Religiosity and Psychotic Ideation in Stable Schizophrenia: A Role for Empathic Perspective-Taking.

The relationship between religiosity and different components of empathy was explored in schizophrenia patients. A total of 81 stable schizophrenia patients and 95 controls from the nearby community completed self-reported questionnaires assessing religiosity and empathy (through the Interpersonal Reactivity Index, IRI). Patients with schizophrenia showed higher religiousness than controls and they presented less perspective-taking and empathic concern but increased personal distress in IRI scores. Regression analyses unveiled an association between religiosity and perspective-taking in schizophrenics after adjusting for age, gender, and psychotic symptoms. In conclusion, religiosity in patients with schizophrenia may be linked to variations in perspective- taking as a component of empathy.

Religiosidad y empatía en profesionales de un servicio de urgencias hospitalario / Religiosity and empathy in a hospital emergency department's staff

Objetivo: Evaluar nexos entre la religiosidad y la empatía de los médicos, enfermeros y auxiliares de enfermería de un servicio de urgencias hospitalario (SUH). Método: Estudio transversal mediante encuesta anónima y voluntaria, que contiene una escala de religiosidad y obtiene medidas de empatía con el índice de reactividad interpersonal. Resultados: Los tres grupos de profesionales mostraron perfiles homogéneos de baja religiosidad y puntuaciones normativas en la habilidad para captar el punto de vista ajeno y sintonizar con los sentimientos y padecimientos de los demás. No hubo, sin embargo, diferencias significativas entre esos grupos en ningún caso. La religiosidad mostró una vinculación tenue, aunque apreciable, con la medida de empatía total (R = 0,18, r2 = 0,03, p 0,02) y lo mismo ocurrió entre la toma de perspectiva (cognición empática) y el relativismo moral (pragmatismo ético) (R = 0,16, r2 = 0,02, p < 0,03). Conclusión: Aparecen indicios de vinculación entre la religiosidad y la empatía en los profesionales del SUH escépticos en materia religiosa. No se obtuvieron diferencias sustantivas, entre los distintos profesionales, ni en propensión religiosa ni en actitudes empáticas y la baja religiosidad no se acompañó de déficits en empatía. Esa homogeneidad quizás sea un reflejo de las exigencias, las normas y los roles de los sanitarios en urgencias

Objective: To assess relationships between religiosity and empathy in physicians, nurses, and assistant nurses in a hospital (ED). Methods: Cross-sectional study using an anonymous, voluntary questionnaire for assessing degree of religiosity and an instrument assessing empathy (interpersonal reactivity index). Results: The 3 staff groups were homogeneous in profile, showing a low degree of religiosity and normative scores on ability to see someone else's point of view and empathize with the feelings and suffering of others. No significant differences between groups were detected. Weak links were found between religiosity and overall empathy (R = 0.18, r2 = 0.03, P.02) and between perspective taking (cognitive empathy) and moral relativism (pragmatic empathy) (R = 0.16, r2 = 0.02, P<.03). Conclusions: There is light of a relationship between religiosity and empathy in ED staff who are skeptical about religion. No substantial differences between the 3 staff groups were noted with regard to religiosity or empathetic attitudes. Low religiosity did not accompany low empathy. The observed homogeneity may reflect the demands of emergency care as well as the roles assigned to caregivers and care guidelines

Cognitive executive performance influences functional outcome in euthymic type I bipolar disorder outpatients / El rendimiento cognitivo ejecutivo afecta al funcionamiento general de pacientes ambulatorios eutímicos con trastorno bipolar tipo I

BACKGROUND: There is a debate about the influence of executive functioning impairment in the functionality of Bipolar Disorder Type I, even when euthymic (EutBDI). The aim of this study was to explore this relationship, taking functional outcome from a multidimensional point of view. METHODS: An extended neuropsychological battery of executive tests and measures of social functioning were administered to 31 EutBDI and 25 non-psychiatric patients. Percentage of patients scoring lower than -1.64 SD was calculated for each executive measure. This was compared in terms of clinical features to those with normal performance. Partial correlations and ANCOVA were applied between psychosocial and executive variables within the EutBDI-group. RESULTS: Patients reached poorer scores in mental flexibility, plan implementing, set-shifting, and fluency (p < 0.05). 76% of patients performed poorly on some of the executive tests, although only around 1/3 reached a clinical deficit (<-1.64SD). Executive functioning was related to some clinical, evolution, and treatment variables. A better use of leisure time, higher competence for independent living and holding a skilled type of profession were significantly associated with a better performance on planning, set-shifting, and fluency tasks. CONCLUSIONS: Persistent executive deficits in EutBDI may be related to their frequently reported difficulties in personal and occupational adjustment

ANTECEDENTES: existe un debate sobre la influencia de los déficits de funciones cognitivas ejecutivas en la funcionalidad de los pacientes con Trastorno Bipolar Tipo I (TB-I), incluso aquellos eutímicos. Nuestro objetivo es explorar esta relación de forma multidimensional. MÉTODO: se administró una amplia batería de tests neuropsicológicos y ejecutivos en una muestra de 31 TB-I eutímicos y 25 adultos sanos. Porcentajes de pacientes puntuando por debajo de -1.64DE se calcularon para cada medida ejecutiva, comparándolos clínicamente con aquellos con ejecuciones normales. Se aplicaron correlaciones parciales y ANCOVAS entre cada variable psicosocial y ejecutiva del grupo TB-I. RESULTADOS: los pacientes puntuaron peor en flexibilidad mental, implementación de planes, atención dividida y fluencia (p < 0.05). Un 76% de los pacientes realizaron pobremente los test ejecutivos, pero solo 1/3 alcanzó déficit clínico (<-1.64 SD). La función ejecutiva se relacionó con determinadas variables clínicas, de evolución y de tratamiento. Mejores resultados en tareas de planificación, atención dividida y fluencia se asociaron con un mejor uso del tiempo libre, mayores competencias para vivir independientemente y disfrutar de una profesión compleja. CONCLUSIONES: los déficits persistentes en las funciones ejecutivas en pacientes bipolares eutímicos pueden relacionarse con las dificultades que refieren en su ajuste personal y ocupacional

Cognitive executive performance influences functional outcome in euthymic type I bipolar disorder outpatients.

BACKGROUND: There is a debate about the influence of executive functioning impairment in the functionality of Bipolar Disorder Type I, even when euthymic (EutBDI). The aim of this study was to explore this relationship, taking functional outcome from a multidimensional point of view. METHODS: An extended neuropsychological battery of executive tests and measures of social functioning were administered to 31 EutBDI and 25 non-psychiatric patients. Percentage of patients scoring lower than -1.64 SD was calculated for each executive measure. This was compared in terms of clinical features to those with normal performance. Partial correlations and ANCOVA were applied between psychosocial and executive variables within the EutBDI-group. RESULTS: Patients reached poorer scores in mental flexibility, plan implementing, set-shifting, and fluency (p<0.05). 76% of patients performed poorly on some of the executive tests, although only around 1/3 reached a clinical deficit (<-1.64SD). Executive functioning was related to some clinical, evolution, and treatment variables. A better use of leisure time, higher competence for independent living and holding a skilled type of profession were significantly associated with a better performance on planning, set-shifting, and fluency tasks. CONCLUSIONS: Persistent executive deficits in EutBDI may be related to their frequently reported difficulties in personaland occupational adjustment.

Influence of the neuropsychological functions in theory of mind in schizophrenia: the false-belief/deception paradigm.

The aim of this study was to investigate the influence of neurocognition in a false-belief/deception theory of mind (ToM) task in a sample of patients with schizophrenia. In a cross-sectional study of 43 remitted patients, the implication of neurocognition in first- and second-order ToM stories was analyzed, controlling for clinical symptoms and duration of illness. None of the cognitive factors were associated with the first-order ToM stories. A logistic regression model with high specificity (96.3%) and sensitivity (75%) was obtained in the second-order ToM story "The Burglar," the Information subtest (odds ratio [OR], 0.783; 95% confidence interval [CI], 0.62-0.99; p = 0.04) and the Block Design subtest (OR, 0.89; 95% CI, 0.79-1; p = 0.056) of the Wechsler Adult Intelligence Scale-III being the best predictive factors. Neurocognition was not related to first- or second-order ToM false-belief performance of the patients with schizophrenia. However, an influence of neuropsychological variables in the second-order ToM deception was observed. The clinical implications in the assessment of ToM are discussed.

Suicidality connected with mentalizing anomalies in schizophrenia: a study with stabilized outpatients.

Deficits in social cognition contribute to the severe difficulties in daily functioning of schizophrenic patients, although they have never been connected with suicidality. Theory of mind (ToM) tasks explore basic social abilities and have been found to be defective in schizophrenia. The relationship between ToM anomalies and suicidal history was studied in a sample of 57 stabilized outpatients. Logistic regression analysis showed an association between poor performance on second-order ToM tasks and a greater likelihood of suicidality in schizophrenic patients (OR = 4.02, 95% CI 1.18-13.62), which was independent of current clinical and neuropsychological status, with the exception of poor premorbid adjustment in infancy and adolescence. We caution against potential biases from mixing cross-sectional ToM scores with lifetime suicidal records and retrospective assessments of premorbid adjustment through repeated testing of patients and their relatives. Hence, the present findings suggest that ToM deficits may contribute to the high risk of suicide in schizophrenia.

Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients.

BACKGROUND: Poor insight and impairment in Theory of Mind (ToM) reasoning are common in schizophrenia, predicting poorer clinical and functional outcomes. The present study aimed to explore the relationship between these phenomena. METHODS: 61 individuals with a DSM-IV diagnosis of schizophrenia during a stable phase were included. ToM was assessed using a picture sequencing task developed by Langdon and Coltheart (1999), and insight with the Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al., 1993). Multivariate linear regression analysis was carried out to estimate the predictive value of insight on ToM, taking into account several possible confounders and interaction variables. RESULTS: No direct significant associations were found between any of the insight dimensions and ToM using bivariate analysis. However, a significant linear regression model which explained 48% of the variance in ToM was revealed in the multivariate analysis. This included the 5 insight dimensions and 3 interaction variables. Misattribution of symptoms--in aware patients with age at onset >20 years--and unawareness of need for medication--in patients with GAF >60--were significantly predictive of better ToM. CONCLUSION: Insight and ToM are two complex and distinct phenomena in schizophrenia. Relationships between them are mediated by psychosocial, clinical, and neurocognitive variables. Intact ToM may be a prerequisite for aware patients to attribute their symptoms to causes other than mental illness, which could in turn be associated with denial of need for medication.

Theory of mind deficits in chronic schizophrenia: evidence for state dependence.

There is evidence that people with schizophrenia show specific deficits in theory of mind (ToM). However, it is a matter of debate whether these are trait or state dependent, and the nature of the relationship between ToM deficits and particular symptoms is controversial. This study aimed to shed further light on these issues by (1) examining ToM abilities in 61 individuals with chronic schizophrenia during a stable phase as compared with 51 healthy controls matched by gender, age, educational level and current IQ, and (2) exploring the relationship between ToM and symptoms. Second order verbal stories and a non-verbal picture-sequencing task were used as ToM measures. Results showed no differences in ToM performance between patients and controls on either measure. Subsequent subgrouping of patients into remitted and non-remitted showed a worse performance of non-remitted patients only on second order ToM tasks. Specific ToM deficits were found associated with delusions. Association with negative symptoms was found to be less specific and accounted for by illness chronicity and general cognitive impairment. The results from the present study are in line with models which hypothesise that specific ToM deficits in schizophrenia are state dependent and associated with delusions. Such associations may also be task specific.

Discharge against medical advice at a general hospital in Catalonia.

Some studies on discharge against medical advice (AMA) in general hospitals report a prevalence between 0.7-7% with 11-42% of this population identified as psychiatric patients. To study the sociodemographic and psychopathological features of patients who leave AMA, we performed a retrospective case-control comparison study of length of hospitalization and presence of psychiatric disturbances on patients who left AMA from the University General Hospital in Catalan Spain over a two-year period. An analysis of the hospital epidemiological discharge register and retrospective chart review for presence of psychiatric disturbances found that AMA prevalence was 0.34%, the total discharge number in the 2-year period being 41,648. AMA rates by medical department were 0.44% for the internal medicine department; 0.24% for surgery; 0.26% for orthopedic surgery, 0.32% for obstetrics-gynecology and 0.93% for rehabilitation. The mean age for AMA patients was 38.63 years, with a higher number of men (59.9%). A total of 45.8% AMA discharges were from the internal medicine department. No significant differences were found in the average length of hospitalization between the AMA and control groups. The presence of psychiatric pathology was significantly higher among the AMA group (P<.05). The prevalence of AMA at our hospital was low in comparison to the rates reported in the literature. The patient at high risk for AMA discharge is a young man with a history of psychiatric pathology, mainly narcotic dependence.