1
|
Warren TL, Tubbs JD, Lesh TA, Corona MB, Pakzad SS, Albuquerque MD, Singh P, Zarubin V, Morse SJ, Sham PC, Carter CS, Nord AS. Association of neurotransmitter pathway polygenic risk with specific symptom profiles in psychosis. Mol Psychiatry 2024:10.1038/s41380-024-02457-0. [PMID: 38491343 DOI: 10.1038/s41380-024-02457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/18/2024]
Abstract
A primary goal of psychiatry is to better understand the pathways that link genetic risk to psychiatric symptoms. Here, we tested association of diagnosis and endophenotypes with overall and neurotransmitter pathway-specific polygenic risk in patients with early-stage psychosis. Subjects included 205 demographically diverse cases with a psychotic disorder who underwent comprehensive psychiatric and neurological phenotyping and 115 matched controls. Following genotyping, we calculated polygenic scores (PGSs) for schizophrenia (SZ) and bipolar disorder (BP) using Psychiatric Genomics Consortium GWAS summary statistics. To test if overall genetic risk can be partitioned into affected neurotransmitter pathways, we calculated pathway PGSs (pPGSs) for SZ risk affecting each of four major neurotransmitter systems: glutamate, GABA, dopamine, and serotonin. Psychosis subjects had elevated SZ PGS versus controls; cases with SZ or BP diagnoses had stronger SZ or BP risk, respectively. There was no significant association within psychosis cases between individual symptom measures and overall PGS. However, neurotransmitter-specific pPGSs were moderately associated with specific endophenotypes; notably, glutamate was associated with SZ diagnosis and with deficits in cognitive control during task-based fMRI, while dopamine was associated with global functioning. Finally, unbiased endophenotype-driven clustering identified three diagnostically mixed case groups that separated on primary deficits of positive symptoms, negative symptoms, global functioning, and cognitive control. All clusters showed strong genome-wide risk. Cluster 2, characterized by deficits in cognitive control and negative symptoms, additionally showed specific risk concentrated in glutamatergic and GABAergic pathways. Due to the intensive characterization of our subjects, the present study was limited to a relatively small cohort. As such, results should be followed up with additional research at the population and mechanism level. Our study suggests pathway-based PGS analysis may be a powerful path forward to study genetic mechanisms driving psychiatric endophenotypes.
Collapse
Affiliation(s)
- Tracy L Warren
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
- Center for Neuroscience, University of California, Davis, CA, USA
| | - Justin D Tubbs
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Tyler A Lesh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Mylena B Corona
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
- Center for Neuroscience, University of California, Davis, CA, USA
| | - Sarvenaz S Pakzad
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Marina D Albuquerque
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Praveena Singh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Vanessa Zarubin
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Sarah J Morse
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
- Center for Neuroscience, University of California, Davis, CA, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Pak Chung Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR.
- Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR.
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR.
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA.
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.
| | - Alex S Nord
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA.
- Center for Neuroscience, University of California, Davis, CA, USA.
| |
Collapse
|
2
|
Warren TL, Tubbs JD, Lesh TA, Corona MB, Pakzad S, Albuquerque M, Singh P, Zarubin V, Morse S, Sham PC, Carter CS, Nord AS. Association of neurotransmitter pathway polygenic risk with specific symptom profiles in psychosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.24.23290465. [PMID: 37292649 PMCID: PMC10246134 DOI: 10.1101/2023.05.24.23290465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A primary goal of psychiatry is to better understand the pathways that link genetic risk to psychiatric symptoms. Here, we tested association of diagnosis and endophenotypes with overall and neurotransmitter pathway-specific polygenic risk in patients with early-stage psychosis. Subjects included 206 demographically diverse cases with a psychotic disorder who underwent comprehensive psychiatric and neurological phenotyping and 115 matched controls. Following genotyping, we calculated polygenic scores (PGSs) for schizophrenia (SZ) and bipolar disorder (BP) using Psychiatric Genomics Consortium GWAS summary statistics. To test if overall genetic risk can be partitioned into affected neurotransmitter pathways, we calculated pathway PGSs (pPGSs) for SZ risk affecting each of four major neurotransmitter systems: glutamate, GABA, dopamine, and serotonin. Psychosis subjects had elevated SZ PGS versus controls; cases with SZ or BP diagnoses had stronger SZ or BP risk, respectively. There was no significant association within psychosis cases between individual symptom measures and overall PGS. However, neurotransmitter-specific pPGSs were moderately associated with specific endophenotypes; notably, glutamate was associated with SZ diagnosis and with deficits in cognitive control during task-based fMRI, while dopamine was associated with global functioning. Finally, unbiased endophenotype-driven clustering identified three diagnostically mixed case groups that separated on primary deficits of positive symptoms, negative symptoms, global functioning, and cognitive control. All clusters showed strong genome-wide risk. Cluster 2, characterized by deficits in cognitive control and negative symptoms, additionally showed specific risk concentrated in glutamatergic and GABAergic pathways. Due to the intensive characterization of our subjects, the present study was limited to a relatively small cohort. As such, results should be followed up with additional research at the population and mechanism level. Our study suggests pathway-based PGS analysis may be a powerful path forward to study genetic mechanisms driving psychiatric endophenotypes.
Collapse
Affiliation(s)
| | - Justin D. Tubbs
- Department of Psychiatry, The University of Hong Kong
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | | | | | | | | | | | | | | | - Pak Chung Sham
- Department of Psychiatry, The University of Hong Kong
- Centre for PanorOmic Sciences, The University of Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | | | | |
Collapse
|
3
|
Moses DG, Palaniappan P, Ponraj PC. Residual experiential symptoms mediate the effect of expressive symptoms over the social functioning in remitted schizophrenia. Ind Psychiatry J 2023; 32:309-316. [PMID: 38161473 PMCID: PMC10756619 DOI: 10.4103/ipj.ipj_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 01/03/2024] Open
Abstract
Context Impairment in social functioning had been consistently found in remitted schizophrenia; yet, predictors of social dysfunction had been hardly explored and intervention trials had rarely included remitted schizophrenia. Methods 60 subjects with schizophrenia (diagnosed based on DSM5), currently in remission (SAPS and SANS global rating ≤2, for a minimum period of 12 weeks) and 46 age and gender-matched healthy controls were recruited after obtaining informed consent. The socio-demographic details, illness characteristics, depressive symptoms, positive and negative symptoms [using Scale for assessment of positive symptoms (SAPS), and scale for assessment of negative symptoms (SANS)] were assessed. The Theory of Mind (ToM) score was derived from the ToM tasks of a culturally validated tool, Social Cognition Rating Tools in Indian Setting. The social functioning was assessed using Groningen social disabilities schedule II (GSDSSII). Results The mean SAPS summary and SANS summary scores were 3.01 ± 2.99 and 4.32 ± 2.94, respectively. The social functioning was significantly impaired in remitted schizophrenia when compared to healthy controls. In the hierarchical regression, experiential dimension (β =1.941, t = 6.097, P < 0.001), followed by expressive dimension predicted social functioning (explained 70.5% of variance) after controlling for confounders. On mediation analysis, the effect of expressive dimension over the social functioning was significantly mediated by experiential dimension (E = 1.1821, Boot SE = 0.2895, C.I: 0.6934 to 1.7862). Conclusion The experiential dimension mediates the effect of expressive dimension over the social dysfunction in remitted schizophrenia. Future studies should focus on targeting the experiential dimension and thereby social functioning.
Collapse
Affiliation(s)
- Dinesh G. Moses
- Department of Psychiatry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Pradeep Palaniappan
- Department of Psychiatry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Pratap Chander Ponraj
- Department of Psychiatry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| |
Collapse
|
4
|
Wu C, Dagg P, Molgat C. Comparable repetition blindness effect in patients with schizophrenia. J Behav Ther Exp Psychiatry 2023; 78:101796. [PMID: 36435538 DOI: 10.1016/j.jbtep.2022.101796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Repetition blindness (RB) refers to the difficulty to report repetitions of stimuli visually presented in a rapid list. To date only two studies have examined RB in patients with schizophrenia and the results are not clear-cut. The current study was designed to employ a task with reduced memory load, more trials in each experimental condition, and more participants to obtain a more reliable RB effect. METHODS A 2x2x3x2 mixed factor repeated measure design was used, with stimulus repetition, lag, and presentation rate as within-subject factors, and group (patient or control) as a between-subject factor. A rapid serial visual presentation (RSVP) procedure was used. Twenty eight inpatients with schizophrenia and 28 healthy controls participated in the experiment. RESULTS The patient group showed significantly impaired performance when compared tothe control group in every experimental condition. Nevertheless, the patient group demonstrated similar RB effect as the control group. Furthermore, the overall RB effect observed in patients did not relate to their illness severity or psychotic symptoms. Neither was it related to their age or education. LIMITATIONS It was difficult to match the age and education of the control group to that of the inpatient group. CONCLUSIONS Patients with schizophrenia performed worse than healthy controls in each experimental condition. Both the control and patient group showed robust RB effect in the short lag with faster rates. In addition, RB effect seemed to be irrelevant to patients' illness severity and clinical symptoms.
Collapse
Affiliation(s)
- Caili Wu
- Hillside Psychiatric Centre, Interior Health Authority, Tertiary Mental Health & Substance Use Services, Kamloops, BC, V2C 2T1, Canada.
| | - Paul Dagg
- Hillside Psychiatric Centre, Interior Health Authority, Tertiary Mental Health & Substance Use Services, Kamloops, BC, V2C 2T1, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Carmen Molgat
- Hillside Psychiatric Centre, Interior Health Authority, Tertiary Mental Health & Substance Use Services, Kamloops, BC, V2C 2T1, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| |
Collapse
|
5
|
Hu HX, Lau WYS, Ma EPY, Hung KSY, Chen SY, Cheng KS, Cheung EFC, Lui SSY, Chan RCK. The Important Role of Motivation and Pleasure Deficits on Social Functioning in Patients With Schizophrenia: A Network Analysis. Schizophr Bull 2022; 48:860-870. [PMID: 35524755 PMCID: PMC9212088 DOI: 10.1093/schbul/sbac017] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Negative symptoms, particularly the motivation and pleasure (MAP) deficits, are associated with impaired social functioning in patients with schizophrenia (SCZ). However, previous studies seldom examined the role of the MAP on social functioning while accounting for the complex interplay between other psychopathology. This network analysis study examined the network structure and interrelationship between negative symptoms (at the "symptom-dimension" and "symptom-item" levels), other psychopathology and social functioning in a sample of 269 patients with SCZ. The psychopathological symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Positive and Negative Syndrome Scale (PANSS). Social functioning was evaluated using the Social and Occupational Functioning Assessment Scale (SOFAS). Centrality indices and relative importance of each node were estimated. The network structures between male and female participants were compared. Our resultant networks at both the "symptom-dimension" and the "symptom-item" levels suggested that the MAP factor/its individual items were closely related to social functioning in SCZ patients, after controlling for the complex interplay between other nodes. Relative importance analysis showed that MAP factor accounted for the largest proportion of variance of social functioning. This study is among the few which used network analysis and the CAINS to examine the interrelationship between negative symptoms and social functioning. Our findings supported the pivotal role of the MAP factor to determine SCZ patients' social functioning, and as a potential intervention target for improving functional outcomes of SCZ.
Collapse
Affiliation(s)
- Hui-Xin Hu
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wilson Y S Lau
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Eugenia P Y Ma
- Department of Adult Psychiatry, Kwai Chung Hospital, Hong Kong Special Administrative Region, China
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Si-Yu Chen
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Kin-Shing Cheng
- Department of Adult Psychiatry, Kwai Chung Hospital, Hong Kong Special Administrative Region, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- To whom correspondence should be addressed; Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China; tel/fax: (852) 2831 5343, e-mail:
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
6
|
Improving Clinical, Cognitive, and Psychosocial Dysfunctions in Patients with Schizophrenia: A Neurofeedback Randomized Control Trial. Neural Plast 2021; 2021:4488664. [PMID: 34434228 PMCID: PMC8380506 DOI: 10.1155/2021/4488664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives The aim of this study was to use neurofeedback (NF) training as the add-on therapy in patients with schizophrenia to improve their clinical, cognitive, and psychosocial condition. The study, thanks to the monitoring of various conditions, quantitative electroencephalogram (QEEG) and brain-derived neurotrophic factor (BDNF), was supposed to give an insight into mechanisms underlying NF training results. Methods Forty-four male patients with schizophrenia, currently in a stable, incomplete remission, were recruited into two, 3-month rehabilitation programs, with standard rehabilitation as a control group (R) or with add-on NF training (NF). Pre- and posttherapy primary outcomes were compared: clinical (Positive and Negative Syndrome Scale (PANSS)), cognitive (Color Trails Test (CTT), d2 test), psychosocial functioning (General Self-Efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS), and Acceptance of Illness Scale (AIS)), quantitative electroencephalogram (QEEG), auditory event-related potentials (ERPs), and serum level of BDNF. Results. Both groups R and NF improved significantly in clinical ratings (Positive and Negative Syndrome Scale (PANSS)). In-between analyses unveiled some advantages of add-on NF therapy over standard rehabilitation. GSES scores improved significantly, giving the NF group of patients greater ability to cope with stressful or difficult social demands. Also, the serum-level BDNF increased significantly more in the NF group. Post hoc analyses indicated the possibility of creating a separate PANSS subsyndrome, specifically related to cognitive, psychosocial, and BDNF effects of NF therapy. Conclusions Neurofeedback can be effectively used as the add-on therapy in schizophrenia rehabilitation programs. The method requires further research regarding its clinical specificity and understanding mechanisms of action.
Collapse
|
7
|
Reinforcement of Self-Regulated Brain Activity in Schizophrenia Patients Undergoing Rehabilitation. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8030485. [PMID: 33855083 PMCID: PMC8019363 DOI: 10.1155/2021/8030485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 01/07/2023]
Abstract
The experiment was aimed to compare the effects of different forms of rehabilitation applied in patients with schizophrenia. Verification of the obtained results was based on the analysis of the level of cognitive and social functioning of the subjects. For this purpose, the following clinical tools were used: Positive and Negative Syndrome Scale (PANSS), Beck Cognitive Insight Scale (BCIS), Color Trial Test (CTT-1, CTT-2), d2 psychological tests, Acceptance of Illness Scale (AIS), Self-efficacy Scale (GSES), Quantitative Electroencephalogram Biofeedback (QEEG-BF), auditory event-related potentials (ERPs), and serum levels of brain-derived neurotrophic factor (BDNF). The subjects were mentally stable male schizophrenia patients who had been in remission. They were divided into two groups which received different types of rehabilitation for three months. Group 1 patients followed a standard rehabilitation and Group 2 patients received GSR Biofeedback (galvanic skin response Biofeedback, GSR-BF) training. Pretherapy and posttherapy measurements were made for each group. Experimental rehabilitation based on GSR-BF training resulted in regulatory control of neurophysiological mechanisms, and the parameters obtained demonstrated improvement in the subjects' cognitive and social function. The following therapy outcomes were observed: (1) reduce psychopathological symptoms (2) improving cognitive (concentration, attention) and social functions (3) increase in the neurotrophic factor BDNF. GSR-BF can be used as an alternative to conventional rehabilitation in schizophrenia patients.
Collapse
|
8
|
Hofer A, Baumgartner S, Edlinger M, Hummer M, Kemmler G, Rettenbacher MA, Schweigkofler H, Schwitzer J, Fleischhacker WW. Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects. Eur Psychiatry 2020; 20:386-94. [PMID: 16171653 DOI: 10.1016/j.eurpsy.2005.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 02/02/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractObjectiveThe present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care.MethodSixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated.ResultsMost psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care.ConclusionOur results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.
Collapse
Affiliation(s)
- Alex Hofer
- Department of Biological Psychiatry, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Li Y, Sun K, Liu D, Chen MX, Li G, Ma J, Zhang X. The Effects of Combined Social Cognition and Interaction Training and Paliperidone on Early-Onset Schizophrenia. Front Psychiatry 2020; 11:525492. [PMID: 33192646 PMCID: PMC7556232 DOI: 10.3389/fpsyt.2020.525492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The limitations associated with antipsychotics in early-onset schizophrenia patients have stimulated more interest in psychological interventions in this population. Nevertheless, the isolated psychosocial interventions are unrealistic in a treatment success covering the complex array of symptoms, and the psychosocial interventions could be an adjunct treatment to the pharmacological treatment. It is necessary to find the benefits of psychological interventions with limited and targeted use of antipsychotics. Social cognition and interaction training (SCIT) was a program for social cognitive rehabilitation in adult schizophrenia. However, it is unclear how generalizable this is to early-onset patients. METHODS The current study tested this hypothesis that combined SCIT and paliperidone was superior to paliperidone alone in treating early-onset schizophrenia patients on cognitive, functional, and symptom outcomes. Two hundred eight inpatients with schizophrenia aged 13 to 17 years old participated in a 24-week work intervention program. Patients completed a battery of measures administered at a pre-SCIT intervention baseline, 4, 8, 12, and 24 weeks post-SCIT, respectively. RESULTS SCIT had significant added benefits above paliperidone for the speed of processing, attention/vigilance, and social cognition of the Chinese version of MATRICS consensus cognitive battery (MCCB) domains (p<0.05). The following logistic regression analysis on the exploration of the influential factors also confirmed the effects of SCIT. However, combined SCIT and paliperidone intervention had a null impact on social functioning and symptomatology. CONCLUSIONS The present study provides the first evidence that combined SCIT and paliperidone intervention has the potential to improve cognitive functions for the early-onset schizophrenia patients. The findings in the current study are suggestive of the extreme importance of SCIT as an adjunctive treatment in early-onset schizophrenia patients.
Collapse
Affiliation(s)
- Yichen Li
- Department of Child & Adolescent Psychiatry, Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ke Sun
- Department of Child & Adolescent Psychiatry, Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Denghua Liu
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Mo-Xian Chen
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Guo Li
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Jun Ma
- Department of Child & Adolescent Psychiatry, Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaofan Zhang
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| |
Collapse
|
10
|
Little B, Gallagher P, Zimmerer V, Varley R, Douglas M, Spencer H, Çokal D, Deamer F, Turkington D, Ferrier IN, Hinzen W, Watson S. Language in schizophrenia and aphasia: the relationship with non-verbal cognition and thought disorder. Cogn Neuropsychiatry 2019; 24:389-405. [PMID: 31550981 DOI: 10.1080/13546805.2019.1668758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To determine the relationship between language abnormalities and broader cognitive impairment and thought disorder by examining language and cognition in schizophrenia and aphasia (a primary language disorder).Methods: Cognitive and linguistic profiles were measured with a battery of standardised tests, and compared in a clinical population of n = 50 (n = 30 with schizophrenia and n = 20 with aphasia) and n = 61 non-clinical comparisons (n = 45 healthy controls and n = 16 non-affected first-degree relatives of patients with schizophrenia).Results: Both clinical groups showed linguistic deficits. Verbal impairment was more severe in participants with aphasia, whereas non-verbal performance was more affected in participants with schizophrenia. In schizophrenia, but not in aphasia, verbal and non-verbal performance were associated. Formal thought disorder was associated with impairment in executive function and in grammatical, but not naming, tasks.Conclusion: While patients with schizophrenia and aphasia showed language impairments, the nature and cognitive basis of these impairments may be different; language performance disassociates from broader cognitive functioning in aphasia but may be an intrinsic expression of a broader cognitive impairment in schizophrenia. Thought disorder may represent a core malfunction of grammatical processing. Results suggests that communicative ability may be a valid target in cognitive remediation strategies in schizophrenia.
Collapse
Affiliation(s)
- Bethany Little
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Vitor Zimmerer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Rosemary Varley
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Maggie Douglas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Spencer
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Derya Çokal
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,School of Electronic Engineering and Computer Science, Cognitive Science Research Group, Queen Mary University of London, London
| | - Felicity Deamer
- Department of Philosophy, Durham University, Durham, UK.,Department of English Studies, Durham University, Durham, UK
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - I Nicol Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Wolfram Hinzen
- ICREA (Catalan Institute of Advanced Studies and Research), Universitat Pompeu Fabra, Barcelona, Spain.,Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,FIDMAG Germanes Hospitalaries Research Foundation, Benito Menni Hospital, Barcelona, Spain
| | - Stuart Watson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
11
|
Zoghbi M, Haddad C, Hallit S, Nabout R, Medlej-Hashim M, Hachem D, Azar J. Cognition and physical functioning in patients with schizophrenia: any role for vitamin D? Nutr Neurosci 2019; 23:911-919. [PMID: 30774039 DOI: 10.1080/1028415x.2019.1580830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: The study's objective was to evaluate the relationship between vitamin D (VD) levels and cognitive performance in patients with schizophrenia. Methods: A cross-sectional study, conducted between March and July 2016, recruited 196 patients with schizophrenia. The Brief Cognitive Rating Scale (BCRS) and the Morningside Rehabilitation Status Scale (MRSS) were used to measure the severity of cognitive impairment and the level of general functioning in psychiatric patients. Lower scores for both scales indicate a better cognition and functioning respectively. Vitamin D levels of participants were divided into four groups: severe VD deficiency (<10 ng/ml), VD deficiency (10-20 ng/ml), VD insufficiency (20-30 ng/ml), VD sufficiency (>30 ng/ml). Relationships between VD level and cognition and functioning were assessed by analyses of covariance and hierarchical multiple regression, adjusted for age, gender, marital status, education level, sun exposure, physical activity and monthly income. Results: Severe VD deficiency was found in 22 patients with schizophrenia (11.3%), while 45.6% of patients had VD deficiency. Severe VD deficiency was significantly associated with an increase in MRSS score after adjusting for covariates (Beta = 2.44), however, no significant association was found with the BCRS score. Conclusion: These findings suggest that severe VD deficiency in patients with schizophrenia might be associated with low general functioning but could not influence cognitive function.
Collapse
Affiliation(s)
- Marouan Zoghbi
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Chadia Haddad
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Rita Nabout
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | | | - Dory Hachem
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Jocelyne Azar
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Sciences, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, Lebanese American University, Byblos, Lebanon
| |
Collapse
|
12
|
Sheffield JM, Karcher NR, Barch DM. Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective. Neuropsychol Rev 2018; 28:509-533. [PMID: 30343458 DOI: 10.1007/s11065-018-9388-2] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.
Collapse
Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN, 37212, USA.
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
13
|
Habtamu K, Alem A, Medhin G, Fekadu A, Hanlon C. Functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:803-814. [PMID: 29947862 DOI: 10.1007/s00127-018-1546-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/06/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low- and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting. METHODS A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing community-ascertained cohort of people with SMD (n = 218), and attendees at the Butajira General Hospital psychiatric clinic (n = 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding 2 years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS) were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment. RESULTS Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects, and internalized stigma were associated with functional impairment across self-reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment. CONCLUSION To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects, and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted.
Collapse
Affiliation(s)
- Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, P.O.BOX: 1176, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Health Services and Population Research Department, Centre for Global Mental Health, Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
14
|
Itakura M, Pu S, Ohdachi H, Matsumura H, Yokoyama K, Nagata I, Iwata M, Kaneko K. Association between social functioning and prefrontal cortex function during a verbal fluency task in schizophrenia: A near-infrared spectroscopic study. Psychiatry Clin Neurosci 2017; 71:769-779. [PMID: 28657683 DOI: 10.1111/pcn.12548] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/19/2017] [Accepted: 06/20/2017] [Indexed: 01/14/2023]
Abstract
AIM Impaired social functioning is a common characteristic of patients with schizophrenia. Social functioning requires the complex operation of various executive functions. Deficits in the prefrontal cortex (PFC) have been implicated in executive dysfunction. Here we aimed to clarify the relation between subjectively and objectively assessed social functioning, and their associations with PFC function in patients with schizophrenia. METHODS Twenty-three patients and 22 age- and sex-matched healthy controls (HC) were assessed. In the schizophrenia group, self- and caregiver-rated social functioning were measured using the Specific Level of Functioning Assessment (SLOF). The hemodynamic responses elicited by a verbal fluency task (VFT) in three regions of interest in the frontotemporal area were measured using multi-channel near-infrared spectroscopy (NIRS). We also investigated psychiatric symptoms, neurocognition, and cognitive insight to assess possible confounding factors. RESULTS Significant positive correlations were found between self- and caregiver-rated SLOF composite scores and three subdomain scores. Self- and caregiver-rated SLOF composite scores were significantly associated with dorsolateral PFC and frontopolar cortex (DLPFC/FPC) activation during the VFT. Psychiatric symptoms, global functioning, neurocognition, and cognitive insight were not associated with NIRS signals. General psychopathology was associated with NIRS signals in the ventrolateral PFC and the anterior temporal cortex. DLPFC and FPC activity may be associated with social functioning in patients with schizophrenia. CONCLUSION Our results suggest that the two distinct assessments of social functioning were significantly correlated. Moreover, DLPFC and FPC function was strongly associated with social functioning and the ability to carry out daily life in patients with schizophrenia.
Collapse
Affiliation(s)
- Masashi Itakura
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan.,Department of Psychiatry, Shimane Prefectural Psychiatric Medical Center, Izumo, Japan
| | - Shenghong Pu
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroaki Ohdachi
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroshi Matsumura
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan
| | - Katsutoshi Yokoyama
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan
| | - Izumi Nagata
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masaaki Iwata
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan
| | - Koichi Kaneko
- Division of Psychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Japan
| |
Collapse
|
15
|
The reliability of the Personal and Social Performance scale - informing its training and use. Psychiatry Res 2016; 243:312-7. [PMID: 27428085 DOI: 10.1016/j.psychres.2016.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/20/2022]
Abstract
Social functioning is as an important outcome in studies of people with schizophrenia. Most measures of social function include a person's ability to manage everyday activities as well as their abilities to engage in leisure and occupational activities. The Personal Social Performance (PSP) scale assesses functioning across four dimensions (socially useful activities, personal and social relationships, self-care, disturbing and aggressive behaviours) rather than one global score and thus has been reported to be easier to use. In a pan-European study of people with severe mental illness a team of 26 researchers received training in rating the scale, after which the inter-rater reliability (IRR) was assessed and found to be not sufficiently high. A brief survey of the researchers elicited information with which to explore the low IRR and their experience of using the PSP. Clinicians were found to have higher IRR, in particular, psychologists. Patients' employment status was found to be the most important predictor of PSP. Researchers used multiple sources of information when rating the scale. Sufficient training is required to ensure IRR, particularly for non-clinical researchers, if the PSP is to be established as a reliable research tool.
Collapse
|
16
|
A structural equation modelling approach to explore the determinants of quality of life in schizophrenia. Schizophr Res 2016; 171:27-34. [PMID: 26781001 DOI: 10.1016/j.schres.2016.01.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/03/2015] [Accepted: 01/04/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to analyse the relationships among psychotic symptoms, depression, neurocognition and functioning as determinants of quality of life (QoL) in patients with schizophrenia. METHODS In this cross-sectional study, we evaluated QoL with the Schizophrenia Quality of Life 18-item scale (S-QoL 18), neurocognition with multiple tests exploring memory, attention and executive functions, the severity of psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), depression with the Calgary Depression Scale for Schizophrenia (CDSS) and functioning using the Functional Remission Of General Schizophrenia (FROGS) scale. We used Structural Equation Modelling (SEM) to describe the relationships among the severity of psychotic symptoms, depression, neurocognition, functioning and QoL. RESULTS Two hundred and seventy-one outpatients with schizophrenia participated in our study. SEM showed good fit with χ(2)/df=1.97, root mean square error of approximation=0.06, comparative fit index=0.93 and standardized root mean square residuals=0.05. This model revealed that depression was the most important feature associated with QoL, mainly for the self-esteem, autonomy and resilience dimensions (direct path coefficient=-0.46). The direct path between functioning and QoL was also significant (path coefficient=0.26). The severity of psychotic symptoms and neurocognitive impairment were weakly and indirectly associated with QoL via functioning (path coefficients=-0.18 and 0.04, respectively). CONCLUSIONS This study contributes to a better understanding of the determinants of QoL in schizophrenia. Our findings should be considered in developing effective strategies for improving QoL among this population.
Collapse
|
17
|
Stergiopoulos V, Schuler A, Nisenbaum R, deRuiter W, Guimond T, Wasylenki D, Hoch JS, Hwang SW, Rouleau K, Dewa C. The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study. BMC Health Serv Res 2015; 15:348. [PMID: 26315398 PMCID: PMC4551376 DOI: 10.1186/s12913-015-1014-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/21/2015] [Indexed: 11/17/2022] Open
Abstract
Background Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. Methods In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains. Results We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures. Conclusions Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.
Collapse
Affiliation(s)
- Vicky Stergiopoulos
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Andrée Schuler
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Rosane Nisenbaum
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada.
| | - Wayne deRuiter
- Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, Ontario, M5S 2G8, Canada.
| | - Tim Guimond
- Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Donald Wasylenki
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Jeffrey S Hoch
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Centre for Excellence in Economic Analysis Research (CLEAR), Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Stephen W Hwang
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Division of General Internal Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Katherine Rouleau
- Global Health Program, Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, 3rd Floor, Toronto, Ontario, M5T 1W7, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Carolyn Dewa
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, Ontario, M5S 2G8, Canada.
| |
Collapse
|
18
|
Harrop C, Ellett L, Brand R, Lobban F. Friends interventions in psychosis: a narrative review and call to action. Early Interv Psychiatry 2015; 9:269-78. [PMID: 25130455 DOI: 10.1111/eip.12172] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 06/22/2014] [Indexed: 11/30/2022]
Abstract
AIMS To highlight the importance of friendships to young people with psychosis, and the need for clinical interventions to help maintain peer relationships during illness. To structure a research agenda for developing evidence-based interventions with friends. METHOD An argument is developed through a narrative review of (i) the proven efficacy of family interventions, and (by comparison) a relative absence of friend-based interventions; (ii) the particular primacy of friendships and dating for young people, and typical effects of exclusion; and (iii) reduced friendship networks and dating experiences in psychosis, in pre-, during and post-psychosis phases, also links between exclusion and psychosis. RESULTS We put forward a model of how poor friendships can potentially be a causal and/or maintenance factor for psychotic symptoms. Given this model, our thesis is that interventions aiming to maintain social networks can be hugely beneficial clinically for young people with psychosis. We give a case study to show how such an intervention can work. CONCLUSIONS We call for 'friends interventions' for young people with psychosis to be developed, where professionals directly work with a young person's authentic social group to support key friendships and maintain social continuity. An agenda for future research is presented that will develop and test theoretically driven interventions.
Collapse
Affiliation(s)
- Chris Harrop
- Early Intervention Service, West London Mental Health Trust, Middlesex, UK
| | - Lyn Ellett
- Department of Clinical Psychology, Royal Holloway, University of London, Surrey, UK
| | - Rachel Brand
- Early Intervention Service, South West London and St Georges Mental Health Trust, London, UK
| | - Fiona Lobban
- Spectrum Centre, University of Lancaster, Lancaster, UK
| |
Collapse
|
19
|
Reckless GE, Andreassen OA, Server A, Østefjells T, Jensen J. Negative symptoms in schizophrenia are associated with aberrant striato-cortical connectivity in a rewarded perceptual decision-making task. Neuroimage Clin 2015. [PMID: 26106553 DOI: 10.1016/j.nicl.2015.04.025.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Negative symptoms in schizophrenia have been associated with structural and functional changes in the prefrontal cortex. They often persist after treatment with antipsychotic medication which targets, in particular, the ventral striatum (VS). As schizophrenia has been suggested to arise from dysfunctional connectivity between neural networks, it is possible that residual aberrant striato-cortical connectivity in medicated patients plays a role in enduring negative symptomology. The present study examined the relationship between striato-cortical connectivity and negative symptoms in medicated schizophrenia patients. METHODS We manipulated motivation in a perceptual decision-making task during functional magnetic resonance imaging. Comparing healthy controls (n = 21) and medicated patients with schizophrenia (n = 18) we investigated how motivation-mediated changes in VS activation affected functional connectivity with the frontal cortex, and how changes in connectivity strength from the neutral to motivated condition related to negative symptom severity. RESULTS A pattern of aberrant striato-cortical connectivity was observed in the presence of intact VS, but altered left inferior frontal gyrus (IFG) motivation-mediated activation in patients. The more severe the patient's negative symptoms, the less the connectivity strength between the right VS and left IFG changed from the neutral to the motivated condition. Despite aberrant striato-cortical connectivity and altered recruitment of the left IFG among patients, both patients and healthy controls adopted a more liberal response strategy in the motivated compared to the neutral condition. CONCLUSIONS The present findings suggest that there is a link between dysfunctional striato-cortical connectivity and negative symptom severity, and offer a possible explanation as to why negative symptoms persist after treatment with antipsychotics.
Collapse
Affiliation(s)
- Greg E Reckless
- NORMENT - KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ; Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT - KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ; Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andres Server
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Tiril Østefjells
- NORMENT - KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jimmy Jensen
- NORMENT - KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ; Department of Clinical Medicine, University of Oslo, Oslo, Norway ; Centre for Psychology, Kristianstad University, Kristianstad, Sweden
| |
Collapse
|
20
|
Cordes JS, Mathiak KA, Dyck M, Alawi EM, Gaber TJ, Zepf FD, Klasen M, Zvyagintsev M, Gur RC, Mathiak K. Cognitive and neural strategies during control of the anterior cingulate cortex by fMRI neurofeedback in patients with schizophrenia. Front Behav Neurosci 2015; 9:169. [PMID: 26161073 PMCID: PMC4480149 DOI: 10.3389/fnbeh.2015.00169] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
Abstract
Cognitive functioning is impaired in patients with schizophrenia, leading to significant disabilities in everyday functioning. Its improvement is an important treatment target. Neurofeedback (NF) seems a promising method to address the neural dysfunctions underlying those cognitive impairments. The anterior cingulate cortex (ACC), a central hub for cognitive processing, is one of the brain regions known to be dysfunctional in schizophrenia. Here we conducted NF training based on real-time functional magnetic resonance imaging (fMRI) in patients with schizophrenia to enable them to control their ACC activity. Training was performed over 3 days in a group of 11 patients with schizophrenia and 11 healthy controls. Social feedback was provided in accordance with the evoked activity in the selected region of interest (ROI). Neural and cognitive strategies were examined off-line. Both groups learned to control the activity of their ACC but used different neural strategies: patients activated the dorsal and healthy controls the rostral subdivision. Patients mainly used imagination of music to elicit activity and the control group imagination of sports. In a stepwise regression analysis, the difference in neural control did not result from the differences in cognitive strategies but from diagnosis alone. Based on social reinforcers, patients with schizophrenia can learn to regulate localized brain activity. However, cognitive strategies and neural network location differ from healthy controls. These data emphasize that for therapeutic interventions in patients with schizophrenia compensatory strategies may emerge. Specific cognitive skills or specific dysfunctional networks should be addressed to train impaired skills. Social NF based on fMRI may be one method to accomplish precise learning targets.
Collapse
Affiliation(s)
- Julia S Cordes
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Krystyna A Mathiak
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany
| | - Miriam Dyck
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Eliza M Alawi
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Tilman J Gaber
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany
| | - Florian D Zepf
- JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany ; Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences and School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561) Perth, WA, Australia ; Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia Perth, WA, Australia
| | - Martin Klasen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania Philadelphia, PA, USA
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| |
Collapse
|
21
|
Negative symptoms in schizophrenia are associated with aberrant striato-cortical connectivity in a rewarded perceptual decision-making task. NEUROIMAGE-CLINICAL 2015; 8:290-7. [PMID: 26106553 PMCID: PMC4474284 DOI: 10.1016/j.nicl.2015.04.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/20/2015] [Accepted: 04/29/2015] [Indexed: 11/24/2022]
Abstract
Background Negative symptoms in schizophrenia have been associated with structural and functional changes in the prefrontal cortex. They often persist after treatment with antipsychotic medication which targets, in particular, the ventral striatum (VS). As schizophrenia has been suggested to arise from dysfunctional connectivity between neural networks, it is possible that residual aberrant striato-cortical connectivity in medicated patients plays a role in enduring negative symptomology. The present study examined the relationship between striato-cortical connectivity and negative symptoms in medicated schizophrenia patients. Methods We manipulated motivation in a perceptual decision-making task during functional magnetic resonance imaging. Comparing healthy controls (n = 21) and medicated patients with schizophrenia (n = 18) we investigated how motivation-mediated changes in VS activation affected functional connectivity with the frontal cortex, and how changes in connectivity strength from the neutral to motivated condition related to negative symptom severity. Results A pattern of aberrant striato-cortical connectivity was observed in the presence of intact VS, but altered left inferior frontal gyrus (IFG) motivation-mediated activation in patients. The more severe the patient's negative symptoms, the less the connectivity strength between the right VS and left IFG changed from the neutral to the motivated condition. Despite aberrant striato-cortical connectivity and altered recruitment of the left IFG among patients, both patients and healthy controls adopted a more liberal response strategy in the motivated compared to the neutral condition. Conclusions The present findings suggest that there is a link between dysfunctional striato-cortical connectivity and negative symptom severity, and offer a possible explanation as to why negative symptoms persist after treatment with antipsychotics. Examined the relationship between striato-cortical connectivity and negative symptoms in medicated schizophrenia patients Patients had normal ventral striatal (VS), but altered left inferior frontal gyrus (IFG) activation. The more severe the negative symptoms, the less the connectivity strength between these regions changed when motivated. Altered striato-cortical connectivity may explain the persistence of negative symptoms after treatment with antipsychotics.
Collapse
|
22
|
Gabrielian S, Bromley E, Hellemann GS, Kern RS, Goldenson NI, Danley ME, Young AS. Factors affecting exits from homelessness among persons with serious mental illness and substance use disorders. J Clin Psychiatry 2015; 76:e469-76. [PMID: 25919839 PMCID: PMC4620999 DOI: 10.4088/jcp.14m09229] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/23/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to understand the housing trajectories of homeless consumers with serious mental illness (SMI) and co-occurring substance use disorders (SUD) and to identify factors that best predicted achievement of independent housing. METHOD Using administrative data, we identified homeless persons with SMI and SUD admitted to a residential rehabilitation program from December 2008 to November 2011. Our primary outcome measure was independent housing status. On a random sample (N = 36), we assessed a range of potential predictors of housing outcomes, including symptoms, cognition, and social/community supports. We used the Residential Time-Line Follow-Back (TLFB) Inventory to gather housing histories since exiting rehabilitation and to identify housing outcomes. We used Recursive Partitioning (RP) to identify variables that best differentiated participants by these outcomes. RESULTS We identified 3 housing trajectories: stable housing (n = 14), unstable housing (n = 15), and continuously engaged in housing services (n = 7). In RP analysis, 2 variables (Symbol Digit Modalities Test [SDMT], a neurocognitive speed of processing measure, and Behavior and Symptom Identification Scale [BASIS-24] Relationships subscale, which quantifies symptoms affecting relationships) were sufficient to capture information provided by 26 predictors to classify participants by housing outcome. Participants predicted to continuously engage in services had impaired processing speeds (SDMT score < 32.5). Among consumers with SDMT score ≥ 32.5, those predicted to achieve stable housing had fewer interpersonal symptoms (BASIS-24 Relationships subscale score < 0.81) than those predicted to have unstable housing. This model explains 57% of this sample's variability and 14% of this population's variability in housing outcomes. CONCLUSIONS Because cognition and symptoms influencing relationships predicted housing outcomes for homeless adults with SMI and SUD, cognitive and social skills training may be useful for this population.
Collapse
Affiliation(s)
- Sonya Gabrielian
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 210A, Los Angeles, CA 90073
| | - Elizabeth Bromley
- Department of Psychiatry, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., Department of Veterans Affairs VISN22 Mental Illness Research and Education Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., VA Center for the Study of Healthcare Innovation, Implementation, and Policy, North Hills, CA, USA
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., VA Center for the Study of Healthcare Innovation, Implementation, and Policy, North Hills, CA, USA
| | - Robert S. Kern
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., Department of Veterans Affairs VISN22 Mental Illness Research and Education Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, USA
| | - Megan E. Danley
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Alexander S. Young
- Department of Psychiatry, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., Department of Veterans Affairs VISN22 Mental Illness Research and Education Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., VA Center for the Study of Healthcare Innovation, Implementation, and Policy, North Hills, CA, USA
| |
Collapse
|
23
|
Suttajit S, Arunpongpaisal S, Srisurapanont M, Thavichachart N, Kongsakon R, Chantakarn S, Chantarasak V, Jariyavilas A, Jaroensook P, Kittiwattanagul K, Nerapusee O. Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains? Neuropsychiatr Dis Treat 2015; 11:2471-7. [PMID: 26491325 PMCID: PMC4599141 DOI: 10.2147/ndt.s88085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aimed to examine symptoms/demographic characteristics as predictors for psychosocial functioning among individuals with schizophrenia. The Personal and Social Performance (PSP) scale was used to assess psychosocial functioning. Other measures of interest included were the Clinical Global Impression, Severity scale, and the Marder's five-factor model of the Positive and Negative Syndrome Scale. This study included 199 participants with non-acute stage schizophrenia. Spearman correlation coefficients and stepwise multiple linear regression analyses were applied to determine the correlates and predictors of PSP domain/total scores. Younger age, earlier age of schizophrenia onset, severe illness, positive symptoms, negative symptoms, disorganized thought, hostility/excitement, and anxiety/depression were found to significantly correlate with poor functioning. Severe illness and negative symptoms are the main predictors of greater impairment of socially useful activities, personal and social relationships, and self-care. Further prospective studies in other settings, which would include an increased number of variables such as neurocognitive function and social support, are warranted.
Collapse
Affiliation(s)
- Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suwanna Arunpongpaisal
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuntika Thavichachart
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ronnachai Kongsakon
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Sunanta Chantakarn
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | | | | | | | | | | |
Collapse
|
24
|
Lystad JU, Falkum E, Mohn C, Haaland VØ, Bull H, Evensen S, Rund BR, Ueland T. The MATRICS Consensus Cognitive Battery (MCCB): performance and functional correlates. Psychiatry Res 2014; 220:1094-101. [PMID: 25242432 DOI: 10.1016/j.psychres.2014.08.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 02/01/2023]
Abstract
Neurocognitive impairment is a core feature in psychotic disorders and the MATRICS Consensus Cognitive Battery (MCCB) is now widely used to assess neurocognition in this group. The MATRICS has been translated into several languages, including Norwegian; although this version has yet to be investigated in an adult clinical population. Further, the relationship between the MATRICS and different measures of functioning needs examination. The purpose of this study was to describe neurocognition assessed with the Norwegian version of the MATRICS battery in a sample of patients with psychotic disorders compared to age and gender matched healthy controls and to examine the association with educational-, occupational- and social-functioning in the patient group. One hundred and thirty one patients and 137 healthy controls completed the battery. The Norwegian version of the MATRICS was sensitive to the magnitude of neurocognitive impairments in patients with psychotic disorders, with patients displaying significant impairments on all domains relative to healthy controls. Neurocognition was also related to both self-rated and objective functional measures such as social functioning, educational- and employment-history.
Collapse
Affiliation(s)
- June Ullevoldsæter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway.
| | - Erik Falkum
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Christine Mohn
- Department of Research, Vestre Viken Hospital Trust, Drammen, Norway
| | - Vegard Øksendal Haaland
- Department of Psychology, University of Oslo, Norway; Department of Psychiatry, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Helen Bull
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway
| | - Stig Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Norway; Department of Research, Vestre Viken Hospital Trust, Drammen, Norway
| | - Torill Ueland
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway
| |
Collapse
|
25
|
Bai YM, Hsiao CY, Chen KC, Huang KL, Lee IH, Hsu JW, Chen PS, Yang YK. The development of a self-reported scale for measuring functionality in patients with schizophrenia--self-reported version of the graphic Personal and Social Performance (SRG-PSP) scale. Schizophr Res 2014; 159:546-51. [PMID: 25257944 DOI: 10.1016/j.schres.2014.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/11/2014] [Accepted: 08/15/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Personal and Social Performance (PSP) scale is used for the assessment of patient function by mental health professionals. This study aimed to evaluate the internal reliability and validity of a self-reported graphic version of the PSP (SRG-PSP) scale and its correlations with psychiatric symptoms, daily life ability and quality of life. METHODS The SRG-PSP scale was developed following the four PSP domains: socially useful activities, personal and social relationships, self-care, and disturbing and aggressive behavior. In total, 108 patients with schizophrenia were enrolled. All participants completed the SRG-PSP, the Activities of Daily Living Rating Scale II (ADLRS-II), and the World Health Organization Quality of Life-BREF (WHOQOL). They were also assessed using the PSP and the Positive and Negative Syndrome Scale (PANSS). Spearman's ρ was used to examine the correlations between SRG-PSP scores and other variables. RESULTS The results of the SRG-PSP were significantly correlated to those of their corresponding criteria on the PSP. The global score of the SRG-PSP and the scores of three domains, socially useful activities, personal and social relationships, and self-care, were positively correlated with most sub items of the ADLRS-II and WHOQOL, and were negatively correlated with the PANSS scores. The disturbing and aggressive behavior domain of the SRG-PSP was negatively correlated with most sub items of the ADLRS-II and WHOQOL (ρ=-0.19 to -0.36, all p<0.05) and positively correlated with the PANSS (ρ=0.24-0.30, all p<0.05), with the exception of negative symptoms (ρ=0.09, p=0.40). CONCLUSION The SRG-PSP is a valid self-reported scale for the assessment of functionality in patients with schizophrenia.
Collapse
Affiliation(s)
- Ya Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih Yin Hsiao
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
26
|
Andreou C, Treszl A, Roesch-Ely D, Köther U, Veckenstedt R, Moritz S. Investigation of the role of the jumping-to-conclusions bias for short-term functional outcome in schizophrenia. Psychiatry Res 2014; 218:341-7. [PMID: 24836199 DOI: 10.1016/j.psychres.2014.04.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/07/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
Abstract
Symptom severity and neuropsychological deficits negatively influence functional outcomes in patients with schizophrenia. Recent research implicates specific types of biased thinking styles (e.g. jumping-to-conclusions) in the pathogenesis of schizophrenia. This is the first study to test the impact of jumping-to-conclusions on functional outcome in schizophrenia. The aim of the study was to investigate the association of psychopathology, neuropsychology and JTC with subjective quality of life, vocational outcome and housing status in schizophrenia. Analyses were carried out both cross-sectionally at baseline, and longitudinally over the course of symptomatic improvement in the immediate aftermath of a psychotic exacerbation. Seventy-nine patients with schizophrenia were included in the study. Data concerning the variables of interest were collected at baseline, after one month, and after six months. Positive symptomatology was the most significant predictor of subjective and vocational outcome and changes across time. Verbal memory deficits were associated with functional status cross-sectionally, whereas general cognitive capacity significantly predicted functional changes over time. Improvement of the jumping-to-conclusions bias positively affected vocational outcome. Though limited, the observed effect of this bias on real-world functioning highlights the possible usefulness of interventions aimed at improving (meta)cognitive deficits in schizophrenia.
Collapse
Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - András Treszl
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Daniela Roesch-Ely
- Department of General Psychiatry, Center for Psychosocial Medicine, Department of Experimental Psychopathology and Neurophysiology, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany
| | - Ulf Köther
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| |
Collapse
|
27
|
Dickerson F, Schroeder J, Stallings C, Origoni A, Katsafanas E, Schwienfurth LAB, Savage CLG, Khushalani S, Yolken R. A longitudinal study of cognitive functioning in schizophrenia: clinical and biological predictors. Schizophr Res 2014; 156:248-53. [PMID: 24827555 DOI: 10.1016/j.schres.2014.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/12/2014] [Accepted: 04/17/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitive deficits are a central feature of schizophrenia but it is not certain how cognitive functioning changes over time. The purpose of this prospective longitudinal study was to determine the temporal change of cognitive functioning and the predictors of cognitive performance from among demographic, clinical, and biological variables. METHODS Participants were individuals with schizophrenia or schizoaffective disorder whose cognitive functioning was assessed at multiple time points with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). At the baseline visit participants had a blood sample drawn from which C-reactive protein, antibodies to Herpes Simplex Virus type 1, and selected genetic polymorphisms were measured. Repeated measures linear regression was used to determine whether cognitive measures changed over time and which variables predicted cognitive performance. RESULTS The sample consisted of 132 participants, mean age 43.7 years at baseline, who received a median of 3 cognitive assessments over a period averaging 2.8 years. The RBANS Total score and Language index showed no statistically significant temporal change; performance on two indices, Immediate Memory and Attention, showed modest but statistically significant improvements (gains of 0.89±0.33 and 0.76±0.29 points per year, respectively); Visuospatial/Constructional performance showed a modest but statistically significant decline (of 0.80±0.25 points per year). Few variables predicted cognitive performance; however greater psychiatric symptom severity was associated with worse cognitive performance for most cognitive measures. CONCLUSIONS Cognitive functioning in middle-aged persons with schizophrenia showed an absence of decline for most measures and modest gains in some measures.
Collapse
Affiliation(s)
- Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
| | | | - Cassie Stallings
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States
| | - Andrea Origoni
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States
| | - Emily Katsafanas
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States
| | - Lucy A B Schwienfurth
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States
| | - Christina L G Savage
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States
| | - Sunil Khushalani
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States
| | - Robert Yolken
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| |
Collapse
|
28
|
Nuechterlein KH, Ventura J, Subotnik KL, Hayata JN, Medalia A, Bell MD. Developing a Cognitive Training Strategy for First-Episode Schizophrenia: Integrating Bottom-Up and Top-Down Approaches. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2014; 17:225-253. [PMID: 25489275 PMCID: PMC4256669 DOI: 10.1080/15487768.2014.935674] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
It is clear that people with schizophrenia typically have cognitive problems in multiple domains as part of their illness. The cognitive deficits are among the main contributors to limitations in their everyday functioning, including their work recovery. Cognitive remediation has been applied successfully to help people with long-term, persistent schizophrenia to improve their cognitive functioning, but it is only beginning to be applied with individuals who have recently had a first episode of psychosis. Several different approaches to cognitive training have been developed. Some approaches emphasize extensive systematic practice with lower-level cognitive processes and building toward higher-level processes ("bottom-up"), while others emphasize greater focus on high-level cognitive processes that normally integrate and organize lower-level processes ("top-down"). Each approach has advantages and disadvantages for a disorder like schizophrenia, with its multiple levels of cognitive dysfunction. In addition, approaches to cognitive remediation differ in the extent to which they systematically facilitate transfer of learning to everyday functioning. We describe in this article the cognitive training approach that was developed for a UCLA study of people with a recent first episode of schizophrenia, a group that may benefit greatly from early intervention that focuses on cognition and recovery of work functioning. This approach integrated bottom-up and top-down computerized cognitive training and incorporated an additional weekly group session to bridge between computerized training and application to everyday work and school functioning.
Collapse
Affiliation(s)
- Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Science, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles ; Department of Psychology, University of California, Los Angeles
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Science, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Science, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Jacqueline N Hayata
- Department of Psychiatry and Biobehavioral Science, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Alice Medalia
- Department of Psychiatry, Columbia University Medical Center
| | | |
Collapse
|
29
|
Deficient gaze pattern during virtual multiparty conversation in patients with schizophrenia. Comput Biol Med 2014; 49:60-6. [DOI: 10.1016/j.compbiomed.2014.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/08/2014] [Accepted: 03/28/2014] [Indexed: 11/23/2022]
|
30
|
Quee PJ, Alizadeh BZ, Aleman A, van den Heuvel ER. Cognitive subtypes in non-affected siblings of schizophrenia patients: characteristics and profile congruency with affected family members. Psychol Med 2014; 44:395-405. [PMID: 23659373 DOI: 10.1017/s0033291713000809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although cognitive subtypes have been suggested in schizophrenia patients, similar analyses have not been carried out in their non-affected siblings. Subtype classification may provide more insight into genetically driven variation in cognitive function. We investigated cognitive subtypes in siblings. METHOD Cluster analyses were performed in 654 non-affected siblings, on a cognitive battery that included tests of attention, intellectual function and episodic memory. Resulting subtypes in the siblings were analyzed for cognitive, demographic and clinical characteristics and compared with those of their probands. RESULTS Three sibling subtypes of cognitive function were distinguished: 'normal', 'mixed' and 'impaired'. Normal profile siblings (n = 192) were unimpaired on cognitive tests, in contrast to their proband (n = 184). Mixed profile siblings (n = 228) and their probands (n = 222) had a more similar performance pattern. Impaired profile siblings had poorer functional outcomes (n = 234) and their profile was almost identical to that of their proband (n = 223). Probands with cognitively impaired siblings could be distinguished from other schizophrenia patients by their own cognitive performance. They also had poorer clinical characteristics, including achievement of symptomatic remission. CONCLUSIONS Unaffected siblings of patients with schizophrenia are heterogeneous with respect to cognitive function. The poorer the cognitive profile of the sibling, the higher the level of correspondence with the proband. The sibling's cognitive subtype was predictive for disease course in the proband. Distinguishing cognitive subtypes of unaffected siblings may be of relevance for genetic studies.
Collapse
Affiliation(s)
- P J Quee
- Department of Psychiatry and Rob Giel Research Center, University of Groningen, University Medical Center Groningen, The Netherlands
| | - B Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - A Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, The Netherlands
| | - E R van den Heuvel
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
| |
Collapse
|
31
|
Rajji TK, Miranda D, Mulsant BH. Cognition, function, and disability in patients with schizophrenia: a review of longitudinal studies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:13-7. [PMID: 24444319 PMCID: PMC4079219 DOI: 10.1177/070674371405900104] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper aims to review longitudinal studies assessing the impact of cognition on function in patients with schizophrenia. PubMed and Scholars Portal were searched using search terms related to schizophrenia, cognition, function, and longitudinal studies. Some functional abilities have been studied more than others. Some studies suggest that the impact of cognition on function depends on the severity of baseline cognitive deficits. Other studies suggest that the impact of cognition on function depend on what phase of the illness the patient is in or what stage in that particular function the patient is involved in. Finally, few studies assessed interactions between cognition and other aspects of schizophrenia in predicting function, such as functional capacity, insight, motivation, and negative symptoms. More longitudinal and comprehensive studies are needed. A focus on community living is of high public significance as patients with schizophrenia continue to grow old. Future studies should also focus on the longitudinal interactions between cognition and other dimensions of schizophrenia as well as on the biological factors that underlie these interactions.
Collapse
Affiliation(s)
- Tarek K Rajji
- Assistant Professor, Department of Psychiatry, University of Toronto; Chief, Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Dielle Miranda
- Research Manager, Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Benoit H Mulsant
- Professor and Vice Chair, Department of Psychiatry, University of Toronto; Physician-in-Chief, Centre for Addiction and Mental Health, Toronto, Ontario
| |
Collapse
|
32
|
Carrión RE, McLaughlin D, Goldberg TE, Auther AM, Olsen RH, Olvet DM, Correll CU, Cornblatt BA. Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA Psychiatry 2013; 70:1133-42. [PMID: 24006090 PMCID: PMC4469070 DOI: 10.1001/jamapsychiatry.2013.1909] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A major public health concern associated with schizophrenia and psychotic disorders is the long-term disability that involves impaired cognition, lack of social support, and an inability to function independently in the community. A critical goal of early detection and intervention studies in psychosis is therefore to understand the factors leading to this often profound impairment. OBJECTIVE To develop a predictive model of functional (social and role) outcome in a clinical high-risk sample for psychosis. DESIGN Prospective, naturalistic, longitudinal 3- to 5-year follow-up study. SETTING The Recognition and Prevention Program in New York, a research clinic located in the Zucker Hillside Hospital in New York. PARTICIPANTS One hundred one treatment-seeking patients at clinical high risk for psychosis. Ninety-two (91%) were followed up prospectively for a mean (SD) of 3 (1.6) years. INTERVENTION Neurocognitive and clinical assessment. MAIN OUTCOMES AND MEASURES The primary outcome variables were social and role functioning at the last follow-up visit. RESULTS Poor social outcome was predicted by reduced processing speed (odds ratio [OR], 1.38; 95% CI, 1.050-1.823; P = .02), impaired social functioning at baseline (OR, 1.85; 95% CI, 1.258-2.732; P = .002), and total disorganized symptoms (OR, 5.06; 95% CI, 1.548-16.527; P = .007). Reduced performance on tests for verbal memory (OR, 1.74; 95% CI, 1.169-2.594; P = .006), role functioning at baseline (OR, 1.34; 95% CI, 1.053-1.711; P = .02), and motor disturbances (OR, 1.77; 95% CI, 1.060-2.969; P = .03) predicted role outcome. The areas under the curve for the social and role prediction models were 0.824 (95% CI, 0.736-0.913; P < .001) and 0.77 (95% CI, 0.68-0.87; P < .001), respectively, demonstrating a high discriminative ability. In addition, poor functional outcomes were not entirely dependent on the development of psychosis, because 40.3% and 45.5% of nonconverters at clinical high risk had poor social and role outcomes, respectively. CONCLUSIONS AND RELEVANCE Results from this study support the increasing emphasis on functional decline as a critically important outcome that parallels conversion to psychosis and suggest that both psychosis and long-term functional disability are equally important targets for prevention. Reduced neurocognitive performance, functional impairments, and nonpositive attenuated symptoms at baseline were associated with an increased risk of poor functional outcomes in our sample. Poor functional outcomes were not entirely dependent on positive symptoms and the development of psychosis, further highlighting the need for intervention at this early stage of development for those who do and do not convert to a full-blown psychotic disorder.
Collapse
Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York2Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Prikryl R, Ustohal L, Prikrylova Kucerova H, Kasparek T, Venclikova S, Vrzalova M, Ceskova E. A detailed analysis of the effect of repetitive transcranial magnetic stimulation on negative symptoms of schizophrenia: a double-blind trial. Schizophr Res 2013; 149:167-73. [PMID: 23810122 DOI: 10.1016/j.schres.2013.06.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/09/2013] [Accepted: 06/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the effect of rTMS not only on the general severity of negative schizophrenia symptoms, but also particularly on their individual domains, such as affective flattening or blunting, alogia, avolition or apathy, anhedonia, and impaired attention. METHODS Forty schizophrenic male patients on stable antipsychotic medication with prominent negative symptoms were included in the study. They were divided into two groups: 23 were treated with active and 17 with placebo rTMS. Both treatments were similar, but placebo rTMS was administered using a purpose-built sham coil. Stimulation was applied to the left dorsolateral prefrontal cortex (DLPFC). The stimulation frequency was 10 Hz; stimulation intensity was 110% of the individual motor threshold intensity. Each patient received 15 rTMS sessions on 15 consecutive working days (five working days "on" and two weekend days "off" design). Each daily session consisted of 20 applications of 10-second duration with 30-second intervals between sequences. The patients and raters were blind to condition of stimulation treatment. RESULTS The active rTMS led to a statistically significantly higher reduction of the Scale for the Assessment of Negative Symptoms (SANS) total score and of all domains of negative symptoms of schizophrenia. After Bonferroni adjustments for multiple testing, the statistical significance disappeared in alogia only. CONCLUSION High-frequency rTMS stimulation over the left DLPFC at a high stimulation intensity with a sufficient number of applied stimulating pulses may represent an efficient augmentation of antipsychotics in alleviating the negative symptoms of schizophrenia.
Collapse
Affiliation(s)
- Radovan Prikryl
- CEITEC - Central European Institute of Technology, Masaryk University, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
34
|
Tanaka S, Nagase T, Suzuki T, Nomura K, Takeuchi H, Nakajima S, Uchida H, Yagi G, Watanabe K, Mimura M. Factor structure of the targeted inventory on problems in schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2013; 11:18-23. [PMID: 23678350 PMCID: PMC3650293 DOI: 10.9758/cpn.2013.11.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/12/2012] [Accepted: 09/28/2012] [Indexed: 11/20/2022]
Abstract
Objective The aim of this study was to explore the factor structure of a novel, 10-item rating scale, the Targeted Inventory on Problems in Schizophrenia (TIP-Sz). Determining the factor structure will be useful in the brief evaluation of medication and non-medication treatment of the disease. Methods An exploratory factor analysis was performed on TIP-Sz scores obtained from 100 patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for schizophrenia. Results The factor analysis extracted four factors that were deemed clinically pertinent, which we labeled: disorganization, social cooperativeness, functional capacity, and emotional state. The items exhibited cross-loadings on the first three factors (i.e., some items loaded on more than one factor). In particular, the 'behavioral dyscontrol and disorganization,' 'insight and reality testing,' and 'overall prognostic impression' items had comparable cross-loadings on all of the first three factors. The emotional state factor was distinct from the other factors in that the items loading on it did not cross-load on other factors. Conclusion The TIP-Sz scale comprises factors that are associated with the psychosocial functioning and emotional state of patients, which are important outcome parameters for successful treatment of the disease.
Collapse
Affiliation(s)
- Shoji Tanaka
- Department of Information and Communication Sciences, Sophia University, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
The executive function (EF) is a set of abilities, which allows us to invoke voluntary control of our behavioral responses. These functions enable human beings to develop and carry out plans, make up analogies, obey social rules, solve problems, adapt to unexpected circumstances, do many tasks simultaneously, and locate episodes in time and place. EF includes divided attention and sustained attention, working memory (WM), set-shifting, flexibility, planning, and the regulation of goal directed behavior and can be defined as a brain function underlying the human faculty to act or think not only in reaction to external events but also in relation with internal goals and states. EF is mostly associated with dorsolateral prefrontal cortex (PFC). Besides EF, PFC is involved in self-regulation of behavior, i.e., the ability to regulate behavior according to internal goals and constraints, particularly in less structured situations. Self-regulation of behavior is subtended by ventral medial/orbital PFC. Impairment of EF is one of the most commonly observed deficits in schizophrenia through the various disease stages. Impairment in tasks measuring conceptualization, planning, cognitive flexibility, verbal fluency, ability to solve complex problems, and WM occur in schizophrenia. Disorders detected by executive tests are consistent with evidence from functional neuroimaging, which have shown PFC dysfunction in patients while performing these kinds of tasks. Schizophrenics also exhibit deficit in odor identifying, decision-making, and self-regulation of behavior suggesting dysfunction of the orbital PFC. However, impairment in executive tests is explained by dysfunction of prefronto-striato-thalamic, prefronto-parietal, and prefronto-temporal neural networks mainly. Disorders in EFs may be considered central facts with respect to schizophrenia and it has been suggested that negative symptoms may be explained by that executive dysfunction.
Collapse
Affiliation(s)
- Gricel Orellana
- Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile , Santiago , Chile
| | | |
Collapse
|
36
|
Okamura A, Kitabayashi Y, Kohigashi M, Shibata K, Ishida T, Narumoto J, Morioka C, Kitabayashi M, Kashima A, Tani N, Nakaaki S, Mimura M, Fukui K. Neuropsychological and functional correlates of clock-drawing test in elderly institutionalized patients with schizophrenia. Psychogeriatrics 2012; 12:242-7. [PMID: 23279146 DOI: 10.1111/j.1479-8301.2012.00425.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been a growing need for a cognitive assessment tool that can be used for older adults with schizophrenia in clinical settings. The clock-drawing test (CDT) is a brief cognitive test that covers a wide range of cognitive function. Although it is widely used to assess patients with dementia, limited data are available on its usefulness in older patients with schizophrenia. Thus, we investigated the psychometric properties of the CDT and their relationship with life functions to examine the test's usefulness for assessing cognitive function in older adults with schizophrenia. METHODS Seventy-three older adults with chronic schizophrenia who had been hospitalized for over 1 year participated in the study. We adopted the executive clock-drawing task for administration and scoring of the CDT, which consists of free-drawn and copy conditions. The Mini-Mental State Examination and the Brief Assessment of Cognition in Schizophrenia were administered. Symptom severity and life functions were assessed with the Positive and Negative Syndrome Scale and the Life Skills Profile, respectively. RESULTS Both free-drawn and copy scores significantly correlated with the Mini-Mental State Examination score and the Brief Assessment of Cognition in Schizophrenia composite score. These scores also significantly correlated with symptom severity and length of current hospitalization. Stepwise regression analysis showed that only the copy score, together with symptom severity, predicted the Life Skills Profile score. CONCLUSIONS The CDT can assess cognitive function in older adults with schizophrenia. Moreover, CDT performance is associated with life functions independent from other clinical variables. These results suggest that the CDT is a useful cognitive assessment tool for this population.
Collapse
Affiliation(s)
- Aiko Okamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kitayama Hospital, Kyoto, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Between one-third and one-half of the individuals who meet diagnostic criteria for schizophrenia remain actively ill despite optimal pharmacological treatment. These individuals tend to progressively deteriorate in terms of social and vocational functioning despite major public and private investments in their rehabilitation. For patients who do not respond to the first prescribed antipsychotic drug, current clinical practice is to switch to a second and a third drug, and eventually to clozapine, the only antipsychotic drug proven to be effective in treatment-refractory schizophrenia (TRS). Occasionally, two antipsychotics are given concomitantly or psychotropic drugs are added to antipsychotic drugs; however, very few empirical data exist to support this practice. Although there are many exceptions, patients who do not benefit from the first prescribed drug will not benefit from any pharmacological intervention. Therefore, efforts are under way to determine the reason for lack of response to available treatments and devise novel, more effective treatments. To be successful these efforts must result in a more specific definition of TRS, as well as in a better understanding of the illness pathophysiology and the mechanism of action of the drugs.
Collapse
Affiliation(s)
- Asaf Caspi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | |
Collapse
|
38
|
Allison G, Harrop C, Ellett L. Perception of peer group rank of individuals with early psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2012; 52:1-11. [PMID: 23398108 DOI: 10.1111/j.2044-8260.2012.02041.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Social rank theory has been applied to psychosis, in particular the relationship between an individual and their voices. However, perceived peer group rank has not been empirically tested in an early psychosis group. The purpose of the study was to test the prediction that individuals with early psychosis will have lower perceived social status, engage in submissive behaviours more frequently, and will feel more entrapped by external events compared to a healthy control group. DESIGN The study employed a cross-sectional design, comparing individuals with early psychosis and healthy controls. METHODS A total of 24 participants with early psychosis and 24 matched controls completed self-report measures of social rank, including social comparison, submissive behaviours and entrapment, measures of depression, anxiety and psychotic symptoms, and measures of peer network size and peer relationship quality. RESULTS Individuals with early psychosis viewed themselves as being of lower social rank and inferior in relation to matched controls, and also reported engaging in submissive behaviours more frequently and felt more entrapped by external events. CONCLUSIONS Perception of lower social rank and inferiority amongst individuals with early psychosis may impact on engagement in peer relationships and impact on the social decline in early psychosis, which could have significant implications for interventions and recovery.
Collapse
Affiliation(s)
- Gemma Allison
- Department of Psychology, Royal Holloway, University of London, UK
| | | | | |
Collapse
|
39
|
Bromley E, Adams GF, Brekke JS. A video ethnography approach for linking naturalistic behaviors to research constructs of neurocognition in schizophrenia. J Neuropsychiatry Clin Neurosci 2012; 24:125-40. [PMID: 22772661 PMCID: PMC4699689 DOI: 10.1176/appi.neuropsych.11080201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Few methods are available to explore the impact of neurocognition in schizophrenia on behaviors performed in usual contexts. The authors developed a video ethnography approach to examine the relationship between naturalistic behaviors and research constructs of neurocognition. Video ethnographers accompanied subjects through usual routines gathering continuous video data. Researchers developed codes to measure four behavioral domains observed on video. This paper describes the psychometric characteristics to be considered in the development of observational approaches. It also highlights differences between behaviors performed in usual environments and neuropsychological constructs. The authors demonstrate that everyday behaviors that have been shown to correspond to neurocognitive skills in a pilot feasibility study can be identified and rated. They further suggest that observational methods could provide novel strategies for linking research findings and clinical concerns.
Collapse
Affiliation(s)
- Elizabeth Bromley
- Center for Health Services and Society, UCLA Semel Institute, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA.
| | | | | |
Collapse
|
40
|
Abstract
Cognitive functioning is moderately to severely impaired in patients with schizophrenia. This impairment is the prime driver of the significant disabilities in occupational, social, and economic functioning in patients with schizophrenia and an important treatment target. The profile of deficits in schizophrenia includes many of the most important aspects of human cognition: attention, memory, reasoning, and processing speed. While various efforts are under way to identify specific aspects of neurocognition that may lie closest to the neurobiological etiology and pathophysiology of the illness, and may provide relevant convergence with animal models of cognition, standard neuropsychological measures continue to demonstrate the greatest sensitivity to functionally relevant cognitive impairment.The effects of antipsychotic medications on cognition in schizophrenia and first-episode psychosis appear to be minimal. Important work on the effects of add-on pharmacologic treatments is ongoing. Very few of the studies completed to date have had sufficient statistical power to generate firm conclusions; recent studies examining novel add-on treatments have produced some encouraging findings. Cognitive remediation programs have generated considerable interest as these methods are far less costly than pharmacologic treatment and are likely to be safer. A growing consensus suggests that these interventions produce modest gains for patients with schizophrenia, but the efficacy of the various methods used has not been empirically investigated.
Collapse
|
41
|
Niitsu T, Shirayama Y, Matsuzawa D, Hasegawa T, Kanahara N, Hashimoto T, Shiraishi T, Shiina A, Fukami G, Fujisaki M, Watanabe H, Nakazato M, Asano M, Kimura S, Hashimoto K, Iyo M. Associations of serum brain-derived neurotrophic factor with cognitive impairments and negative symptoms in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1836-40. [PMID: 21930178 DOI: 10.1016/j.pnpbp.2011.09.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 08/25/2011] [Accepted: 09/05/2011] [Indexed: 11/29/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) may be involved in the pathophysiology of schizophrenia. The aim of this study was to examine the associations of serum BDNF levels with the cognition and clinical characteristics in patients with schizophrenia. Sixty-three patients with schizophrenia and 52 age- and sex-matched healthy controls were examined with neuropsychological tests. Serum BDNF levels were determined by enzyme-linked immunosorbent assay (ELISA). There were no significant differences in serum BDNF levels between normal controls and patients with schizophrenia. Serum BDNF levels of normal controls showed negative correlations with verbal working memory, but this was not the case with schizophrenic patients. Meanwhile, serum BDNF levels of schizophrenic patients showed positive correlations with the scores of the Scale for the Assessment of Negative Symptoms (SANS) and the Information subtest scores of Wechsler Adult Intelligence Scale Revised (WAIS-R). Serum BDNF levels are related with the impairment of verbal working memory and negative symptoms in patients with schizophrenia.
Collapse
Affiliation(s)
- Tomihisa Niitsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Brand RM, Harrop C, Ellett L. What is it like to be friends with a young person with psychosis? A qualitative study. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2011. [DOI: 10.1080/17522439.2010.528562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
43
|
Piskulic D, Addington J, Auther A, Cornblatt BA. Using the global functioning social and role scales in a first-episode sample. Early Interv Psychiatry 2011; 5:219-23. [PMID: 21481198 DOI: 10.1111/j.1751-7893.2011.00263.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Dysfunction in social and role functioning is a hallmark of schizophrenia, which is present in both the prodromal phase and at the first episode of the illness. Two new measures, Global Functioning: Social and Global Functioning: Role, were developed to address functioning in the prodromal phase of the illness. The purpose of this study was to determine if these measures would be useful in a first episode population. METHODS Forty-eight stable outpatients were assessed using the new social and role scales. A subsample of 33 subjects was assessed at 6 and 12 months. All subjects were additionally assessed using standardized measures of psychotic symptoms, social functioning, self-esteem and beliefs about illness. RESULTS Average ratings on the Global Functioning: Social and Role scales were 6 (standard deviation (SD) = 1.60) and 5.5 (SD = 2.2), respectively. Both social and role scales were significantly correlated with relevant subscales on the Social Functioning Scale. Good social but not role functioning was related to low levels of both positive and negative symptoms and to high self-esteem. Role but not social functioning was related to personal beliefs about the illness, such as having control over illness and feeling less stigmatized. Repeated measures analyses demonstrated no change over time for either social or role functioning. CONCLUSION The Global Functioning: Social and Role scales appear to be useful and valid measures of functioning in first-episode patients. These ratings are similar to those reported in prodromal studies supporting the idea that poor functioning may be a stable long-standing deficit.
Collapse
Affiliation(s)
- Danijela Piskulic
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
| | | | | | | |
Collapse
|
44
|
Veltro F, Mazza M, Vendittelli N, Alberti M, Casacchia M, Roncone R. A comparison of the effectiveness of problem solving training and of cognitive-emotional rehabilitation on neurocognition, social cognition and social functioning in people with schizophrenia. Clin Pract Epidemiol Ment Health 2011; 7:123-32. [PMID: 21792373 PMCID: PMC3141333 DOI: 10.2174/1745017901107010123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 04/28/2011] [Accepted: 04/30/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Social cognition and Problem Solving (PS) impairments are common characteristics in patients with schizophrenia. Experimental neuropsychological findings support the hypothesis that schizophrenia is characterized by a broad range of heterogeneous cognitive impairments. Since that time Problem Solving Training has been employed as a core strategy in a wide variety of therapeutic settings. Renewed interest in cognitive functioning, including social Problem Solving skills and social cognition in schizophrenia, has led us to reconsider the potential value of metacognitive strategy as a rehabilitation strategy. METHODS The present study reports the results obtained by 24 persons with schizophrenia who were randomly assigned to one of two training session groups: Cognitive-Emotional Rehabilitation (REC) vs Problem Solving Training (PST). Both treatments were administered to small groups composed of subjects suffering from schizophrenic disorders over a 12 months period: primary measures of clinical, social outcomes and secondary measures of cognitive and Problem Solving functions were conducted at 0, and 12 months. RESULTS Results showed that both training methods were found to be effective in psychopathological measures and in social functioning. On cognitive function improvements were specific to the rehabilitative approach. PST are mainly improved capacities for planning and memory, while the REC improved measures such as social cognition Theory of mind and emotion recognition. CONCLUSION The results confirmed that it is no necessary to divide the rehabilitation training in treatments directed to specific domains. The conceptualization and applicability of PST and REC its implications for persons with schizophrenia, and future studies in this research area have also been discussed.
Collapse
Affiliation(s)
| | - Monica Mazza
- Department of Science of Health, University of L’Aquila, Italy
| | | | | | | | - Rita Roncone
- Department of Science of Health, University of L’Aquila, Italy
| |
Collapse
|
45
|
Hsieh PC, Huang HY, Wang HC, Liu YC, Bai YM, Chen KC, Yang YK. Intercorrelations between the Personal and Social Performance Scale, cognitive function, and activities of daily living. J Nerv Ment Dis 2011; 199:513-5. [PMID: 21716067 DOI: 10.1097/nmd.0b013e318221447e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the intercorrelation between the Personal and Social Performance (PSP) score, cognitive function, and activities of daily living (ADLs). Twenty patients with chronic schizophrenia were recruited; the PSP and ADL scales and psychological assessments including the Wisconsin Card Sorting Test, the Wechsler Memory Scale-Revised (WMS-R), and the Continuous Performance Test (CPT) were administered. Positive correlations between the total PSP scale score and performance in the WMS-R, CPT, and ADL scores were identified. The PSP score was found to be of good reliability for cognitive function and ADL evaluation.
Collapse
Affiliation(s)
- Pei Chun Hsieh
- Department of Psychiatry, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, Taiwan
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
The diagnosis of schizophrenia can only be made in the presence of a loss of functioning in domains such as employment, independent living, and social functioning. Accurately measuring functioning is central to research on the course of the disorder, treatment and rehabilitation outcomes, and biosocial factors in schizophrenia. Assessments of functional disability have described three dimensions of functioning: functional capacity, functional performance, and functional outcome. The "competence/performance" distinction refers to the observation that an individual may demonstrate an ability to perform a functional task (capacity) but may not do so in her own community environment (performance). Functional outcomes are the result of both capacity and performance. Several recent reviews have compared the characteristics, reliability, and validity of various functional assessment instruments. Two major initiatives are underway to gather additional comparative data about functional assessment strategies. Recently, both the recovery movement and the recognition of the role of environmental factors in functioning have raised questions about the conceptual content of the functioning construct (construct validity). For instance, several studies have demonstrated that features of functioning need not track together over the course of the illness. In addition, the notion of recovery emphasizes processes like community integration and subjective well-being that are not static outcomes but are continually evolving features of the life course in chronic illness. Findings on the dynamic role of environmental moderators such as support and opportunity also present challenges to scientific constructs. For these reasons and others, the ecological validity of functional assessments has become a central concern. Both the verisimilitude and veridicality of functional assessments can be empirically assessed, but to date very few studies have measured the extent to which functional measures accurately predict individuals' behavior in their usual environments. Observational studies in naturalistic environments are one important area for future research.
Collapse
|
47
|
Corcoran CM, Kimhy D, Parrilla-Escobar MA, Cressman VL, Stanford AD, Thompson J, David SB, Crumbley A, Schobel S, Moore H, Malaspina D. The relationship of social function to depressive and negative symptoms in individuals at clinical high risk for psychosis. Psychol Med 2011; 41:251-261. [PMID: 20444306 PMCID: PMC3376746 DOI: 10.1017/s0033291710000802] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Social dysfunction is a hallmark symptom of schizophrenia which commonly precedes the onset of psychosis. It is unclear if social symptoms in clinical high-risk patients reflect depressive symptoms or are a manifestation of negative symptoms. METHOD We compared social function scores on the Social Adjustment Scale-Self Report between 56 young people (aged 13-27 years) at clinical high risk for psychosis and 22 healthy controls. The cases were also assessed for depressive and 'prodromal' symptoms (subthreshold positive, negative, disorganized and general symptoms). RESULTS Poor social function was related to both depressive and negative symptoms, as well as to disorganized and general symptoms. The symptoms were highly intercorrelated but linear regression analysis demonstrated that poor social function was primarily explained by negative symptoms within this cohort, particularly in ethnic minority patients. CONCLUSIONS Although this study demonstrated a relationship between social dysfunction and depressive symptoms in clinical high-risk cases, this association was primarily explained by the relationship of each of these to negative symptoms. In individuals at heightened risk for psychosis, affective changes may be related to a progressive decrease in social interaction and loss of reinforcement of social behaviors. These findings have relevance for potential treatment strategies for social dysfunction in schizophrenia and its risk states and predict that antidepressant drugs, cognitive behavioral therapy and/or social skills training may be effective.
Collapse
Affiliation(s)
- C M Corcoran
- Centre of Prevention and Evaluation, Department of Psychiatry, New York State Psychiatric Institute at Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Allott K, Liu P, Proffitt TM, Killackey E. Cognition at illness onset as a predictor of later functional outcome in early psychosis: systematic review and methodological critique. Schizophr Res 2011; 125:221-35. [PMID: 21111577 DOI: 10.1016/j.schres.2010.11.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 10/25/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cognitive deficits occur early in the course of psychosis, are mostly stable, and have been identified as potential functional prognostic markers. Previous reviews of chronic schizophrenia have concluded that specific cognitive deficits are strongly associated with poorer functional outcomes. However, results of schizophrenia studies may be influenced by the effects of long-term illness or treatment or be biased toward individuals with poorer outcomes and may not be relevant to early psychosis (EP). This review aimed to systematically examine the evidence regarding general and social cognitive predictors of later functional outcome in EP and critique the methodology of the studies reviewed. A final aim was to conduct a meta-analysis of the studies reviewed, but methodological reasons precluded this. METHOD A comprehensive search of PsycINFO and MEDLINE databases identified 15 relevant articles and 7 further articles following a reference list search, totaling 22 included articles. RESULTS Most studies found at least one cognitive domain predicted functional outcome, but examination of separate cognitive domains revealed there were more null than significant associations between cognition and functional outcome across every cognitive domain. No study examined social cognition as a predictor of outcome. The frequency with which different cognitive domains predicted outcome varied depending on study methodology and this was most noticeable when studies with short-term follow-up were compared with longer-term follow-up studies. CONCLUSIONS Due to the methodological variability and limitations of the studies reviewed, firm conclusions regarding the relationship between cognition and functional outcomes in EP cannot be made. Tentatively, cognition may be prognostic in EP, especially for longer-term outcomes. However, further research that addresses the methodological issues identified, including examination of social cognition and other non-cognitive predictors, is needed.
Collapse
Affiliation(s)
- Kelly Allott
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychology, The University of Melbourne, Victoria, Australia.
| | | | | | | |
Collapse
|
49
|
Bozikas VP, Andreou C. Longitudinal studies of cognition in first episode psychosis: a systematic review of the literature. Aust N Z J Psychiatry 2011; 45:93-108. [PMID: 21320033 DOI: 10.3109/00048674.2010.541418] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although cognitive deficits are recognized as a core feature in schizophrenia, their evolution over the course of the illness is still debated. Longitudinal studies of cognition in patients after a first episode of psychosis (FEP) provide extremely useful information, in that they include an adequate and realistic baseline measure of cognitive performance, while at the same time minimizing the effect of confounding variables associated with chronicity. The aim of this systematic review was to summarize findings of studies assessing the longitudinal course of neuropsychological deficits in patients with FEP for durations of at least one year. Overall, the neuropsychological deficits that are present following a first episode of psychosis appeared to remain stable over time for periods of up to ten years, the only possible exception being verbal memory deficits, where there is some evidence of further deterioration over the long term. However, further studies are needed to confirm this conclusion, especially in the (somewhat inconsistently defined) domain of executive function. Improvements in psychopathology appear to positively influence the course of cognitive deficits, although the effects of antipsychotic medication are not as clear.
Collapse
Affiliation(s)
- Vasilis P Bozikas
- Department of Psychiatry, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Eykarpia, Greece.
| | | |
Collapse
|
50
|
Xiang YT, Shum D, Chiu HFK, Tang WK, Ungvari GS. Association of demographic characteristics, symptomatology, retrospective and prospective memory, executive functioning and intelligence with social functioning in schizophrenia. Aust N Z J Psychiatry 2010; 44:1112-7. [PMID: 21070107 DOI: 10.3109/00048674.2010.514854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to explore the influence of socio-demographic and clinical factors and neurocognitive variables (i.e. prospective and retrospective memory, executive functioning, and intelligence) on social functioning in Chinese schizophrenia patients. METHODS The study sample comprised 110 Chinese schizophrenia patients. Their clinical condition and social functioning were evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Functional Needs Assessment (FNA), respectively. Three prospective memory (PM) tasks (time-, event-, and activity-based), three tests of executive functioning (the Design Fluency Test [DFT], Tower of London [TOL], and Wisconsin Card Sorting Test [WCST]), one test of intelligence (Raven's Progressive Matrices), and two retrospective memory (RM) tasks (the immediate and delayed recall conditions of the Logical Memory subtest of the Wechsler Memory Scales-Revised [WMS-R]) were administered to all patients. RESULTS In correlation analyses higher education and better performance on the WCST (categories completed) and the Logical Memory subtests (delayed and immediate) of the WMS-R are significantly correlated with better social functioning, whereas a lower WCST score (perseverative errors) and more severe negative symptoms are associated with poorer social functioning. Multiple linear regression analysis revealed that higher education and a lower WCST score (perseverative errors) independently contribute to better social functioning. CONCLUSIONS Unexpectedly, most socio-demographic and clinical factors do not seem to have a significant impact on social functioning of Chinese schizophrenia patients living in a Chinese society. Negative symptoms and certain cognitive deficits were the main predictors of social functioning and they should be the main targets for antipsychotic treatment and psychosocial interventions to improve social adjustment in Chinese schizophrenia patients.
Collapse
Affiliation(s)
- Yu-Tao Xiang
- Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | | | | | | | | |
Collapse
|