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Vulnerability and Social Functioning in Schizophrenia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis offers a broad approach in elucidating biological risk factors, as well as psychological and social functioning in schizophrenia. The aims are as follows: (I) investigate the association between birth characteristics and schizophrenia, (II) study the association between levels of neurotransmitter neuropeptide Y (NPY) in cerebrospinal fluid (CSF), social function and longitudinal outcome in schizophrenia, (III) compare social functioning of patients with schizophrenia with their biological siblings and (IV) explore how siblings to patients with schizophrenia perceive the sibling relationship and their role.

Paper I was a cohort analysis of 11,360 same-sexed twins in which obstetric records were used. Low birth weight and small head circumference were associated with later development of schizophrenia. To some extent the results persisted in the within-pair analyses conducted on 82 pairs discordant for schizophrenia.

Fifty-six patients with schizophrenia were included in paper II. Levels of NPY in CSF correlated to social competence at index admission. For each standard deviation increase in baseline NPY, there was a concomitant increased risk of being unemployed, having moderate or severe symptoms or recent hospitalization at the 3-year follow-up.

In paper III, social functioning was investigated using the Swedish version of the videotaped test Assessment of Interpersonal Problem Solving Skills (AIPSS) in 70 participants (25 patients with schizophrenia, 20 siblings and 25 randomly selected controls). The patients presented severe deficits in social functioning. The siblings expressed subtle impairments in nonverbal language but did not generally differ from the controls.

To explore the siblings’ perspective on schizophrenia a qualitative study was conducted with interviews of 16 siblings in paper IV. A unifying major theme was an emotional sibling bond. Siblings developed several coping patterns, including avoidance, isolation, normalization, care giving and grieving. A third major theme consisted of the fear of inheriting schizophrenia.

In conclusion, fetal growth, altered levels of NPY in CSF and subtle impairments in nonverbal social behavior might be important risk factors in schizophrenia. Patients with schizophrenia revealed extensive impaired social functioning, and from the siblings’ perspective, a brother or sister’s diagnosis of schizophrenia seems to have a profound psychological impact on the siblings.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 71 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 943
Keyword [en]
Coping, fetal growth, low birth weight, neuropeptides, outcome, problem solving skills, psychosis, risk factors, schizophrenia, siblings, social function, twins
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-209626ISBN: 978-91-554-8789-8 (print)OAI: oai:DiVA.org:uu-209626DiVA: diva2:658743
Public defence
2013-12-06, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-11-14 Created: 2013-10-22 Last updated: 2014-01-23
List of papers
1. Fetal growth restriction and schizophrenia: A Swedish twin study.
Open this publication in new window or tab >>Fetal growth restriction and schizophrenia: A Swedish twin study.
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2005 (English)In: Twin Research and Human Genetics, Vol. 8, no 4, 402-408 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-25200 (URN)
Available from: 2007-03-08 Created: 2007-03-08 Last updated: 2014-01-23
2. Neuropeptide Y, social function and long-term outcome in schizophrenia
Open this publication in new window or tab >>Neuropeptide Y, social function and long-term outcome in schizophrenia
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2014 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 156, no 2-3, 223-227 p.Article in journal (Refereed) Published
Abstract [en]

There is a lack of biomarkers in schizophrenia and the mechanisms underlying the observed deficits in social functioning are poorly understood. This cohort study aimed to explore whether neurotransmitter neuropeptide Y (NPY) in cerebrospinal fluid (CSF) from patients with schizophrenia is correlated to social function and clinical variables. A further aim was to determine whether baseline levels of NPY were associated with subsequent 3-year outcome. Fifty-six consecutively admitted patients with schizophrenia were included and underwent lumbar puncture and symptom ratings before antipsychotic treatment. NPY levels in CSF were determined by radioimmunoassay. Social function (Social Competence and Social Interest) was assessed by Nurses' Observation Scale for Inpatient Evaluation while psychiatric symptoms were rated using the Comprehensive Psychopathological Rating Scale. Three-year outcome was assessed with the Strauss–Carpenter Outcome Scale. Cross-sectional analysis showed a correlation between level of NPY and Social Competence at index admission (rs = 0.37, p < 0.05). The longitudinal analysis (i.e. at the 3-year follow-up) indicated that, for each standard deviation increase in baseline NPY, there was an increased risk of being unemployed (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.07–3.82), having moderate or severe symptoms (OR 3.09, CI 1.30–7.32) or being hospitalized at least 6 months the previous year (OR 3.24, CI 1.09–9.64). However, NPY was not correlated to Social Interest or clinical variables at index admission. In conclusion, NPY levels in CSF are correlated to Social Competence and seem to predict some aspects of longitudinal outcome in schizophrenia.

Keyword
Neuropeptides, Biological predictor, Social skills, Psychosis
National Category
Psychiatry
Research subject
Psychiatry; Neuroscience; Psychology
Identifiers
urn:nbn:se:uu:diva-209625 (URN)10.1016/j.schres.2014.04.006 (DOI)000341313200014 ()
Available from: 2013-10-22 Created: 2013-10-22 Last updated: 2017-12-06Bibliographically approved
3. Video-based assessment of interpersonal problem solving skills in patients with schizophrenia, their siblings and non-psychiatric controls
Open this publication in new window or tab >>Video-based assessment of interpersonal problem solving skills in patients with schizophrenia, their siblings and non-psychiatric controls
2008 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 49, no 1, 77-82 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to analyze social functioning in patients with schizophrenia and their biological relatives with a Swedish version of the video-based vignette test Assessment of Interpersonal Problem Solving Skills (AIPSS). In a new video production with simulated "real life" situations we tested the ability to receive, process and send social information in 25 individuals with a DSM-IV diagnosis of schizophrenia, 20 siblings to patients with schizophrenia and 25 randomly selected non-psychiatric controls. The test proved to have good validity and interrater reliability. After controlling for positive or negative symptoms, patients had poor performance especially in acting out solutions leading to effective problem solving. Siblings generally did not differ from controls, but showed some deficiencies in non-verbal language. To conclude, AIPSS is appropriate for use in a Swedish-speaking context and might be useful in research on vulnerability indicators and in assessment of treatment interventions.

Keyword
interpersonal problem solving skills, AIPSS, Swedish version, schizophrenia, siblings
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-141654 (URN)10.1111/j.1467-9450.2007.00615.x (DOI)000252210300009 ()18190405 (PubMedID)
Available from: 2011-01-12 Created: 2011-01-12 Last updated: 2017-12-11Bibliographically approved
4. Siblings of Patients With Schizophrenia: Sibling Bond, Coping Patterns, and Fear of Possible Schizophrenia Heredity
Open this publication in new window or tab >>Siblings of Patients With Schizophrenia: Sibling Bond, Coping Patterns, and Fear of Possible Schizophrenia Heredity
2004 (English)In: Schizophrenia Bulletin, Vol. 30, no 2, 445-458 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-73879 (URN)
Available from: 2005-07-11 Created: 2005-07-11 Last updated: 2014-01-23

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