Historically, measures of everyday functioning have focused exclusively on real-world performance. Despite the unquestionable value of "real-world functioning", it has become clear that instruments ...for its assessment might not be as accurate as desirable. Functional capacity is a domain of everyday functioning that can be assessed through performance-based measures. In the last decade, functional capacity has become a cornerstone for the assessment of everyday functioning, since, alongside measures of real-world functioning, it provides a much more comprehensive picture of functional outcomes than any measurement alone. Functional capacity is more stable and less vulnerable to influence from environmental factors than other domains, and its correlation with cognitive functions has encouraged the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) project to suggest that a performance-based measure of functional capacity be included as a co-primary assessment of cognition in clinical trials. Functional capacity assessment instruments may be also useful in the evaluation of remission in schizophrenia. Validation of these instruments in different countries is desirable, and should always include cross-cultural adaptation; within large countries, adjustment for regional variations should be considered.
To investigate the determinants of family burden in a sample of patients with schizophrenia and their caregivers.
Thirty-one stable patients with schizophrenia and their main caregivers were ...recruited. Sociodemographic variables were assessed in a semi-structured interview, and positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Cognitive performance was assessed with the Schizophrenia Cognition Rating Scale (SCoRS). Levels of burden on caregivers were assessed with the Family Burden Interview Schedule (FBIS). Interactions among variables were analyzed using Pearson correlations and linear regression analysis.
Objective and subjective FBIS scores were 1.9 (standard deviation SD = 0.5) and 2.4 (SD = 0.6) respectively. Objective burden correlated positively with positive and negative symptoms, and cognitive impairment. Subjective burden correlated positively with positive symptoms and negatively with mean age of disease onset. Positive, negative and cognitive symptoms accounted for 47.6% of the variance of objective burden, with negative symptoms accounting independently for 30.3%. Age of onset, parents as caregivers and positive symptoms accounted for 28% of the variance of subjective burden, with age of onset independently explaining 20.3%.
Patients' clinical and sociodemographic variables are important determinants of family burden in schizophrenia. Objective burden is predicted by symptoms, particularly negative ones. Subjective burden is predicted by symptoms and sociodemographic variables, particularly age of disease onset.
Abstract The UCSD Performance-based Skills Assessment (UPSA) is a measure of Functional Capacity and assesses skills involved in community tasks. It has good psychometrics properties, and is ...currently recommended as a co-primary assessment of cognition in the MATRICS Project. To our knowledge so far, there are no studies in western developing countries concerning Functional Capacity in Schizophrenia. The aims of this study were to translate, culturally adapt and validate the UPSA to assess Functional Capacity in community-dwelling patients with Schizophrenia living in Brazil. Eighty-two subjects (52 patients, 30 controls) were evaluated using: the Brazilian version of the UPSA (UPSA-1-BR), PANSS, Personal and Social Performance (PSP) and Global Assessment of Functioning (GAF). In the reliability test, UPSA-1-BR showed good Internal Consistency (Cronbach’s alpha of 0.88) and strong correlation between test and retest (4-month gap; r = 0.91; p < 0.01). Spearman’s rho values showed a moderate correlation between UPSA-1-BR and both PSP (0.50; p < 0.01) and GAF (0.46; p < 0.01) scores. UPSA-1-BR is capable of differentiating people with and without Schizophrenia. Patients scored lower than controls (58.9 versus 79.1), with an AUC of 0.79 (95%IC: 0.69–0.89). Sensitivity and specificity values of 0.71 and 0.70, respectively, were found in the cut-off point of 73.5, for separation of patients and controls, with predictive values of 80% (positive) and 58% (negative). UPSA-B-BR was also evaluated. UPSA-1-BR and its brief version presented adequate psychometric properties and proved to be valid and reliable instruments in the assessment of Functional Capacity in subjects with Schizophrenia.
Neuropsychiatric disorders are a leading source of disability and require novel treatments that target mechanisms of disease. As such disorders are thought to result from aberrant neuronal circuit ...activity, neuromodulation approaches are of increasing interest given their potential for manipulating circuits directly. Low intensity transcranial electrical stimulation (tES) with direct currents (transcranial direct current stimulation, tDCS) or alternating currents (transcranial alternating current stimulation, tACS) represent novel, safe, well-tolerated, and relatively inexpensive putative treatment modalities.
This report seeks to promote the science, technology and effective clinical applications of these modalities, identify research challenges, and suggest approaches for addressing these needs in order to achieve rigorous, reproducible findings that can advance clinical treatment.
The National Institute of Mental Health (NIMH) convened a workshop in September 2016 that brought together experts in basic and human neuroscience, electrical stimulation biophysics and devices, and clinical trial methods to examine the physiological mechanisms underlying tDCS/tACS, technologies and technical strategies for optimizing stimulation protocols, and the state of the science with respect to therapeutic applications and trial designs.
Advances in understanding mechanisms, methodological and technological improvements (e.g., electronics, computational models to facilitate proper dosing), and improved clinical trial designs are poised to advance rigorous, reproducible therapeutic applications of these techniques. A number of challenges were identified and meeting participants made recommendations made to address them.
These recommendations align with requirements in NIMH funding opportunity announcements to, among other needs, define dosimetry, demonstrate dose/response relationships, implement rigorous blinded trial designs, employ computational modeling, and demonstrate target engagement when testing stimulation-based interventions for the treatment of mental disorders.
•This NIMH workshop report seeks to promote the science, technology and effective clinical applications of tDCS and tACS.•Knowledge of how tES induces behavioral change in humans is limited. Mechanistic studies aimed at this question are needed.•Improved reporting of protocols and use of computational models to relate dose to current flow in brain will be important.•Predictive biomarkers, target engagement measures, and rigorous study designs are critical for advancing clinical trials.•The above elements align with requirements in NIMH funding opportunity announcements and are important for reproducibility.
This paper presents in-depth comparative analyses of nonlinear nonconvex programming (NLNCP) and second-order conic programming (SOCP) models to solve the optimal power flow problem in electric power ...systems. For comparative purposes, two objective functions are considered (1) minimization of the active power generation costs and (2) minimization of the active power losses in the transmission branches. The robustness and precision of the NLNCP and SOCP models are analyzed and discussed considering the feasibility of the active and reactive power balance constraints and the values of the objective functions. The obtained operational points are verified through the solution of the AC power flow problem using the Newton–Raphson method. For both models, numerical experiments show consistent active power dispatch; however, limit violations in the reactive power generation limits are observed in the solutions obtained by the SOCP model. To address this issue, two variations in the formulation of the SOCP model are proposed (1) considering a penalty factor in the generation of reactive energy and (2) considering a minimum resistance in branches of the power system that have resistance equal to zero. The solution of these modified SOCP models can eliminate or significantly reduce reactive power dispatch limit violations.
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