with a randomized, controlled clinical trial design (CTCT) and pre-post measurements, with two arms. Fifty-four people with schizophrenia and their primary caregivers, randomly assigned to experimental and control groups, were studied. The main outcome variable was social functioning. As secondary outcomes, clinical symptoms and treatment adherence in people with schizophrenia were evaluated. Expressed emotion was evaluated in the primary caregiver. Results FBT was effective in improving the social functioning of people with schizophrenia and decreasing expressed emotion in the primary caregiver, with a large effect size (d > 0.80). Conclusions The implementation of FBT as a protocolized intervention, complementing usual care, helps to improve psychosocial outcomes in people with schizophrenia and their caregivers.

Resumen Objetivo Evaluar la efectividad de la TFC, respecto de los cuidados usuales, en personas con esquizofrenia atendidas en un servicio de psiquiatría ambulatorio de un hospital público de Chile. Método Estudio cuantitativo, longitudinal, con diseño de ensayo clínico controlado aleatorizado (ECCA) y mediciones pre-post, a dos brazos. Se estudiaron 54 personas con esquizofrenia y sus cuidadores principales, asignados aleatoriamente a grupo control y experimental. La variable de resultado primaria fue el funcionamiento social; como resultados secundarios se evaluaron la sintomatología clínica y la adherencia a tratamiento del paciente y la emoción expresada en el cuidador principal. Resultados La TFC fue efectiva en el mejoramiento del funcionamiento social de la persona con esquizofrenia y en la disminución de la emocionalidad expresada en el cuidador principal, con un tamaño de efecto grande (d > 0.80). Conclusiones La implementación de la TFC, como intervención protocolizada y complementaria a los cuidados usuales, contribuye a mejorar resultados psicosociales en personas con esquizofrenia y en sus cuidadores.

Neurophysiological and Psychological Predictors of Social Functioning in Patients with Schizophrenia and Bipolar Disorder

OBJECTIVE: The aim of this study is to examine social functioning in patients with schizophrenia and bipolar disorder and explore the psychological and neurophysiological predictors of social functioning. METHODS: Twenty-seven patients with schizophrenia and thirty patients with bipolar disorder, as well as twenty-five healthy controls, completed measures of social functioning (questionnaire of social functioning), neurocognition (Verbal fluency, Korean-Auditory Verbal Learning Test), and social cognition (basic empathy scale and Social Attribution Task-Multiple Choice), and the childhood trauma questionnaire (CTQ). For neurophysiological measurements, mismatch negativity and heart rate variability (HRV) were recorded from all participants. Multiple hierarchical regression was performed to explore the impact of factors on social functioning. RESULTS: The results showed that CTQ-emotional neglect significantly predicted social functioning in schizophrenia group, while HRV-high frequency significantly predicted social functioning in bipolar disorder patients. Furthermore, emotional neglect and HRV-HF still predicted social functioning in all of the subjects after controlling for the diagnostic criteria. CONCLUSION: Our results implicated that even though each group has different predictors of social functioning, early traumatic events and HRV could be important indicators of functional outcome irrespective of what group they are.

The effect of combining constraint-induced movement therapy with virtual reality games in rehabilitating the motor function of hemiplegic children with cerebral palsy / 中华物理医学与康复杂志

Objective To observe the effect of supplementing constraint-induced movement therapy (CIMT) with virtual reality games in rehabilitating the motor function of hemiplegic children with cerebral palsy (CP).Methods Fifty hemiplegic children with CP were randomly divided into a control group and a treatment group,each of 25.All were given conventional rehabilitation.The children in the control group received CIMT for 4 hours,plus 1 hour of occupational therapy for the more-affected limb supported by therapists and 3 hours of daily training in life activities with their guardians' help.Those in the treatment group received occupational therapy for 1 hour,played virtual reality games for 1 hour and practiced daily life activities for 2 hours per day.All of the treatments were carried out five days a week for 3 weeks.Before and after the intervention the quality of upper extremity skills test (QUEST),the Chinese version of the gross motor function measuring scale (GMFM) and the pediatric evaluation of disability inventory (PEDI) were used to evaluate upper limb function,gross motor function and the social abilities.Results After the treatment,significant improvement was observed in the average QUEST,GMFM and PEDI scores of both groups,but the average scores in the treatment group were significantly higher than among the controls.Conclusions CIMT combined with playing virtual reality games improves the motor function and social abilities of hemiplegic children with CP.

Comparisons of the Clinical Variables between High and Low Self-Stigma Group in the Outpatients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The purpose of this research was to investigate the differences of clinical variables between high and low self-stigma group in the outpatients with schizophrenia. METHODS: 209 schizophrenic outpatients were assigned to high self stigma group (n=76) and low self stigma group (n=133) based on the scores of perceived stigma, and compared age, sex, education, age of onset, duration of illness, number of hospitalization, symptom, social functioning, insight, self-esteem, empowerment between two groups. RESULTS: 1) The high self-stigma group had significantly lower age of onset, higher duration of illness and number of hospitalizations compared to the low self-stigma group. 2) In the PANSS, the high self-stigma group showed significantly higher score in the total score and general symptoms compared to the low self-stigma group. No significant difference was found in the positive symptoms and negative symptoms between two groups. 3) The high self-stigma group had significantly lower empowerment and self-esteem compared to the low self-stigma group. 4) The high self-stigma group had significantly higher insight compared to the low self-stigma group. CONCLUSION: Self-stigma in patients with schizophrenia directly reduces self-esteem and empowerment, and may cause depression and a lower quality of life. Therefore, identifying self-stigma and its degree is one of the important factors for good outcome.

Factors Influencing Burden on the Primary Caregivers of Remitted Schizophrenic Outpatients / 대한정신분열병학회지

OBJECTIVES: The purpose of this study is to investigate the variables besides symptom that influence the family burden in the primary caregivers of remitted schizophrenic outpatients, and to evaluate the impact of changeable or unchangeable variables by clinical practice on the family burden. METHODS: A total 105 remitted schizophrenic outpatients and 105 their primary caregivers were participated in the psychiatric outpatient clinic of the university hospital. Socio-demographic characteristics (age, sex, education, income, marital status, religion), clinical variables (duration of illness, age of onset), patients' symptom (korean version of the positive and negative syndrome scale), patients' social function (korean version of the social functioning scale), patients' insight (self-appraisal of illness questionnaire), patients' attitude toward medication (drug attitude inventory), family perceived social support (multidimensional scale of perceived social support), family attitude toward patient (family attitude scale) were gathered from subjects. RESULTS: Total score of family burden scale (0–144) of the primary caregivers of remitted schizophrenic outpatients was 71.3 (SD 20.7) and mean score per item was 1.9. Unchangeable six variables by clinical practice (relation with patient, patients' education, age of onset, duration of illness, parent age, parent income) explain 17%, and changeable four variables (family attitude toward patient, family perceived social support, patients' social function, patients' insight) explain 72% of family burden. Four areas such as interpersonal communication, independence-performance, independence-competence, occupation/ employment explain family burden significantly in the seven areas of the social functioning scale. CONCLUSION: Primary caregivers of remitted schizophrenic outpatients feel burden considerably even though their ill relatives show few psychiatric symptoms. Changeable variables by clinical practice were more explanation than unchangeable variables on the family burden.

Factors Influencing Burden on the Primary Caregivers of Remitted Schizophrenic Outpatients / 대한정신분열병학회지

OBJECTIVES: The purpose of this study is to investigate the variables besides symptom that influence the family burden in the primary caregivers of remitted schizophrenic outpatients, and to evaluate the impact of changeable or unchangeable variables by clinical practice on the family burden. METHODS: A total 105 remitted schizophrenic outpatients and 105 their primary caregivers were participated in the psychiatric outpatient clinic of the university hospital. Socio-demographic characteristics (age, sex, education, income, marital status, religion), clinical variables (duration of illness, age of onset), patients' symptom (korean version of the positive and negative syndrome scale), patients' social function (korean version of the social functioning scale), patients' insight (self-appraisal of illness questionnaire), patients' attitude toward medication (drug attitude inventory), family perceived social support (multidimensional scale of perceived social support), family attitude toward patient (family attitude scale) were gathered from subjects. RESULTS: Total score of family burden scale (0–144) of the primary caregivers of remitted schizophrenic outpatients was 71.3 (SD 20.7) and mean score per item was 1.9. Unchangeable six variables by clinical practice (relation with patient, patients' education, age of onset, duration of illness, parent age, parent income) explain 17%, and changeable four variables (family attitude toward patient, family perceived social support, patients' social function, patients' insight) explain 72% of family burden. Four areas such as interpersonal communication, independence-performance, independence-competence, occupation/ employment explain family burden significantly in the seven areas of the social functioning scale. CONCLUSION: Primary caregivers of remitted schizophrenic outpatients feel burden considerably even though their ill relatives show few psychiatric symptoms. Changeable variables by clinical practice were more explanation than unchangeable variables on the family burden.

Factors Predicting Personal and Social Performance in Schizophrenia Patients / 대한정신분열병학회지

OBJECTIVES: Schizophrenia is a chronic psychiatric disorder characterized by its debilitating course. It leads to personal and social dysfunctions, burdening patients and guardians heavily. Enhancing functional outcome is a major treatment goal, but pharmacotherapy alone is usually not enough. Hence, it is important to reveal clinical factors that can predict personal and social performance in schizophrenia patients. Analyze factors influencing personal and social performance in schizophrenia patients. METHODS: 66 schizophrenia patients from three University hospitals in Korea were enrolled, completing clinical scales between January 2008 and December 2009. 38 patients dropped out during follow up. 28 patients were included in the final study. Personal and social performance was measured using the Personal and Social Performance scale (PSP) since January 2015. Correlation and multiple regression analyses were performed to reveal associations between demographic and clinical factors and PSP. RESULTS: Correlation analyses resulted in statistically significant correlations between CGI-S (r=-0.646, p<0.01), PANSS (r=-0.419, p<0.05), KISP (r=-0.523, r<0.01), KmSWN (r=0.388, p<0.05), Trail making B (r=0.608, p<0.01), KDAI (r=0.608, p<0.01), and PSP. Stepwise multiple regression analyses showed significant models with CGI-S (β=-0.485, p<0.01), and KDAI (β=0.423, p<0.01). CONCLUSION: Our results show that attitude toward drugs and symptom severity affect a patient’s personal and social performance most prominently. We advise to focus on patient education to reinforce attitude toward drugs, and to concentrate on reducing symptom severity to enhance personal and social performance in schizophrenia patients.

Social Function in Patients with Personality Disorder Diagnosed by Single Dimensional Severity Using Korean Version of Social Functioning Questionnaire / 신경정신의학

OBJECTIVES: The aims of this study were to examine validity and reliability of the Korean version of the Social Function Questionnaire (SFQ) and evaluated social function with SFQ in patients with personality disorder. METHODS: The SFQ was administered to 186 psychiatric patients (155 patients with personality disorder and 31 patients without personality disorder), and 22 healthy men were recruited to examine the test-retest reliability of SFQ. The severity of personality disorders was determined using the proposed the International Classification of Diseases (ICD)-11th revision (ICD-11) personality disorders. All participants completed the NEO-Five Factor Inventory, Beck Depression Inventory, and Spielberger State and Trait Anxiety Inventory to examine the convergent validity of SFQ. RESULTS: The Korean version of the SFQ showed good internal consistency (Cronbach's alpha=0.811) and test-retest reliability (r=0.746). Patients with personality disorder had more social dysfunction than those without personality disorder. A graded increase in social dysfunction was observed with increasing severity of personality disorder. Social dysfunction showed a strong linear relationship with the 5 factor model. CONCLUSION: The Korean version of the SFQ has good psychometric properties. The results of our study support the severity classification of personality disorder integrated to upcoming ICD-11.

A comparative study of effectiveness about systemic rehabilitation exercise on chronic schizophrenic patients / 中国基层医药

Objective To examine the influence of systemic rehabilitation exercise on social functioning in chronic schizophrenic patients.Methods 60 qualified cases selected from chronic psychiatric inpatient department were randomly divided into two groups according to admission number (AD).30 cases in treatment group accepted hospitalized systemic rehabilitation exercise and 30 controls accepted ordinary treatment for 6 months.Social functio-ning evaluated with SSPI and PSP.Results The total score of SSPI(t=1.322,P=0.256) and PSP(t=1.563,P=0.362) were not significantly higher(P>0.05),The total score of SSPI [(37.44 ±4.33)points,t=2.719,P=0.001]and PSP[(72.14 ±6.86)points,t=3.985,P=0.000]total score in the treatment group were significantly higher than that in the control group(P0.05).Conclusion Systemic rehabilitation training does influence on social functioning in chronic schizophrenic patients.

The relationship between social functioning and psychiatric symptoms with schizophrenia of the convalescent stage: Mediating roles of self-esteem and self-efficacy / 中国实用护理杂志

Objective To examine the relationship between social functioning and psychiatric symptoms,and the mediation effect of self-esteem and emotion between social functioning and psychiatric symptoms among schizophrenia patients of the convalescent stage.Methods The Personal and Social Performance Scale,Brief Psychiatric Rating Scale,Self-Esteem Scale,General Self-Efficacy Scale were used to investigate patients with schizophrenia of the convalescent stage of Chifeng.Results Social functioning for patients with schizophrenia of the convalescent stage could predict psychiatric symptoms directly.Self-esteem and self-efficacy could make a negative prediction for psychiatric symptoms.Self-esteem and self-efficacy played a mediating role between social functioning and psychiatric symptoms.Conclusions Mental health workers should pay close attention to the mediating roles of self-esteem and self-efficacy,and give comprehensive assessment for the patients and provide continuous individualized psychosocial interventions,and thereby to alleviate psychiatric symptoms.

Factor Structure of the Targeted Inventory on Problems in Schizophrenia

OBJECTIVE: The aim of this study was to explore the factor structure of a novel, 10-item rating scale, the Targeted Inventory on Problems in Schizophrenia (TIP-Sz). Determining the factor structure will be useful in the brief evaluation of medication and non-medication treatment of the disease. METHODS: An exploratory factor analysis was performed on TIP-Sz scores obtained from 100 patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for schizophrenia. RESULTS: The factor analysis extracted four factors that were deemed clinically pertinent, which we labeled: disorganization, social cooperativeness, functional capacity, and emotional state. The items exhibited cross-loadings on the first three factors (i.e., some items loaded on more than one factor). In particular, the 'behavioral dyscontrol and disorganization,' 'insight and reality testing,' and 'overall prognostic impression' items had comparable cross-loadings on all of the first three factors. The emotional state factor was distinct from the other factors in that the items loading on it did not cross-load on other factors. CONCLUSION: The TIP-Sz scale comprises factors that are associated with the psychosocial functioning and emotional state of patients, which are important outcome parameters for successful treatment of the disease.

Relationship between prospective memory and social functioning in patients with schizophrenia / 中华行为医学与脑科学杂志

ObjectiveTo investigate the event-based prospective memory (EBPM)and time-based prospective memory( TBPM )in stable patients with schizophrenia and to explore the relationships between prospective memory and social functioning.Methods40 schizophrenic patients and 40 normal controls matched in age,gender and education were assessed with a neuropsychological battery of tests including EBPM and TBPM tasks.The patients were also assessed with social disability screening schedule(SDSS).ResultsA statistically significant in EBPM was observed between patients with schizophrenia and normal controls (4.18 ± 1.04 vs 5.33 ±0.86,t=- 5.408,P ＜ 0.01) and the same result in TBPM ( 3.45 ± 1.48 vs 5.20 ± 0.82,t =- 6.522,P ＜ 0.01).In patients with schizophrenia TBPM was impaired more significantly than EBPM ( z=-3.238,P＜0.01 ).After controlling the total score of PANSS,the negatively correlate was showed between the total scores of SDSS and EBPM ( r =- 0.346,P ＜ 0.05 ),TBPM ( r =- 0.374,P ＜ 0.05 ) in the patients.ConclusionThe results suggest schizophrenic patients impairs both EBPM and TBPM,and TBPM is impaired more significantly than EBPM.PM shows positively correlated with social functioning moderately in the patient.

The reliability and validity analysis on the scale of social function deficit due to mental disorders / 中华行为医学与脑科学杂志

Objective To test the reliability and validity of the rating scale of social function deficit due to mental disorders (SSFD-MD). Methods 1003 cases with mental disability evaluation were tested by SSFDMD. At sametime, 100 cases of 1003 cases were test-retested and back to back tested by two examiners. 300 cases of 1003 cases also were tested by social disability screening schedule( SDSS),scale of social function for psychosis inpatients(SSPI),global assessment function(GAF) ,the brief psychiatric rating scale(BPRS) ,WH0 disability assessment scale Ⅱ (WHO-DASⅡ ), adult rating scale of mentally disabled ( ARSMD) and rating scale for extrapyramidal side effects (RSESE). Results ①The Cronbach's α coefficients of the total score and all dimensions of SSFD-MD were more than 0.90. The test-retest reliability ranged from 0.67～0. 83 ,and the scorer reliability were 0. 87～0.97. ②The correlations between item scores ranged from 0.46 ～0.74(P＜0.01). The correlations between the factor scores and the total scores ranged from 0.73～0.87(P＜0.01). To extract five full-scale principal components after orthogonal rotation to maximize variance,the cumulative total variance explained was 82.25%.There were highly correlations between SSFD-MD and SDSS.SSPI and GAF,respectively ( r = 0. 71,0.72 and 0. 78). There were moderate correlations between SSFD-MD and BPRS WHO-DAS II ARSMD,respectively(0.62,0. 50 and 0.46). There was a low correlations between SSFD-MD and RSESE ( r = 0.22) ,but all correlations were significant(P＜0.01). Conclusion SSFD-MD has acceptable psychometrics properties on reliability and validity.

Relationship between eye expression recognition and social functioning in patients with schizophrenia / 中华行为医学与脑科学杂志

Objective To compare eye expression recognition in stable outpatients with schizophrenia with that in normal controls and to explore the relationships between eye expression recognition and social functioning.Methods 107 schizophrenic outpatients and 66 normal controls matched in age,sex and years of education were assessed with Eye Basic Emotion Discrimination Task(EBEDT) and Eye Complex Emotion Discrimination Task(ECEDT).The patients were also assessed with Social Disability Screening Schedule (SDSS).Results The correct numbers were significantly lower for patients to identify basic emotions of eye expressions(13.2±3.8 vs16.0±2.6,P<0.01) and complex emotions of eye expressions(17.9±4.3 vs 20.6±3.5,P<0.01)than those for controls respectively;the correct numbers to identify anger(3.1±1.0 vs.2.1±1.2,P<0.01),fear(1.8±1.0 vs 1.3±1.0,P<0.01) and disgust(1.8±1.1 vs 1.4±1.2,P<0.05)for controls were higher than those for patients significantly.The correct numbers to identify total basic emotions(r=-0.335,P<0.05)and total complex emotions (r=-0.374,P<0.05)in eye expressions showed negatively correlated with the total scores of SDSS in the patients after controlling age and total score of PANSS.Conclusions The ability to recognize basic and complicated emotions in eye expressions in the outpatients with schizophrenia is lower than that in the controls. It shows positively correlated with social functioning moderately in the patients.

The effect of combination treatment by paliperidone and psychological intervention on first-episode schizophrenic out-patient / 中华行为医学与脑科学杂志

Objective To evaluate the effect of combination treatment by psychological intervention and a new atypical antipsychotic Paliperidone extended-release tablets(paliperidone ER)on first-episode schizophrenic out-patients.Methods All 62 patients diagnosed as first-episode schizophrenia by DSM-Ⅳ were randomly allocated into,combination treatment group and control group,for a 12-month treatment study.The combination treatment group was treated by paliperidone ER once a day and psychological counseling once a month,while the control group was treated only by paliperidone ER.The efficacy and social function were assessed by Positive and Negative Syndrome Scale(PANSS)and Personal and Social Performance Scale(PSP)individually at baseline,and following 1,3,6,9,12 months.The remission rate was calculated at the end of the 3rd,6th,9th month.The safety and tolerability were assessed using Barnes Akathisia Scale(BARS),extrapyramidal side effects scale(SAS)and involuntary movement scale(AIMS).Results Twenty-seven patients of combination treatment group and seventeen patients of the control group completed the trial with the discontinuation rate 12.9% and 45.2%,respectively.The difference between the above two groups was statistically significant(P＜0.05).The mean total score of PANSS and the PSP of the both groups were significantly improved(P＜0.05)after treatment.PANSS total score reduced more than 30% compared with baseline,and PSP total score increased more than 7.The remission rate of combination treatment group was 74.2%,51.6% and 67.7% at the end of 3rd,6th,and 9th month,which was better than the control group(45.2%,38.7% and 38.7%)(P＜0.05).Both incidence and types of adverse events were almost same between the two groups.The major adverse events were extrapyramidal symptoms,tachycardia,gastrointestinal discomfort and akathisia.Conclusion Paliperidone ER treatment combined with psychological intervention on first-episode schizophrenia out-patients can improve their treatment compliance by reducing the discontinuation rate.And this combination treatment can increase the remission rate and improve social functioning of the patients.

Predictive Factors of Social Functioning in Patients with Schizophrenia: Exploration for the Best Combination of Variables Using Data Mining

OBJECTIVE: This study aimed to use data mining to explore the significantly contributing variables to good social functioning in schizophrenia patients. METHODS: The study cohort comprised 67 schizophrenia patients on stable medication. A total of 51 variables (6 demographic data, 3 illness history, 22 social cognition, 16 neurocognition, 4 psychiatric symptoms) were input into a data-mining decision tree using the Answer Tree program to find the pathway for the best social functioning. RESULTS: Several contributing factors for good social functioning were found. Continuous attention was the strongest contributing factor. Three variables involving best social functioning included good continuous attention, good theory of mind (TOM), and low sensitivity of disgust emotion. CONCLUSION: Our results confirmed the mediating roles of social cognition between neurocognition and functional outcomes, and suggested that social cognition can significantly predict social functioning in schizophrenia patients.

Development of the Korean Version of the Social Functioning Scale in the Schizophrenics : A Study on the Reliability and Validity

Objectives : The purpose of this study was to develop the Korean version of the Social Functioning Scale (KSFS) in the patients with schizophrenia. METHODS : KSFS was administered to 90 schizophrenic patients and 80 their parents and 90 normal controls for examining the reliability and validity. RESULTS : Data analysis showed statistically significant reliabilities and validities of KSFS. The test-retest reliability, rater vs. self-report reliability, and internal consistency for total scores of KSFS were 0.93, 0.44 and 0.94 respectively. Evidence for discriminant validity of KSFS comes from the results that the mean scores of schizophrenic patients were significantly higher than those of normal controls. Construct validity was assessed by calculating the 7 inter-areas correlations of the KSFS, and all areas were statistically significant. Significant correlations between the total scores of KSFS and those of SOFAS lend support for the concurrent validity of this instrument. Factor analyses were performed and two factors were extracted accounting for 63.7% of the variance. Sensitivity was assessed indirectly via the distribution and range of scores on the SFS. The normal control group showed a distribution around a higher mean with a moderate positive skew. CONCLUSION : KSFS was found to be a valid, reliable, and sensitive instrument which can be used to evaluate the degree of social functioning in the patients with schizophrenia.

A Study on the Attention, Intellectual Functioning and Behavior Characteristics of Girls with Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The purpose of this study was to investigate the characteristics of attention, intellectual functioning and adaptation of girls with attention-deficit hyperactivity disorder (ADHD). METHODS: The scores of the ADHD Diagnostic System (ADS), the Korean Wechsler Intelligence Scale for Children-III (K-WISC-III) and the Korean Personality Inventory for Children (KPI-C) were compared between 26 girls with ADHD and 26 boys with ADHD. RESULTS: 1)There was no significant gender difference in the intellectual functioning, except for the picture completion subscale. 2) Compared to the boys, the girls responded more slowly on the ADS visual task. 3) The girls were rated higher by their parents for the depression and social relationship problems of the KPI-C. CONCLUSIONS: The results suggest that there are noticeable gender differences for the attention problems and social functioning of children with ADHD.

Relación entre la emoción expresada por el familiar responsable y la conducta sintomática de pacientes con esquizofrenia, incluido el funcionamiento social / Relationship between expressed emotion of the relative in charge and symptomatic behavior and social functioning of patients with schizophrenia

In the 1950's, several authors carried out a series of studies focusing on the course of schizophrenia rather than its etiology. They found a link between the living conditions to which patients returned after being discharged from the hospital, and their risk of relapse. A higher risk was observed in those patients that returned to their conjugal or parental home, compared to those who returned to other living conditions. This line of work that explored stressful family mechanisms coined a term known as expressed emotion (EE) -high and low- in the family, which refers to the evaluation of the quantity and quality of attitudes and feelings such as criticism, hostility and over-involvement of a family member towards the person diagnosed with schizophrenia. These attitudes among family members have been associated with the presence of relapse in patients two years after being discharged from the hospital when family members and the patient live in the same household and are in contact 35 hours or more per week. It has been proved that these attitudes exert an influence, either increasing or decreasing the exacerbation of symptoms and, in some cases, leading to the patient's rehospitalization. Higher rates of relapse (92%) have been found in patients that spend over 35 hours a week with the relative in charge (RIC) and were not taking antipsychotic medication. It has also been found that when a RIC with high EE is in close contact with the patient, the latter is at risk of experiencing a symptom exacerbation that increases two to four times the probability of relapse. The most typical emotional expressions are critical comments, hostility, and excessive affective involvement. Criticism and over-involvement are usually perceived as stressful. Criticism implies intolerance and disapproval, whereas over-involvement suggests intrusiveness and control, and includes high levels of anxiety in the patient. Some positive aspects are also found, like the demonstration of warm feelings. a) Criticism. Includes comments and statements which due to the way that are expressed by the RIC represent unfavorable comments about the behavior or personality of the individual being referred to. In other words, it shows aversion or disapproval of a person's behavior or characteristics. b)Over-involvement. More commonly found in parents than in other relatives, it includes over-protection or consent, self-sacrifice and emotional distress. The patient is regarded as less competent and more vulnerable. c) Hostility. Generally occurs when there is criticism, which is why it is of little value as an independent predictor. Hostility occurs when the patient is attacked for what he is, rather than for what he does. The main objective of this article is to show the relationship between the level of expressed emotion (EE) (high or low) of the relative in charge with symptomatic behavior (SB) and social functioning (SF) of the patient with schizophrenia. It also includes a proposal of a conceptual model to evaluate the predictive factors of high EE. A transversal non-probabilistic study of 33 relatives of patients with schizophrenia was carried out. The relatives were contacted through the Schizophrenia Clinic in the outpatient unit at the hospital of The National Institute of Psychiatry Ramón de la Fuente in Mexico City. The instruments used were: 1. The Social Behavior Assessment Schedule (SBAS) and 2. The Questionaire for Measuring the Level of Expressed Emotion (Cuestionario-encuesta, evaluación del nivel de EE [CEEE]). The results indicated that 14 (42.4%) of the interviewed relatives had high EE and 19 (57.6%) had low EE. The main characteristics associated with high EE in RIC were: living in the same household with the patient's mean age of 54.8 years, having less than 12 years of education, being employed and not having a spouse. The most frequent expressed emotions were criticism, hostility and over-involvement. In patients, the main characteristics were: being male, young, with a mean age of 29.2 years, single and without employment alternatives, with two or more relapses and with a diagnosis of schizophrenia for five or more years. The presence of symptoms in the patient's according to relatives with low EE was 31.6% as opposed to 74.1% reported by RIC with high EE. Relatives with high EE mentioned greater personal neglect, irritability, violent behavior and isolation on the part of the patient, whereas relatives with low EE reported more fears, forgetfulness, dependence and strange ideas as problematic behaviors in the patients. The differences found between relatives with high and low EE regarding the patients' functioning were clearly demonstrated. Relatives with low EE reported better functioning in patients' performance of chores, demonstration of affect, involvement in leisure activities and better communication skills. Relatives with low EE reported that the persistence of the symptoms in their patients was 31.6%, whereas for those with high EE it was 71.4%. A logistic regression was used to identify the best predictors of EE, where the dependent variable was the total EE score, and the predictors were the continuous variables for social functioning and symptomatic behavior. A significant association was found between the two variables. Poor social functioning, symptomatic instability in the patient and being the patient's sibling explained 46% of the variance in RIC with high EE. The predictors had high levels of statistical significance. The model revealed the independent contribution of each variable and its interaction with the others. The level of family EE can be considered as the best predictor of relapse in patients with schizophrenia. Thus, EE acquires a special relevance: when high EE causes relapse, the reduction of the level of EE will lead to a decrease in relapse rates. Although the traditional means of measuring EE through the CFI has been found to be highly effective, it takes a long time to apply and classify the answers of the instrument. Another alternative is the CEEE that has been used in this study, since it has been used in other clinical trials due to the brief time required for training, application and classification of the data.

La línea de estudios que contempla los mecanismos familiares estresantes utiliza un concepto denominado Emoción Expresada (EE) en el ambiente familiar, que se refiere a la evaluación de la cantidad y calidad de las actitudes y sentimientos relacionados con la crítica, hostilidad y sobreinvolucramiento que uno de los familiares expresa acerca de uno o varios miembros de la familia diagnosticado con esquizofrenia. Estas actitudes de los familiares se han asociado con la presencia de recaídas en los pacientes a los dos años de haber sido dados de alta, especialmente cuando los miembros de la familia y el paciente conviven en el mismo espacio y pueden tener contacto por lo menos 35 horas o más semanales. Las expresiones emocionales más características comprenden: comentarios críticos, hostilidad, exceso de involucramiento afectivo y aspectos positivos como la calidez, los cuales son percibidos en general como estresantes. La crítica implica intolerancia y desaprobación, el sobreinvolucramiento sugiere intrusividad y control, que incluyen niveles altos de ansiedad en el paciente y que se describen de la siguiente manera: a) La crítica. Originalmente fue definida como aquellos comentarios o aseveraciones los cuales, por la manera en que son expresados, constituyen comentarios desfavorables sobre la conducta o personalidad del individuo a quién se refiere. Es decir, muestran aversión o desaprobación de la conducta o las características de una persona. b) El sobreinvolucramiento o sobreprotección. Se presenta más comúnmente en los padres que en algún otro familiar; está compuesta por aspectos de sobreprotección o consentimiento, autosacrificio y malestar emocional, es similar al trato que generalmente se le da a un niño sobreprotegido, con niveles inapropiados de preocupación por parte del familiar. El paciente es visto como menos competente que antes y más vulnerable. c) La hostilidad. Se presenta cuando existe crítica, por lo que tiene poco valor como predictor independiente. Se considera que está presente cuando el paciente es atacado por lo que es, más que por lo que hace, lo que refleja una dificultad para tolerar y algunas veces para comprender la situación del familiar enfermo. El propósito de este trabajo consiste en mostrar la relación entre el tipo de Emoción Expresada (EE) (tanto alta como baja) por el familiar responsable (FR), y la Conducta Sintomática (CS), así como con el Funcionamiento Social (FS) del paciente con esquizofrenia. Se plantea también un modelo conceptual para evaluar los factores predictores de la EE alta. Se utilizó un diseño transversal de una muestra no probabilística y de tipo circunstancial, la selección fue de manera secuencial, los sujetos de estudio fueron 33 familiares responsables de pacientes con esquizofrenia, que asistían a la consulta externa de la Clínica de Esquizofrenia del Instituto Nacional de Psiquiatría Ramón de la Fuente, en la Ciudad de México. Los instrumentos empleados fueron: 1. Cédula de evaluación de la conducta del paciente (SBAS) y 2. Cuestionario-encuesta, evaluación del nivel de Emoción Expresada (CEEE). Los resultados indicaron que los familiares con EE alta observaron un mayor descuido personal, irritabilidad, violencia y aislamiento por parte del paciente, en tanto que los familiares con EE baja reportaron más miedos o temores, olvidos, dependencia e ideas extrañas como las conductas problemáticas de las personas enfermas. En los familiares con EE baja se observó un mejor funcionamiento en el desempeño de tareas domésticas, en la demostración de afecto, en las actividades realizadas en el tiempo libre, en la conversación y en la demostración de apoyo entre el informante y el paciente. El modelo de estudio demostró que la mayor presencia de CS y el menor nivel de FS del paciente, fueron variables predictoras de una interacción familiar con características de mayor demostración de crítica, hostilidad y/o sobreinvolucramiento, que explicó 46% de la varianza con niveles de significancia estadística.