Recovery in schizophrenia: focus on neurocognitive functioning.

Recovery encompasses symptom remission and functional elements such as cognition, social functioning and quality of life. Personal recovery is also important in illness management to help the person stay on track with treatment and focus on activities unrelated to taking medication that maintain mental health. In the present study we aimed to identify neurocognitive functioning in two clinically stable groups of patients with personal recovery and non-recovered patients. The results showered generalized cognitive deficits in both groups while the non-recovery group was more impaired in verbal and visual memory, acoustic and tactile gnosis and neurodynamics and executing functioning. Interestingly the recovery group demonstrated lack of programming of actions and sufficient error monitoring and self-correction whereas the non-recovery group was significantly more impaired in all executive domains. The obtained results could be beneficial in identifying a target for psychosocial treatments and specifically cognitive remediation for patients with schizophrenia to facilitate the process of recovery.

Dehydration among long-term care elderly patients with oropharyngeal dysphagia.

INTRODUCTION: Long-term care (LTC) residents, especially the orally fed with dysphagia, are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly. However, combinations of these indices are more reliable. OBJECTIVE: Assessment of hydration status among elderly LTC residents with oropharyngeal dysphagia. METHODS: A total of 28 orally fed patients with grade-2 feeding difficulties on the functional outcome swallowing scale (FOSS) and 67 naso-gastric tube (NGT)-fed LTC residents entered the study. The common laboratory, serum and urinary tests were used as indices of hydration status. The results were considered as indicative of dehydration and used as 'markers of dehydration', if they were above the accepted normal values. RESULTS: The mean number of dehydration markers was significantly higher in the FOSS-2 group (3.8 +/- 1.3 vs. 2 +/- 1.4, p = 0.000). About 75% of these FOSS-2 patients had > or =4 dehydration markers versus 18% of the NGT-fed group (p = 0.000). A low urine output (<800 ml/day) was significantly more common in the FOSS-2 group (39 vs. 12%, p = 0.002). Above normal values of blood urea nitrogen (BUN), BUN/serum creatinine ratio (BUN/S(Cr)), urine/serum osmolality ratio (U/S(Osm)), and urine osmolality U(Osm), were significantly more frequent in the dehydration-prone FOSS-2 group. This combination of 4 indices was present in 65% of low urine output patients. In contrast, it was present in only 36% of the higher urine output patients (p = 0.01). Patients with a 'normal' daily urine output (>800 ml/day) also had a significant number (2 +/- 1.5) of positive indices of dehydration. CONCLUSIONS: Dehydration was found to be common among orally fed FOSS-2 LTC patients. Surprisingly, probable dehydration, although of a mild degree, was not a rarity among NGT-fed patients either. The combination of 4 parameters, BUN, BUN/S(Cr ), U/S(Osm) and U(Osm), offers reasonable reliability to be used as an indication of dehydration status in daily clinical practice.