Efficacy of the combination of water aerobics and metacognitive training on psychological and physical health variables and their relationship with SP1 and SP4 biomarkers in people with psychosis: a study protocol.

Background: Metacognitive Training (MCT) is widely used and effective in reducing positive symptoms in psychosis. Physical exercise, such as Water Aerobics (WA), improves general health, quality of life and symptoms as a low impact activity that allows social interactions. Preliminary results suggest a relationship between dopamine and psychotic symptoms, through SP transcription factors, SP1 and SP4 biomarkers. The aims of the project are to evaluate the efficacy of a combined intervention (WA and MCT) for psychosis to improve psychotic symptoms, physical health, and transcription levels of SP biomarkers. Materials and methods: This is a unicentric randomized controlled trial of three parallel intervention groups: MCT, WA and combined intervention. The estimated sample will be 48 patients with a psychotic spectrum disorder diagnosis. The assessment will be performed at baseline and at 2-months' follow-up. Instruments used in the assessment will include clinical, cognitive, metacognitive, social cognitive and psychosocial variables. Discussion: This will be the first study investigating the impact of the combination of MCT and WA in psychosis. Moreover, it will be the first study analyzing changes in the transcriptional biomarkers SP1 and SP4 after interventions. The results of this study may have clinical implications contributing to the improvement of treatment selection. Clinical trial registration: https://clinicaltrials.gov/, identifier: NCT05455593.

Clinical symptoms and social functioning in schizophrenia.

INTRODUCTION: The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. MATERIAL AND METHODS: A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). RESULTS: SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05-0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. CONCLUSIONS: Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

Clinical symptoms and social functioning in schizophrenia / Síntomas clínicos y funcionamiento social en la esquizofrenia

Introduction: The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. Material and methods: A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). Results: SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05–0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. Conclusions: Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community. (AU)

Introducción: El objetivo del presente estudio fue evaluar la relación entre el funcionamiento social y los síntomas en las personas esquizofrénicas, analizando la influencia del funcionamiento social global y los aspectos específicos del funcionamiento social, la asertividad y las competencias de comunicación en la explicación del tipo de síntomas. Material y métodos: Se realizó un estudio descriptivo transversal integrado por 125 personas con diagnóstico de esquizofrenia. Se evaluó a los pacientes utilizando Communication Skills Questionnaire (CSQ), Gambrill and Richey Assertiveness Inventory (GR), Global Assessment of Functioning Scale (GAF) y Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale y Clinical Global Impression scale for Schizophrenia (CGI-S). Resultados: SOFAS, LSP y GR están relacionadas con cada una de las sub-escalas y puntuaciones totales de los síntomas (p<0,05-0,001). Las regresiones múltiples muestran que SOFAS y GR justifican el 59% de los síntomas totales. SOFAS y GR, que representan el 65% de la varianza, explican los síntomas positivos. GR y SOFAS justificaron el 34% de la varianza de síntomas negativos. SOFAS, CSQ y LSP, que representaron el 20% de la varianza, justificaron los síntomas depresivos. SOFAS justificó el 46% de la varianza de los síntomas cognitivos. Conclusiones: Nuestros hallazgos sugieren la utilidad de la evaluación del funcionamiento social para explicar los síntomas clínicos de las personas esquizofrénicas. Además, nuestros resultados apuntan que, no solo deberían considerarse en el proceso de rehabilitación los síntomas negativos y cognitivos, sino también los síntomas positivos y depresivos, a fin de mejorar la adaptación del paciente dentro de la comunidad. (AU)

Usability of a Psychotherapeutic Interactive Gaming Tool Used in Facial Emotion Recognition for People with Schizophrenia.

The objective of the study was to test the usability of 'Feeling Master' as a psychotherapeutic interactive gaming tool with LEGO cartoon faces showing the five basic emotions, for the assessment of emotional recognition in people with schizophrenia in comparison with healthy controls, and the relationship between face affect recognition (FER), attributional style, and theory of mind (ToM), which is the ability to understand the potential mental states and intentions of others. Nineteen individuals with schizophrenia (SZ) and 17 healthy control (HC) subjects completed the 'Feeling Master' that includes five basic emotions. To assess social cognition, the group with schizophrenia was evaluated with the Personal and Situational Attribution Questionnaire (IPSAQ) for the assessment of attributional style and the Hinting Task (ToM). Patients with SZ showed significant impairments in emotion recognition and their response time appeared to be slower than the HC in the recognition of each emotion. Taking into account the impairment in the recognition of each emotion, we only found a trend toward significance in error rates on fear recognition. The correlations between correct response on the 'Feeling Master' and the hinting task appeared to be significant in the correlation of surprise and theory of mind. In conclusion, this study demonstrated that the 'Feeling Master' could be useful for the evaluation of FER in people with schizophrenia. These results sustain the notion that impairments in emotion recognition are more prevalent in people with schizophrenia and that these are related with impairment in ToM.

Clinical symptoms and social functioning in schizophrenia.

INTRODUCTION: The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. MATERIAL AND METHODS: A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). RESULTS: SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05-0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. CONCLUSIONS: Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

Gender differences in social functioning in people with schizophrenia in psychosocial rehabilitation services using one-dimensional and multidimensional instruments.

Women with schizophrenia have shown better social and clinical functioning than men in several previous studies. The aim of this study was to assess gender differences in social functioning of people with a diagnosis of schizophrenia who are in psychosocial rehabilitation treatment in Catalonia, using several different one-dimensional and multidimensional measures of clinical and social functioning. Gender differences were found only in several daily life activities, in which women showed better functioning: independence-competence (p = 0.006) and independence-performance (p = 0.017). No other differences between genders were observed. Our results clearly suggest that women with schizophrenia undergoing the rehabilitation process could benefit as do men from psychosocial intervention in order to improve social skills and functioning.

Spanish version of the link´s perceived devaluaton and discrimination scale / Versión española de la escala Perceived Devaluation and Discrimination de Link

BACKGROUND: The aim of this study is to translate, adapt and validate the «Perceived Devaluation and Discrimination Scale» (PDD) in Spanish in a sample of people with schizophrenia. METHOD: A total of 130 people between 18 and 65 years and with a diagnosis of schizophrenia according to DSM-IV-R criteria from Barcelona and Vitoria were included. The patients were assessed with the translated version of the PDD, the Social Functioning Scale (SFS), the Global Assessment of Functioning (GAF), the Clinical Global Impression Scale (CGI-S) and the Self-perception of Stigma Questionnaire for people with schizophrenia (SSQ). RESULTS: The questionnaire scored a Cronbach's a of .868 regarding its internal consistency reliability. Two components were found in the factorial analysis explaining 40% of the variance of the instrument (component 1 associated with individual self-perception and component 2 refers more to social stigma). The stability of the instrument measured using the intraclass correlation coefficient on both occasions oscillated between .415 and .806. Significant correlations were found with SSQ and SFS. CONCLUSIONS: The Spanish version of the PDD seems a good instrument for the assessment of self stigma

ANTECEDENTES: el objetivo de este estudio es traducir, adaptar y validar la «Perceived Devaluation and Discrimination Scale» (PDD) en español en una muestra de personas con esquizofrenia. MÉTODO: se incluyeron un total de 130 personas de entre 18 y 65 años con un diagnóstico de esquizofrenia según los criterios del DSM-IV-R de Barcelona y Vitoria. Los pacientes fueron evaluados con la versión traducida de la PDD, la Escala de Funcionamiento Social (SFS), la Evaluación Global de Funcionamiento (GAF), la escala Clinical Global Impresión (CGI-S) y la autopercepción de Estigma Cuestionario para las personas con esquizofrenia (SSQ). RESULTADOS: la consistencia interna del cuestionario, evaluada utilizando a de Cronbach, fue .868. Dos componentes fueron encontrados en el análisis factorial explicando el 40% de la varianza del instrumento (componente 1 asociado a la auto-percepción y el componente 2 individual se refiere más al estigma social). Los valores de estabilidad temporal medidos utilizando el coeficiente de correlación intraclase en ambas ocasiones oscilan entre .415 y .806. Se encontraron correlaciones significativas con SSQ y SFS. CONCLUSIONES: la versión española de PDD parece un buen instrumento para la evaluación del auto-estigma

Development and validation of the Self-Stigma Questionnaire (SSQ) for people with schizophrenia and its relation to social functioning.

Self-stigma specifically in people with schizophrenia has been little studied. The aims of the present study were to validate a new instrument for the assessment of self-stigma (SSQ) and to assess the relationship between self-stigma and social functioning in people with schizophrenia. A sample of 76 people with schizophrenia was assessed at two moments in time with the SSQ, the PDD (stigma), two scales of social functioning (LSP, SFS), and a scale of general functioning (GAF). The results indicated that SSQ presented good psychometric properties, with Cronbach's alpha ranging between 0.75 and 0.901. The stability of the instrument was between 0.836 and 0.402. Three factors were found in the factor analysis (social discrimination, perceived capabilities, concealment of the disease), explaining 62.66% of the total variance. A relationship was found between self-stigma and social functioning in people with schizophrenia, especially in relation to social contact. In conclusion, the SSQ seems to be a valid and reliable questionnaire for the assessment of self-stigma in people with schizophrenia, and interventions should be designed to cope with self-stigma in order to improve the social functioning of people who suffer schizophrenia.

Validation of the Communication Skills Questionnaire (CSQ) in people with schizophrenia.

This present study describes the validation of the Communication Skills Questionnaire (CSQ) in people with schizophrenia. A total of 125 clinically stable people in rehabilitation treatment who were diagnosed with schizophrenia were included. For convergent and discriminant validity the following tests were administered; the Gambrill and Richie (GR) Assertiveness Inventory, the Social Functioning Scale (SFS), Life Skills Profile (LSP), Clinical Global Impression scale for schizophrenia (CGI-S) and the Global Assessment of Functioning (GAF) scale. Internal consistency of the CSQ had a Cronbach׳s alpha of 0.96. Test-retest reliability showed coefficients between 0.60 and 0.70. Convergent validity showed significant relations at p<0.0001 for all instruments assessed. None of the subscales used for assessing discriminant validity showed a significant correlation with the CSQ except for the CGI-S depression subscale. The instrument shows good psychometric properties and demonstrates that it is a useful instrument for evaluating communication skills in people with schizophrenia.

Instrumentos de evaluación en rehabilitación psicosocial / Assessment in psychosocial rehabilitation

Se realiza una revisión de los instrumentos de evaluación disponibles en castellano en seis áreas: rehabilitación psicosocial general, necesidades, discapacidad, calidad de vida, psicopatología y carga familiar (AU)

The paper reviews all the assessment instruments available in Spanish in six areas: general psychosocial rehabilitation, needs, disability, quality of life, psychopathology and family burden (AU)