Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Reviews
Full Version
Cognition and Functional Recovery in Severe Mental Disorders-A Narrative Review
Correspondence Address :
Dr. Suvarna Jyothi Kantipudi,
F-30, Staff Quarters, SRMC College Campus, Porur, Chennai-600116, Tamil Nadu, India.
E-mail: suvarna.srmc@gmail.com
Severe Mental Illness (SMI) like schizophrenia and mood disorders has a prolonged and strenuous course which takes a major toll on the lives of the patients. In an effort to understand the consequence of these illness functional recovery has been studied in detail in the past. Cognitive impairment has been identified as an important contributor to the functional recovery. Cognitive impairment is an important component, independent of the symptoms, of SMI. Various cognitive deficits are found to occur in patients with SMI. Patients with lesser cognitive deficits were found to have better outcomes. This narrative review explains about cognitive impairment and functional outcome in people with SMI and the existing evidence for the relationship between both. Authors had performed manual search strategy of PubMed, Google Scholar engines for relevant research publications and reviewed them along with cross references from the retrieved articles. A broad review on the research shows, cognitive impairment has been recognised in both patients with schizophrenia and bipolar disorder even during periods of symptomatic remission and that people with symptomatic recovery continued to have functional deficits. This review also showed that patient with lesser cognitive deficits had better outcomes. Keeping this in mind, cognitive rehabilitation should be made a part of the management of SMI to achieve complete functional recovery.
Neurocognition, Psychiatric disorders, Remission
The Severe Mental Illness (SMI) in psychiatry involves a range of mental illnesses, of which psychotic disorders and mood disorders form a major part (1). People with SMI experience many obstacles on their path to recovery leading to lifelong disability and functional impairment (2). Recovery in SMI is a dynamic concept, which contributes significantly to societal and economic burden, when disrupted. Recovery is no longer seen as clinical improvement alone, but as a holistic approach, where the aim is to help individuals with SMI live independently and reintegrate into the society. Un-remitting symptoms, treatment failure, co-existing medical illness, cognitive deficits, lack of insight, lack of psychosocial support are some of the factors contributing to the disability (3). The role of cognition in recovery has made it a key area of focus in psychiatric conditions. Impairment in cognition has been found to occur in SMI like schizophrenia and mood disorders. While looking at cognition in SMI, a number of factors relating to the symptoms, prognosis and management have come to light. A review of previous literature on the role of cognition in SMI, concept of functional recovery in SMI and the relationship between cognitive impairment and functional recovery has been presented in this article.
Literature search: Manual search was performed in PubMed, Google Scholar and other relevant publications were reviewed by the authors. The search terms used in PubMed were cognitive impairment AND schizophrenia OR Bipolar disorder, Functional recovery AND schizophrenia OR Bipolar disorder. Obtained articles were filtered based on the title and abstract by searching the electronic databases. Around 200 articles were retrieved based on clinical relevance and cross reference from the articles. A total of 69 articles were reviewed by both the authors (Table/Fig 1).
What is Cognition?
Cognition in essence refers to acquiring, understanding, and processing of information (4). It entails many conscious (as well as unconscious) mental activities like attention, working memory, execution, learning, problem solving, judgement, insight, etc., (5). Many of the cognitive functions are unique to the human species (6). The neural correlation of cognition is attributed to the sustained firing of neurons in the Dorsolateral Prefrontal Cortex (DLPFC) (7). Functional imaging studies have made it possible to understand how certain cognitive functions are related to specific regions of the cerebral cortex (6). Cognition is a highly complex ensemble of activities which interacts with affective domain as well. The state of cognition influences emotional well-being and similarly affective changes do influence the cognitive status (6),(8).
Assessment of cognition: Evaluation of cognitive functions is essential to identify the domains affected and the cortical regions involved in the disorder causing cognitive disturbances. Many tools have been introduced over the years to screen for cognitive impairment (9).
Mini Mental State Examination (MMSE): MMSE is a widely used tool for cognitive assessment by clinicians. It can be administered in <10 minutes and it is scored out of 30. It tests attention, orientation, verbal fluency, memory, abstraction. Lesser weightage is given testing visuospatial skills (10).
Montreal Cognitive Assessment (MoCA): MoCA is scored out of 30, and it tests visuospatial skills, executive function, memory, verbal fluency, attention, abstraction. MoCA has a higher sensitivity in detecting MCI (11).
Adden brooke’s Cognitive Examination (ACE) III: ACE-III covers a wide range of cognitive domains including attention, calculation, executive functions, verbal fluency, language, memory. It is scored out of 100 and a score of 88 is the cut-off. It takes about 20-30 minutes more than other screening tools (12).
Various neuropsychological tests are used to assess individual domains of cognition (Table/Fig 2) (13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23).
Cognition in Severe Mental Illness (SMI)
Cognitive impairment is a term used to describe abnormalities in any of the multiple domains of cognition (5). Some areas of cognitive impairment present in SMI range from inattention, difficulty in concentrating, working memory deficits, visuospatial deficits etc., (6). Cognitive deficits have been identified in schizophrenia, even before the onset of psychotic symptoms (24). Moderate to severe impairments have been found to co-occur during the first episode of psychosis (24). Impairment in attention, verbal learning and memory, verbal fluency, executive function has been identified in schizophrenia (5). Over the years, researchers have determined that cognitive deficits persisted in individuals with schizophrenia who were in remission (25). Research has confirmed that after statistical adjustment for Positive and Negative Symptoms Scale (PANSS) and IQ scores, patients with schizophrenia continued to have cognitive deficits (26). Recent studies have also shown cognitive impairment in patients with bipolar disorder, particularly in the areas of attention, executive function, and verbal memory during remission (5),(27). The severity of cognitive impairment correlates with number and severity of the episodes (27).
While looking at why cognitive deficits in SMI are important, authors come to understand that cognitive impairment plays an important role in determining the functional outcome of SMI making it an important component of treatment.
The Road to Recovery
What functional recovery means has been a sector of active research over many years. According to various researchers, psychosocial well-being has been explained as independence and living a meaningful life (28). Independence in terms of taking charge of their personal needs of daily living, medications, and their finance (28). Additionally, being able to find a job or return to work and receive remuneration for their work is also a part of psychosocial well-being. A person who has recovered from a psychiatric illness should be in a position to effectively communicate with others, live as a part of a family, integrate into community and fulfill their age appropriate role in the society with the least impact of the illness on the patient, the family and the community (26),(29).
Investigations into the details of what hampers functional recovery in patients with SMI, a multifold of elements have come into light (30). Environmental agents, history of substance use, familial support have been found to have a role in predicting functional recovery (31),(32). However, neurocognition, negative symptoms and personalised stigma towards the illness have stood out among the determinants (33).
Functional Recovery in Severe Mental Illness (SMI)
My whole mental power has disappeared, I have sunk intellectually below the level of a beast” (a patient with schizophrenia, quoted by Kraepelin, 1919, p. 25) (34).
Schizophrenia is a complex and SMI which is chronic, heterogeneous, and incapacitating. The remission in Schizophrenia Working Group defined symptomatic remission in schizophrenia as “the state in which the patient shows improvement in signs and symptoms, to such an extent that they do not interfere significantly in their behavior, and they are below the diagnostic threshold” (35). Advances in therapeutic approaches have made it possible today to help patients with schizophrenia achieve symptomatic remission (36). Nevertheless, schizophrenia remains to be one of the top 10 causes of disability and causes a high degree of global burden, making functional recovery an important area to be addressed in the future (29).
Functional recovery in schizophrenia is a multi-dimensional theory which entails personal, social, interpersonal, occupational domains (36). Studies have found that the patients with schizophrenia have difficulty in acquiring and maintaining jobs, establishing social relationships, and living independently [24,37,38]. Bipolar disorder was initially thought to be an episodic illness with inter-episodic premorbid level functioning. However, recent studies have shown that patients with bipolar disorder do not achieve their premorbid psychosocial functioning even during remission (39),(40),(41). Bipolar disorder patients continue have deficits in various domains of functional recovery.
Assessment of Functional Impairment
Several tools are used worldwide to assess functional impairment. The commonly used tools are:
WHO Disability Assessment Scale (WHODAS) 2.0 (42): WHO Disability Assessment Scale 2.0 is a reliable instrument developed by World Health Organisation (WHO) that can be used across cultures to assess disability. There are 2 versions, a self-administered 36 item score and a shorter 12 item version that can be administered in 5 minutes. It covers six domains, and each domain is scored between 0 and 4 (42).
Indian Disability Evaluation and Assessment Scale (IDEAS) (43): The Indian Disability Evaluation and Assessment Scale (IDEAS) were introduced by Indian Psychiatric Society in 2001. Self-care, interpersonal activities, communication, and work are the 4 areas assessed in IDEAS. Each area is scored between 0 and 4 (43).
Global Assessment of Functioning (GAF) (44): GAF scale was developed to rate Axis 5 of DSM 4. It is a 100-point scale that is rated by clinicians. Significant weightage is given to symptoms in GAF, which can lead to biases in scoring. Individuals with persistent symptoms might score lesser despite good functioning (44).
WHO Quality of Life (WHOQOL) (45): WHO has developed WHOQOL to assess the quality of life. This instrument helps to capture many subjective aspects of quality of life among patients. 2 versions WHOQOL 100 and WHOQOL BREF are available. WHOQOL 100 gives scores of individual facets (positive feelings, support etc.,) while WHODAS BREF gives scores of the domains (psychological, social, and physical) (45),(46).
Social and Occupational Functioning Scale (SOFAS) (47): SOFAS was designed to rate Axis 5 of DSM 4. It is scored between 0-100, lower scores denote lower level of functioning. It differs from GAF by focusing on functioning rather than individual symptoms (47),(48).
Relationship between Cognitive Deficits and Functional Outcome
Multiple studies have proved that patients with schizophrenia had deficits in cognitive domains that have translated to disabilities in life activities and participation (49)[,50]. Association between verbal memory and living either independently or in a community has been found (51). Deficits in language, visuospatial ability, verbal memory has been associated with performing activities of daily living (51). Associations between attention and performing life skills and work performance have been identified (51). Similarly, patients with bipolar affective disorders during their euthymic states continued to live with occupational and social impairment (52). The neurocognitive domains affected in patients with bipolar disorders during euthymic phase includes impairments in executive functions, attention deficits, working memory (52),(53). Research has shown associations between psychosocial functioning and verbal memory, attention deficits as well (38). The (Table/Fig 3) below summarises the findings of different studies involving cognitive deficits and functional outcome in schizophrenia and bipolar patients in the last two decades (54),(55),(56),(57),(58),(59),(60),(61),(62),(63),(64),(65),(66),(67).
With this in mind, cognitive remediation therapy has become a focus of patient rehabilitation. Cognitive remediation therapy has been defined as “a behavioral training-based intervention that aims to improve cognitive processes (attention, memory, executive function, social cognition, or metacognition) with the goal of durability and generalisation” (68). It uses simple tasks and exercises that were found to have a huge effect in improving cognitive functions in people with mental illness (69).
A high proportion of patients with SMI have persisting disability and poor quality of life. This is a matter of concern, as it adds significantly to the global burden. From review of research, it can be understood that people with SMI continue to have cognitive deficits inspite of symptomatic recovery. And the significant role of cognitive impairment in the functional recovery of patients with SMI like schizophrenia and bipolar disorder has been identified. Consequently, it can be concluded that targeting cognitive enhancement will go a long way in the rehabilitation and reintegration of patients with schizophrenia and bipolar disorders into the society.
DOI: 10.7860/JCDR/2023/59557.17638
Date of Submission: Aug 08, 2022
Date of Peer Review: Oct 06, 2022
Date of Acceptance: Nov 16, 2022
Date of Publishing: Mar 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 13, 2022
• Manual Googling: Oct 12, 2022
• iThenticate Software: Nov 08, 2022 (18%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com