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KJ Adhitya Putra W Ana Fitria Lisa Rachmayanti Rifqi Ali Zaki Sisilia Anggraeni 01.208.5578 01.209.5834 01.208.5702 01.208.5765 01.208.5783
Clinical Clerkship Psychiatry RSJ Prof. dr. Soerojo Magelang Medical Faculty of UNISSULA 2013
Atypical mild improvement in the Global Cognitive Index (speed of processing and learning tasks) and moderately better in neuropsychological tests
Improvement in attention
Anticholinergic drug
Impair memory
CATIE (Clinical Antipsychotic Trials for Intervention Effectiveness) EUFEST (European First-Episode Schizophrenia Trial) CUTLASS (Cost Utility of The Latest Antipsychotic Drugs in Schizophrenia Study) TEOSS (Treatment of Early Onset Schizophrenia Spectrum Disorder)
Antipsychotic drugs minimum neurocognitive improvement Benefit in firstepisode psychosis symptom reduction Cognitive enhancement practice effect Controversial
Hempel et al. Meta Analysis of 8 studies (Effects of antipsychotic medication on facial affect recognition in schizophrenia) No substansial improvement after treatment with either typical or atypical antipsychotic drug
Deficits in emotion perception are not significantly improved with atypical antipsychotic medication
Aim Asses emotional and cognitive functioning in schizophrenia patients currently treated with conventional or atypical antipsychotic drugs
Objectives Determine the extent and nature of emotional and attentional deficits in these patients
AGE
Medication Type
SE X
Evaluate relationship deficit to:
Education
Duration of illness
Current mood
Scale for
Scale for
Inform Consent
150 Participants
50 Controls
Atypical Antipsychotic
Olanzapine
Risperidone
Amisulpride Clozapine
39 Typical Antipsychotic
61 Atypical Antipsychotic
Quetiapine
Participants
SANS (Scale for The Assesment of Negative Symptom) SAPS (Scale for The Assesment for Positive Symptom)
Assesment
Exclusion Criteria
Inclusion Criteria
< 60 y.o. Completed BDI and instrument for self-rating of symptom of depression No history of psychiatric illness for participants in control group
Presence of Neurological Dissorder (Epilepsy, Dementia, etc) Habitual drug Alcohol abuse Difficulties with vision (poor acuity, lack of correction) Severe hearing problems Unable to complete the full set of tests Discharged before completing the experimental sessions
FERT (Facial Expression Recognition Test) Reading The Mind in The Eyes (Eyes Test) BEES (Balanced Emotional Empathy Scale)
Based on ecologically plausible activities searching maps, looking through telephone directories, and listening to lottery number broadcasts. This test provides norm-referenced scores on tests that are sensitive to selective attention, sustained attention and attentional switching. For study purposes, 3 subtests were used:
Visual selective attention map search task. Subjects search a map for
2 minutes. Auditory selective attention elevator counting with distraction task. Subjects count how many times they hear a tone, while ignoring a distracting tone of a higher note. Sustained visual attention visual elevator task. Subjects count each elevator door, imagining that it represents a floor. Both accuracy and timing are assessed
A forced-choice recognition memory test. It consists of 25 unfamiliar grey-scale male faces, which are presented at a rate of 1 every 3 seconds (timed by stop watch). The subject is required to respond yes or no to each item, depending on whether the face is judged to be pleasant or not. Recognition memory is assessed immediately after the presentation of the stimuli using a 2-choice format, each stimulus item being paired with 1 distracter item. The number of correct choices for each subtest was recorded.
computerized task based on 25 facial expressions from a standardized series. Subjects view prototypical facial expressions of the 6 basic emotions (fear, disgust, anger, surprise, happiness, sadness) and neutral facial expressions. They judge the emotion displayed by each facial expression.
measure of adult metalizing. It assesses how well the subject can put themselves into the mind of another person and empathies with their mental state. Subjects see 36 photographs of the eye region of unknown faces, and choose which of 2 words best describes what the person in the photo is thinking or feeling
A
The
full-length (30 item) BEES was used. When completing the scale, subjects were asked to state the extent to which they agreed or disagreed with 30 statements (examples: Unhappy movie endings haunt me for hours afterward; I cannot feel much sorrow for those who are responsible for their own misery) using a 9-point agreement-disagreement scale.
SPSS
Pearson Correlation
ANCOVAs
Results
The Independent Samples Ttest Controls outperformed patients in all tests (p<0.001)
Results
Atypical Antipsychotic Drugs
Less severely ill (lower mean scores on both SANS and SAPS) Less depressed (lower mean BDI score) Younger Lower numbers of admissions Shorter illness duration.
Results
Post-hoc Turkey Multiple Comparison
Instrument TEA SRMT FERT Eyes Test BEES Sa/Sc Mean Difference 1.14 0.36 0.91 2.27 4.83 P 0.43 0.82 0.48 0.89 0.59
Not Significant
Results
Highly Significant
Results
Pearson Correlations
FERT SAPS SANS Admission Illness Duration Age Sc (p) 0.004 0.001 0.001 0.001 0.001 Sa (p) 0.03 0.01 0.003 0.003 0.002
Results
Pearson Correlations
Eyes Test Admission Illness Duration P 0.01 0.002
Age
0.016
Results
Instrument Statistic Analysis Covariance BEES Pearson Correlation Atypical Antipsychotic BDI Education BDI SAPS SANS TEA Pearson Correlation Typical Antipsychotic Admission Duration of Illness Age Pearson Correlation Atypical Antipsychotic Admission Duration of Illness Education - BDI P 0.05
BEES - SANS
0.036
0.04 0.002 0.04 0.008 0.004 0.001 0.001 0.001 0.001 0.014 0.012
SMRT
Education
Control Group
Schizophrenia Patient
Difficulties in Schizophrenia
Recognizing emotions Empathizing with others and putting themselves into someone else shoes (theory of mind) Demonstrate deficits in understanding social instructions
Schizophrenia Deficits
Perception of emotions Scope of reading the state of mind of other people (theory of mind) The emotional empathy level Attention function
Schizophrenia patients did not show significant impairment in processing facial information.
Neither the positive effect of atypical antipsychotics nor the negative influence of conventional antipsychotic drugs on emotional and attentional functions in schizophrenia
The type of the antipsychotic drug used in the study (typical versus atypical) seems not to have a substantial effect on improvement or deterioration in emotional and cognitive domains
Hempel et al, Herbener at al, Penn et al, Sergi et al Selva Vera et al No statistically significant in effect of antipsychotic No greater cognitive drugs on restoring enhancement over 2 years emotional functioning in in patient with atypical schizophrenia antipsychotic, compared to those treated with typical antipsichotic
Patients with a diagnosis of schizophrenia compared with healthy people demonstrated the following deficits:
Facial emotion perception, Empathy/theory of mind, Attention (visual selective attention/speed, and attentional
switching).
There was no difference between the performance of atypical and conventional treated patient groups, even when controlling for the prescription of atypical antipsychotic drugs to younger, less severely ill patients.
Population Schizophrenia patients, age 18-60 years old, at the 4 weeks treatment, number of admisson: 1-16 Intervention Patients were received typical and atypical antipsychotic drugs Comparation Compared with control group Outcome Emotional and cognitive functioning in schizophrenia patients currently treated with conventional or atypical antipsychotic drugs
The
Abstrak
The Structure
Consist of 4 part Background, Material/Method, Results, Conclusion. There are key words. Informative : Yes Less than 250 words : Yes (211)
Background
Consist of two paragraph or part : No (9 paragraph) The first paragraph explain background of the
research : Yes The second paragraph explain hypothesis or objective : No (on paragraph 9) Less than one page : Yes
METHOD
: Cross Sectional : Department of Psychiatry, Lublin University of Medical School, Lublin, Poland Time : Not Mentioned
The Population
Achieved Population: Schizophrenia patients, age 18-60 years
old, at the 4 weeks treatment, number of admisson: 1-16 in Department of Psychiatry, Lublin University of Medical School, Lublin, Poland Target Population: Population:Schizophrenia patients, age 1860 years old
Inclusion and Exclusion Criteria : Mentioned Sampling Technique : Not mentioned Calculation of Sampling : Not mentioned Detail of Observation, calculation, and intervention for application in other research/clinical : Not mentioned
Blind
Medical School
Inform Consent Inform consent was obtained from each
Results
Characteristic
Subject Table : Included Characteristic Subject Before Intervention that was Compared with The Result : No Table Total Subject in Intervention : Was written Drop Out / Withdrawal : Was written] Accuracy of Numeric Data : Trusted Accuracy and Compability of Analytic Computer Program : Trusted Include The Result of The Analysis, Degree of Freedom and P Value : Included
Discussion
All of Relevan Thing are Discussed : Yes Not Repeated : Yes The Limitation : Was written The Previous Research : Included The Relation of Result and Clinical Process : Yes Side Effect : Yes Addition of The Research : No Data Statistic Analysis that Addition : Not written
Literarture The Structure : Appropiate with guidelines Appropiatewith Any Citation : Yes
old, at the 4 weeks treatment, number of admisson: 1-16 in Department of Psychiatry, Lublin University of Medical School, Lublin, Poland Target Population: Population:Schizophrenia patients, age 18-60 years old
Schizophrenia Patient
Subjective : Included
B. Internal Validity (Non-causal Relationship) 1. Was The Result Influenced by Bias? On Subject Selection
Prevalence Bias (Neyman Bias)
Cant be assesed (no prevalence data) Admission Rate Bias (Berksons Fallacy) No Bias. There is data of number admission Non-Response Bias Cant be assesed (no data) Membership Bias Cant be assesed (no data) Procedure Selection Bias Cant be assesed (no data)
o o o
o
o
2. Was the result influenced by opportunity factor? No 3. Was the observation influenced by confounding factor? No
D. External Validity
1. Can the result be applicated on the subject of this research? Yes 2. Can the result be applicated on achieved population? Yes, it can
3. Can the result be applicated on target population? Yes, it can