Reducing negative symptoms in schizophrenia: Feasibility and acceptability of a combined cognitive-behavioral social skills training and compensatory cognitive training intervention

Serum Levels of Tumor Necrosis Factor-α and Vascular Endothelial Growth Factor in the Subtypes of Clinical High Risk Individuals: A Prospective Cohort Study

Introduction

Numerous studies have established the roles of inflammation and angioneurins in the pathogenesis of schizophrenia (SCZ). This study aimed to compare the serum levels of tumour necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF) in patients at clinical high risk (CHR) for psychosis or SCZ at baseline and one year after treatment.

Methods

A total of 289 CHR participants from the Shanghai At Risk for Psychosis Extended Program (SHARP) were tracked for a year. They were divided into two and four subtypes based on symptom severity according to the Structured Interview for Prodromal Syndromes (SIPS) and received standard medical care. At baseline and one-year follow-up, TNF-α and VEGF were detected using enzyme-linked immunosorbent assay, and pathological features were assessed using the Global Assessment of Function (GAF) score.

Results

Baseline TNF-α levels did not differ significantly, while VEGF levels were lower in patients with more severe symptoms. VEGF showed a negative correlation with negative features, both overall (r = -0.212, p = 0.010) and in the subgroup with higher positive scores (r = -0.370, p = 0.005). TNF-α was positively correlated with negative symptoms in the subgroup with higher negative scores (r = 0.352, p = 0.002). A three-way multivariate analysis of variance demonstrated that participants in Subtype 1 of positive or negative symptoms performed better than those in Subtype 2, with significant main effects and interactions of group and both cytokines.

Discussion

TNF-α and VEGF levels are higher and lower, respectively, in CHR patients with more severe clinical symptoms, particularly negative symptoms, which point to a worsening inflammatory and vascular status in the brain.

A Patient-Clinician Discussion of Current Challenges in Schizophrenia Part 2: Negative Symptoms in Schizophrenia [Podcast]

Dr John Kane discusses negative symptoms in schizophrenia alongside fellow expert, Dr William Carpenter, and Mr Matthew Racher, a Certified Recovery Peer Specialist and dedicated advocate for people living with schizophrenia, who is currently studying for his Master of Social Work (MSW) in Miami, Florida. In this podcast, the authors discuss challenges and opportunities faced by patients and clinicians in the assessment and treatment of negative symptoms. They also touch upon emerging therapeutic strategies, with the aim of raising awareness of the unmet therapeutic needs of those living with negative symptoms. Mr Racher provides a unique patient perspective to this discussion, drawing on his own daily experiences of living with negative symptoms, as well as offering positive insights from his recovery from schizophrenia.

Association between motivation and engagement with changes in cognition and symptoms after digital cognitive training in schizophrenia

BACKGROUND

Digital cognitive training can remediate cognitive deficits present in schizophrenia. However, limited motivation and engagement may impact adherence to training. Therefore, identifying factors that may enhance (facilitators) or decrease (barriers) engagement in digital cognitive training and possibly modulate its effects are of great clinical relevance.

METHODS

We measured cognition, symptom severity, motivation (semi-structured interview), and engagement (adapted Utrecht Work Engagement Scale - UWES) of 27 patients with schizophrenia after a 40-h digital cognitive training. The interview transcript quotes were coded and categorized into facilitators and barriers. Thereafter, we tested the association of motivation and engagement with changes in cognition and symptoms after training.

RESULTS

The facilitator 'good performance' and the barrier 'difficult exercise' were associated with larger gains in attention (p = 0.03) and reasoning and problem solving (p = 0.02), respectively. 'Poor performance' was associated with smaller gains in global cognition (p < 0.01), attention (p = 0.03), and working memory (p = 0.02). The facilitator 'welcoming setting' was associated with larger reductions in the negative (p = 0.01) and total (p = 0.01) symptoms measured by the Positive and Negative Syndrome Scale. The UWES engagement scale was associated with different facilitators and barriers that emerged from the interview, an indication of consistency among both qualitative and quantitative assessments.

DISCUSSION

Using a mixed quantitative and qualitative research design, we showed associations between motivation and engagement and the response to digital cognitive training in schizophrenia. Facilitators and barriers were associated with engagement, gains in cognition, and reduced symptoms after the intervention, providing insights on how to increase engagement in the digital cognitive training delivered to subjects with schizophrenia.

The effect of cognitive behavioral therapy-based psychoeducation on internalized stigma and functional remission in individuals diagnosed with schizophrenia

PURPOSE

The aim of this study is to determine the effect of cognitive behavioral therapy-based psychoeducation provided to individuals diagnosed with schizophrenia on internalized stigma and functional remission.

DESIGN AND METHODS

The study was conducted based on the quasi-experimental design with pretest-posttest control group with 100 individuals, who were diagnosed with schizophrenia, in a Community Mental Health Center between September 2020 and June 2021.

FINDINGS

It was determined that after the cognitive behavioral therapy-based psychoeducation, the internalized stigma level decreased and the functional remission level increased in the experimental group compared with the control group.

PRACTICE IMPLICATIONS

In the study, it was determined that the experimental and control groups had low levels of functional remission and high levels of internalized stigma before the cognitive behavioral therapy-based psychoeducation, and the functional remission levels increased and the internalized stigma levels decreased in the experimental group compared with the control group after the cognitive behavioral therapy-based psychoeducation.

The Effect of Social Cognitive Interaction Training on Schizophrenia: A Systematic Review and Meta-Analysis of Comparison with Conventional Treatment

Background

Existing antipsychotic medications may alleviate the majority of patients' symptoms, but they have no discernible impact on improving social function and quality of life. Psychotherapy is required for the treatment of schizophrenia. However, contemporary psychotherapy technology intervention techniques are limited to a single intervention, and there is a lack of holistic and complete intervention approaches. Social cognition and interaction training is a comprehensive therapy strategy that has been employed in clinical practice; however, the therapeutic efficacy has been inconsistently reported. As a result, we included controlled clinical trials for meta-analysis in order to carefully assess the efficacy of this therapy.

Methods

This meta-analysis searched all RCT literatures related to social cognitive interaction training (SCIT) published before April 2022 and assessed the effect of this method in the treatment of schizophrenia. The data in the literatures were combined, and the standardized mean difference (SMD) and mean difference (MD) with 95% confidence interval (95% CI) were calculated to predict the negative symptom score, positive symptom score, PANSS score, and social function score of the patients after treatment.

Results

14 RCT studies including 1167 inpatients with schizophrenia were included in this study using a retrospective observational study method, including 590 patients treated with SCIT and 577 patients treated with treatment as usual (TAU). The pooled analysis showed that patients after SCIT had lower negative symptom scores (SMD = -1.66, 95% CI (-2.32, -1.00), P < 0.0001), lower positive symptom scores (MD = -4.03, 95% CI (-7.69, -0.36), P = 0.03), lower PANSS total scores (MD = -6.33, 95% CI (-12.43, -0.23), P = 0.02), and higher social functioning scores (SMD = 0.77, 95% CI (0.34, 1.20), P < 0.001) than those after TAU.

Conclusion

Our findings support that SCIT is helpful to improve the relief of symptoms and the improvement of social function in patients with schizophrenia, providing a basis for the application of SCIT in hospitalized patients and community patients, and can guide the treatment and intervention of patients with schizophrenia.

Modifiable predictors of self-reported and performance-based functioning in individuals with schizophrenia-spectrum disorders and high levels of negative symptoms

Individuals with schizophrenia who have high negative symptoms are at high risk for poor functional outcomes. However, the determinants of psychosocial functioning in this group are not well understood. We aimed to examine modifiable predictors of both objective, performance-based functional capacity and social skills, and self-reported functioning in individuals with schizophrenia and schizoaffective disorder and high negative symptoms. Fifty-five adults with moderate-to-severe negative symptoms were administered measures of neuropsychological performance, performance-based functional capacity and social competence, self-reported functioning, psychiatric symptom severity, defeatist/asocial beliefs, and intrinsic motivation. In the context of multiple significant predictor variables identified through bivariate correlations, multiple regression models showed that neuropsychological performance was the only significant predictor of performance-based functional capacity; neuropsychological performance and motivation/pleasure negative symptoms were significant predictors of performance-based social competence. For two different measures of self-reported functioning, intrinsic motivation, asocial beliefs, and diminished expression emerged as significant predictors. Neurocognitive ability was a better predictor of performance-based functional skills whereas motivation and beliefs more strongly predicted self-reported real-world functioning. The findings of this study suggest a complex picture of predictors of performance-based functional capacity (objective neuropsychological functioning) and self-reported functioning (motivation and beliefs), underscoring the clinical and scientific utility of including both self-reported and objective measures of functioning to identify treatment approach. Individuals with high negative symptoms and a cognitive/functional skills deficit may benefit from interventions such as cognitive remediation or skills training, whereas individuals with motivational difficulties may benefit from treatments such as cognitive behavioral therapy.

Integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training for Negative Symptoms of Psychosis: Effects in a Pilot Randomized Controlled Trial

OBJECTIVE

Negative symptoms and cognitive impairment in schizophrenia (SZ) remain unmet treatment needs as they are highly prevalent, associated with poor functional outcomes, and resistant to pharmacologic treatment. The current pilot randomized controlled trial examined the efficacy of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared to Goal-focused Supportive Contact (SC) on negative symptoms and cognitive performance.

METHODS

Fifty-five adults with SZ or schizoaffective disorder with moderate-to-severe negative symptoms were randomized to receive 25 twice-weekly, 1-h manualized group sessions (12.5 weeks total duration) of either CBSST-CCT or SC delivered by master's level clinicians in five community settings. Assessments of negative symptom severity (primary outcomes) and neuropsychological performance, functional capacity, social skills performance, and self-reported functional ability/everyday functioning, psychiatric symptom severity, and motivation (secondary outcomes) were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up.

RESULTS

Mixed-effects models using baseline, mid-treatment, and post-treatment data demonstrated significant CBSST-CCT-associated effects on negative symptom severity, as assessed by the Scale for the Assessment of Negative Symptoms (p = .049, r = 0.22), with improvements in diminished motivation driving this effect (p = .037, r = 0.24). The CBSST-CCT group also demonstrated improved verbal learning compared to SC participants (p = .026, r = 0.36). The effects of CBSST-CCT appeared to be durable at 6-month follow-up.

CONCLUSIONS

CBSST-CCT improved negative symptom severity and verbal learning in high-negative-symptom individuals relative to SC. CBSST-CCT warrants larger investigations to examine its efficacy in treating negative symptoms, along with other symptoms, cognition, and, ultimately, real-world functional outcomes. Clinical Trial registration number NCT02170051.

Assessment of Subclinical Psychotic Symptoms in Patients with Rheumatoid Arthritis and Spondyloarthritis

Inflammatory and autoimmune processes have been associated with the onset of depressive and psychotic symptoms. Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are rheumatic diseases with an inflammatory etiology. A high prevalence of depressive and anxiety-related comorbidity has been reported for both diseases, with no evidence of a greater prevalence of psychosis. The objective of the present study was to evaluate for the first time subclinical psychotic symptoms in patients with RA and SpA. This is a cross-sectional, single-center study including RA and SpA patients, as well as healthy controls. Abnormal psychotic experiences (positive, negative, and depressive symptoms) were evaluated using the Community Assessment of Psychic Experiences (CAPE-42). Functional capacity was evaluated using the Short-Form Health Survey SF-12. We compared the CAPE and SF-12 scores between the three groups. We recruited 385 individuals: 218 with RA, 100 with SpA, and 67 healthy controls. According to the CAPE scale, the frequency of subclinical psychotic symptoms was greater in patients than in healthy controls (RA, 1.90 vs. 1.63, p < 0.001; SpA, 1.88 vs. 1.63, p = 0.001). Distress was also greater in patients than in controls owing to the presence of symptoms. No differences were observed between the three groups for the mental dimension scores in the SF-12 Health Survey (43.75 in RA, 45.54 in SpA, and 43.19 in healthy controls). Our findings point to a greater prevalence of subclinical psychotic symptoms in patients with RA and patients with SpA than in the general population. The results suggest an association between inflammation and depression/subclinical psychotic symptoms.