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Lyngstad SH, Lyne JP, Ihler HM, van der Meer L, Færden A, Melle I. Turning the Spotlight on Apathy: Identification and Treatment in Schizophrenia Spectrum Disorders. Schizophr Bull 2023; 49:1099-1104. [PMID: 37193675 PMCID: PMC10483442 DOI: 10.1093/schbul/sbad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Among negative symptoms, apathy is central to the impairments in real-life functioning in schizophrenia spectrum disorders (SSD). Thus, optimizing treatment for apathy appears key to improve outcomes. In treatment research, however, negative symptoms are typically studied as a unifactorial construct. We, therefore, aim to shed necessary light on the status of apathy identification and treatment in SSD.
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Affiliation(s)
- Siv Hege Lyngstad
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - John Paul Lyne
- Department of Psychiatry, Royal College of Surgeons in Ireland, Newcastle Hospital, Wicklow, Ireland
| | - Henrik Myhre Ihler
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Ann Færden
- Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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2
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Granholm E, Twamley EW, Mahmood Z, Keller AV, Lykins HC, Parrish EM, Thomas ML, Perivoliotis D, Holden JL. Integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training for Negative Symptoms of Psychosis: Effects in a Pilot Randomized Controlled Trial. Schizophr Bull 2021; 48:359-370. [PMID: 34665853 PMCID: PMC8886598 DOI: 10.1093/schbul/sbab126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Eric Granholm
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Research Service and Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA,To whom correspondence should be addressed; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (9116A), La Jolla, CA 92093, USA; tel: +858-642-3848, e-mail:
| | - Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Amber V Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Hannah C Lykins
- Research Service and Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emma M Parrish
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Michael L Thomas
- Psychology Department, Colorado State University, Fort Collins, CO, USA
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jason L Holden
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Zhu X, Song H, Chang R, Chen B, Song Y, Liu J, Wang K. Combining compensatory cognitive training and medication self-management skills training, in inpatients with schizophrenia: A three-arm parallel, single-blind, randomized controlled trial. Gen Hosp Psychiatry 2021; 69:94-103. [PMID: 33588196 DOI: 10.1016/j.genhosppsych.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cognitive impairment has a critical impact on functional outcomes in patients with schizophrenia. Compensatory cognitive training (CCT) has shown promise as a cognitive rehabilitation tool but little is known about its effectiveness when combined with medication self-management skills training (MSST) in patients with schizophrenia. Thus, this study compared the effects of a combined CCT and MSST with CCT and treatment as usual (TAU) on cognitive function, symptoms, and medication adherence. METHOD Eighty-seven inpatients with schizophrenia were randomly assigned to the TAU, CCT, or CCT + MSST groups. Assessments of cognitive function using the Brief Assessment of Cognition in Schizophrenia, symptoms using the Positive and Negative Syndrome Scale, and medication adherence using the Medication Adherence Questionnaire, were administered to all participants at baseline and at post-intervention. RESULTS Compared with the TAU group, the CCT group had significant improvements in verbal fluency, total cognitive function and medication adherence, and the CCT + MSST group had significant improvements in verbal fluency, total cognitive function, positive symptoms, and medication adherence. Compared with the CCT group, the CCT + MSST group had significant improvements in total cognitive function. CONCLUSIONS These results indicate that the integrated intervention may be more advantageous than CCT alone in improving total cognitive function and positive symptoms. Future research should seek to further explore the long-term effects of such a joint intervention.
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Affiliation(s)
- Xiaodan Zhu
- Division of Nursing Fundamentals, School of Nursing, Shandong University, Wenhua Xi Road #44, Shandong, China; Division of Nursing Fundamentals, School of Nursing, Ningxia Medical University, Shengli Road #1160, Ningxia, China
| | - Hong Song
- Inpatient Department, Ningxia Min-Kang Hospital, Huanghe Dong Road #878, Ningxia, China
| | - Ru Chang
- Division of Nursing Fundamentals, School of Nursing, Ningxia Medical University, Shengli Road #1160, Ningxia, China
| | - Bing Chen
- Division of Nursing Fundamentals, School of Nursing, Ningxia Medical University, Shengli Road #1160, Ningxia, China
| | - Yuanyuan Song
- Division of Nursing Fundamentals, School of Nursing, Ningxia Medical University, Shengli Road #1160, Ningxia, China
| | - Juan Liu
- Division of Anatomy, School of Basic Medical Sciences, Ningxia Medical University, Shengli Road #1160, Ningxia, China.
| | - Kefang Wang
- Division of Nursing Fundamentals, School of Nursing, Shandong University, Wenhua Xi Road #44, Shandong, China.
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Mahmood Z, Van Patten R, Keller AV, Lykins HC, Perivoliotis D, Granholm E, Twamley EW. Reducing negative symptoms in schizophrenia: Feasibility and acceptability of a combined cognitive-behavioral social skills training and compensatory cognitive training intervention. Psychiatry Res 2021; 295:113620. [PMID: 33290939 PMCID: PMC7779756 DOI: 10.1016/j.psychres.2020.113620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/28/2020] [Indexed: 12/25/2022]
Abstract
The current study examined the feasibility and acceptability of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared with Goal-Focused Supportive Contact (SC) in a pilot randomized controlled trial for people with schizophrenia with high negative symptom severity. The sample included 55 participants from five community settings; masters-level study clinicians delivered interventions on-site. Participants completed assessments of cognitive, functional, and psychiatric symptoms at baseline, mid-treatment, post-treatment (12.5 weeks), and 6-month follow-up. Enrollment goals were not initially met, necessitating the addition of a fifth site; however, all groups and assessments were completed on-site. Study procedures were acceptable, as evidenced by 100% enrollment and completion of baseline assessments following informed consent; however, over 1/3rd of participants dropped out. No modifications were necessary to the intervention procedures and CBSST-CCT fidelity ratings were acceptable. The intervention was deemed acceptable among participants who attended ≥1 session, as evidenced by similar attendance rates in CBSST-CCT compared to SC. Among CBSST-CCT participants, lower positive symptoms were significantly associated with better attendance. Overall, we found mixed evidence for the feasibility and acceptability of the CBSST-CCT protocol in people with schizophrenia with high negative symptoms. Challenges are highlighted and recommendations for future investigations are provided.
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Affiliation(s)
- Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA.
| | - Ryan Van Patten
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA.
| | - Amber V Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA.
| | - Hannah C Lykins
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA.
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA; Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116B), San Diego, CA 92161, USA.
| | - Eric Granholm
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA; Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116B), San Diego, CA 92161, USA.
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161, USA.
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Ebrahimi A, Poursharifi H, Dolatshahi B, Rezaee O, Hassanabadi HR, Naeem F. The Cognitive Model of Negative Symptoms in Schizophrenia: A Hierarchical Component Model With PLS-SEM. Front Psychiatry 2021; 12:707291. [PMID: 34366940 PMCID: PMC8339582 DOI: 10.3389/fpsyt.2021.707291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
The cognitive model of negative symptoms suggests that some dysfunctional beliefs mediate the relationship between neurocognitive deficits and negative symptoms and disability. This study tested the hypothesis that dysfunctional performance beliefs mediate neurocognitive deficits, negative symptoms, and disability. We used a hierarchal component model with 85 men patients diagnosed with chronic schizophrenia. Results showed a moderate to strong correlation between dysfunctional performance beliefs, neurocognitive deficits, negative symptoms, and disability. These results support the Hierarchal component model (HCM) of the cognitive model of negative symptoms. Our results indicated that the disability in schizophrenia is mediated through dysfunctional performance beliefs, neurocognitive deficits, and negative symptoms pathway. Further, dysfunctional performance beliefs have a crucial role in this pathway. Therefore, targeting this vicious cycle of dysfunctional beliefs can improve disability in patients with schizophrenia.
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Affiliation(s)
- Ali Ebrahimi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Poursharifi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Omid Rezaee
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Hassanabadi
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
| | - Farooq Naeem
- Department of Psychiatry, University of Toronto & Centre for Addiction and Mental Health, Toronto, ON, Canada
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A cognitive model of diminished expression in schizophrenia: The interface of metacognition, cognitive symptoms and language disturbances. J Psychiatr Res 2020; 131:169-176. [PMID: 32979692 PMCID: PMC8100971 DOI: 10.1016/j.jpsychires.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 12/20/2022]
Abstract
The resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive symptoms interact and thus interfere with persons' ability to understand and express emotions in ways others can recognize. Individuals with schizophrenia-spectrum disorders (N = 201) provided personal narratives detailing their life story and reflections about their mental illness. Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants' personal narratives via Coh-Metrix 3.0, an automated program that calculates language indices. Diminished expression and cognitive symptoms were measured with the Positive and Negative Syndrome Scale. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive symptoms and situation models on diminished expression. Results of the SEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = -.073, p = .008, ±95% CI [-0.126, -0.019]). and fully mediated the influence of cognitive symptoms in diminished expression (β = 0.099, p = .001, ±95% CI [0.038, 0.160]). In conclusion, results suggest that self-reflectivity, linguistic cohesion, and cognitive symptoms may be useful targets for intervention in efforts to treat diminished expression in psychosis.
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7
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Rakhshan Rouhakhtar P, Schiffman J. Community Rehabilitation for Youth with Psychosis Spectrum Disorders. Child Adolesc Psychiatr Clin N Am 2020; 29:225-239. [PMID: 31708049 DOI: 10.1016/j.chc.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recovery-oriented treatment for youth with psychosis goes beyond a symptom and deficit-amelioration model, promoting engagement and functioning within the community. Given the challenges young people with psychosis face, early psychosis treatment programs often integrate rehabilitative components targeting functional outcomes. The current article reviews 4 community rehabilitation programs in early psychosis: care coordination, cognitive rehabilitation, supported education and employment, and peer support. For each of these rehabilitative intervention programs, we discuss challenges faced by youth with psychosis, clinical intervention practices, the current state of evidence, and clinical and/or research considerations.
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Affiliation(s)
- Pamela Rakhshan Rouhakhtar
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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Mahmood Z, Keller AV, Burton CZ, Vella L, Matt GE, McGurk SR, Twamley EW. Modifiable Predictors of Supported Employment Outcomes Among People With Severe Mental Illness. Psychiatr Serv 2019; 70:782-792. [PMID: 31185856 PMCID: PMC6718295 DOI: 10.1176/appi.ps.201800562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Among people with severe mental illnesses, neuropsychological abilities may contribute to vocational outcomes, such as job attainment, job tenure, and wages earned. The current study aimed to determine the strongest neuropsychological and other modifiable predictors of work outcomes in 153 people with severe mental illness (schizophrenia, 38%; bipolar disorder, 24%; and major depression, 38%) who participated in a 2-year supported employment study. METHODS Assessments of neuropsychological performance, functional capacity, social skills, and psychiatric symptom severity were administered at baseline; work outcomes (job attainment, weeks worked, and wages earned) were collected weekly for 2 years. RESULTS Independent of education, diagnosis, and estimated intellectual functioning, more recent work history and less severe negative symptoms significantly predicted job attainment during the 2-year study. Among the 47% who obtained jobs, better global neuropsychological performance (i.e., lower global deficit score) was a significant predictor of greater weeks worked. Both global neuropsychological performance and more recent work history predicted higher wages earned. CONCLUSIONS Modifiable predictors of supported employment outcomes included cognitive functioning and negative symptom severity; thus, interventions to improve these factors may improve work outcomes and decrease the loss of productivity associated with severe mental illness.
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Affiliation(s)
- Zanjbeel Mahmood
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Amber V Keller
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Cynthia Z Burton
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Lea Vella
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Georg E Matt
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Susan R McGurk
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Elizabeth W Twamley
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
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Mahmood Z, Kelsven S, Cadenhead K, Wyckoff J, Reyes-Madrigal F, de la Fuente-Sandoval C, Twamley EW. Compensatory Cognitive Training for Latino Youth at Clinical High Risk for Psychosis: Study Protocol for a Randomized Controlled Trial. Front Psychiatry 2019; 10:951. [PMID: 31998163 PMCID: PMC6967834 DOI: 10.3389/fpsyt.2019.00951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Early psychosocial interventions targeting cognitive and functional outcomes in individuals at clinical high risk for psychosis are a research priority. An even greater need is the identification of effective interventions in underserved populations. Compensatory Cognitive Training (CCT) is a psychosocial intervention with demonstrated efficacy in chronic schizophrenia and first episode psychosis, but remains to be evaluated in pre-illness phases. The aim of this study was to describe the development and implementation of an ongoing pilot randomized controlled trial investigating the efficacy of group-based, manualized CCT, as compared to recreational therapy (RT), for Latino participants at clinical high risk for psychosis (CHR) in both the United States and Mexico. It is hypothesized that, in comparison to those receiving RT, participants receiving CCT will show significant improvements in neurocognitive performance and functional capacity (co-primary outcomes) and self-rated functioning and clinical symptoms (secondary outcomes). Methods: Latino CHR participants aged 12-30 years will be included in the study. Both CCT and RT will be delivered in either Spanish or English, depending on group preference. Additionally, all assessments will be administered in participants' preferred language. A comprehensive assessment of neurocognitive and functional performance and clinical symptomatology will be performed at baseline, mid-intervention (4 weeks, 8 weeks), post-intervention (12 weeks) and 3-month follow-up. The primary outcome measures are neurocognition and functional capacity, as assessed by the MATRICS (Measurement and Treatment Research in Cognition in Schizophrenia) Consensus Cognitive Battery and the University of California, San Diego Performance-Based Skills Assessment-Brief, respectively. Furthermore, secondary outcomes measures will be used to examine change in clinical symptoms and self-reported functioning in response to CCT versus RT. Discussion: The evaluation of a novel treatment such as CCT in CHR youth will provide empirical support for a low risk, comprehensive cognitive intervention that could have important implications for public health if it improves neurocognition and functioning.
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Affiliation(s)
- Zanjbeel Mahmood
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States.,Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Skylar Kelsven
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Kristin Cadenhead
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Janae Wyckoff
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Francisco Reyes-Madrigal
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.,Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
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10
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Bosia M, Buonocore M, Bechi M, Santarelli L, Spangaro M, Cocchi F, Guglielmino C, Bianchi L, Bringheli S, Bosinelli F, Cavallaro R. Improving Cognition to Increase Treatment Efficacy in Schizophrenia: Effects of Metabolic Syndrome on Cognitive Remediation's Outcome. Front Psychiatry 2018; 9:647. [PMID: 30581395 PMCID: PMC6293025 DOI: 10.3389/fpsyt.2018.00647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/16/2018] [Indexed: 11/18/2022] Open
Abstract
Cognitive impairment, typically more severe in treatment resistant patients, is considered a hallmark of schizophrenia and the prime driver of functional disability. Recent evidence suggests that metabolic syndrome may contribute to cognitive deficits in schizophrenia, possibly through shared underlying mechanisms. However, results are still contradictory and no study has so far examined the influence of metabolic syndrome on cognitive outcome after cognitive remediation therapy (CRT). Based on these premises, this study aims to investigate the relationship between metabolic syndrome and cognition, specifically considering cognitive outcome after treatment. Secondary objectives include the analysis of the association between cognitive impairment and psychopathological status and, in a subgroup of patients, the evaluation of the effect of Sterol Regulatory Element Binding Transcription Factor 1 (SREBF-1) rs11868035 genetic polymorphism, previously associated with metabolic alterations, on both cognition and metabolic syndrome. One-hundred seventy-two outpatients with schizophrenia were assessed for metabolic parameters and neurocognitive measures and 138 patients, who completed CRT, were re-evaluated for cognition. A subsample of 51 patients was also genotyped for rs11868035 from peripheral blood sample. Results show a negative impact of metabolic syndrome on executive functions and global cognitive outcome after CRT. Data also revealed a significant effect of SREBF-1 polymorphism, with a higher prevalence of metabolic syndrome and worse processing speed performance among G/G homozygous subjects, compared the A allele carriers. Overall these findings support the hypothesis that metabolic alterations may hamper the capacity to restore cognitive deficits, as well as they highlight the need to further explore possible converging mechanisms underlying both cognitive and metabolic dysfunction. At the clinical level, results point to the importance of a comprehensive assessment including the metabolic status of patients and of individualized strategies addressing metabolic dysfunction in order to potentiate treatment outcome in schizophrenia.
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Affiliation(s)
- Marta Bosia
- School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy.,Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mariachiara Buonocore
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Santarelli
- School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
| | - Marco Spangaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cocchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmelo Guglielmino
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Bianchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Bringheli
- School of Psychology, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Roberto Cavallaro
- School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy.,Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
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