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Dalkner N, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Negative mood states as a correlate of cognitive performance and self-assessment of cognitive performance in bipolar disorder versus schizophrenia. Schizophr Res 2023; 252:1-9. [PMID: 36608492 PMCID: PMC9974828 DOI: 10.1016/j.schres.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/15/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Mood states have been reported to manifest a cross-sectional correlation with self-assessment accuracy across functional domains and psychiatric conditions. Ecological momentary assessment (EMA) provides a strategy to examine the momentary course and correlates of mood states. This study tested the association of moods assessed longitudinally with accuracy of immediate self-assessments of cognitive test performance in participants with schizophrenia and bipolar disorder. METHODS 240 well-diagnosed participants with schizophrenia and bipolar disorder completed a subset of tests from the MATRICS Consensus Cognitive Battery and an immediate self-assessment of cognitive performance. Differences between actual and self-reported performance were used to index the accuracy of self-assessment. Daily smartphone EMA, 3× per day for 30 days, sampled participants´ momentary moods (sad, happy, relaxed, anxious), aggregated into positive affect and negative affect (NA). RESULTS Bipolar participants had better cognitive performance, but both samples had equivalent mis-estimation. Repeated-measures analyses found that NA did not manifest significant variability over time either between or within participants in the two diagnostic groups. Within-group analyses found that higher average NA was associated with greater mis-estimation and poorer cognitive performance in participants with bipolar disorder, but not in those with schizophrenia. CONCLUSION Negative moods had a significant association with impairments in self-assessment of cognitive performance in participants with bipolar disorder. Our study did not confirm previous cross-sectional findings of more accurate self-assessment associated with greater NA in schizophrenia. These findings suggest that cross-sectional assessments, particularly self-reports, may lead to different results than aggregated data from longitudinal evaluations.
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Affiliation(s)
- Nina Dalkner
- Medical University Graz, Austria; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA, USA; San Diego VA Medical Center La Jolla, CA, USA
| | | | | | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA; Bruce W. Carter VA Medical Center, Miami, FL, USA.
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Morgan O, Strassnig MT, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Accuracy of immediate self-assessment of neurocognitive test performance: Associations with psychiatric diagnosis and longitudinal psychotic symptoms. J Psychiatr Res 2022; 156:594-601. [PMID: 36372002 PMCID: PMC9899150 DOI: 10.1016/j.jpsychires.2022.10.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Participants with schizophrenia (SCZ) and bipolar disorder (BD) have challenges in self-evaluation of their cognitive and functional abilities, referred to as introspective accuracy (IA). Although psychotic symptoms are commonly found to be uncorrelated with cognitive performance, many models of the development of delusions focus on failures in self-assessment and responses biases during momentary monitoring. We performed a single 4-test cognitive assessment on 240 participants (schizophrenia n = 126; bipolar disorder n = 114) and asked them to make a judgment about their performance immediately after completion of each task. We related performance and these judgments to results of Ecological Momentary Assessments (EMA) of the momentary occurrence of psychotic symptoms (Voices, paranoid ideas, other delusions) collected over up to 90 surveys over a 30 days prior to the single cognitive assessment. We examined test performance and the accuracy of self-assessment at that assessment, looking at diagnostic differences in performance and mis-estimation of performance. Participants with bipolar disorder had better cognitive performance, but there were no differences in mis-estimation. Analyses of the correlation between cognitive performance and self-assessment were all significant and better cognitive performance predicted reduced errors in self-assessment. Examination of the 30-day course of psychotic symptoms and IA could only be performed in participants with schizophrenia, revealing correlations between more common occurrences of all three psychotic symptoms and increased absolute values for IA errors. These data are consistent with theories of cognitive response biases and the formation of delusions.
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Affiliation(s)
- Orly Morgan
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL, 33136, USA
| | - Martin T Strassnig
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL, 33136, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert A Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL, 33136, USA; Research Service, Miami VA Healthcare System, Miami, FL, USA.
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Depp CA, Kamarsu S, Filip TF, Parrish EM, Harvey PD, Granholm EL, Chalker S, Moore RC, Pinkham A. Ecological momentary facial emotion recognition in psychotic disorders. Psychol Med 2022; 52:2531-2539. [PMID: 33431072 PMCID: PMC8621678 DOI: 10.1017/s0033291720004419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cognitive tasks delivered during ecological momentary assessment (EMA) may elucidate the short-term dynamics and contextual influences on cognition and judgements of performance. This paper provides initial validation of a smartphone task of facial emotion recognition in serious mental illness. METHODS A total of 86 participants with psychotic disorders (non-affective and affective psychosis), aged 19-65, were administered in-lab 'gold standard' affect recognition, neurocognition, and symptom assessments. They subsequently completed 10 days of the mobile facial emotion recognition task, assessing both accuracy and self-assessed performance, along with concurrent EMA of psychotic symptoms and mood. Validation focused on task adherence and predictors of adherence, gold standard convergent validity, and symptom and diagnostic group variation. RESULTS The mean rate of adherence to the task was 79%; no demographic or clinical variables predicted adherence. Convergent validity was observed with in-lab measures of facial emotion recognition, and no practice effects were observed on the mobile facial emotion recognition task. EMA reports of more severe voices, sadness, and paranoia were associated with worse performance, whereas mood more strongly associated with self-assessed performance. CONCLUSION The mobile facial emotion recognition task was tolerated and demonstrated convergent validity with in-lab measures of the same construct. Social cognitive performance, and biased judgements previously shown to predict function, can be evaluated in real-time in naturalistic environments.
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Affiliation(s)
- Colin A Depp
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Snigdha Kamarsu
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Tess F Filip
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Emma M Parrish
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Eric L Granholm
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Samantha Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Raeanne C Moore
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Amy Pinkham
- The University of Texas at Dallas, Dallas, TX, USA
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Gabrielian S, Koosis ER, Cohenmehr J, Hellemann G, Tuepker A, Green MF, Vazzano JK, Young AS. Factors associated with recovery from homelessness among veterans in permanent supportive housing. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2144-2162. [PMID: 34862803 DOI: 10.1002/jcop.22760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
AIMS We sought to identify person- and program-level factors distinguishing permanent supportive housing (PSH) residents with higher versus lower social integration; and higher versus lower instrumental functioning. METHODS Among 60 PSH residents at Los Angeles' VA, surveys and medical records captured person-level factors. Using a median split, we dichotomized participants with higher versus lower social integration; and higher versus lower instrumental functioning. Recursive partitioning (RP) identified variables that best-differentiated these subgroups. Interviews with 26 participants captured their perceptions on social integration and instrumental functioning. RESULTS Using RP, health-related quality of life, psychiatric symptoms and case management frequency best-differentiated the social integration subgroups. Few perceived that PSH affected social integration. RP did not yield a stable model to differentiate the instrumental functioning subgroups; participants perceived that PSH addressed most functional deficits. CONCLUSIONS Services that enhance social integration may benefit PSH residents with poor health; existing services may adequately address instrumental functioning.
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Affiliation(s)
- Sonya Gabrielian
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ella R Koosis
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
| | - Jennifer Cohenmehr
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gerhard Hellemann
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anaïs Tuepker
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care, Portland, Oregon, USA
- Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael F Green
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jesse K Vazzano
- Care Management and Social Work, VA Western Colorado Health Care System, Grand Junction, Colorado, USA
| | - Alexander S Young
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Miller ML, Raugh IM, Strauss GP, Harvey PD. Remote digital phenotyping in serious mental illness: Focus on negative symptoms, mood symptoms, and self-awareness. Biomark Neuropsychiatry 2022. [DOI: 10.1016/j.bionps.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Yoldi-Negrete M, Palacios-Cruz L, Tirado-Durán E, Jiménez-Rodríguez LI, Jiménez-Pavón J, Hernández S, Aguilar A, Morales-Cedillo IP, Jiménez-Tirado M, Fresán-Orellana A, Juárez García F, Becerra-Palars C, Camarena-Medellin B. Looking for factors affecting functioning in euthymic patients with bipolar I disorder: the importance of cognitive complaints and BDNF's Val66Met polymorphism. J Affect Disord 2022; 302:131-138. [PMID: 34990638 DOI: 10.1016/j.jad.2022.01.006] [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: 08/27/2021] [Revised: 11/14/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Functioning in Bipolar Disorder (BD) is affected in a substantial proportion of patients. The impact of demographic, clinical, cognitive, and genetic factors on functioning has been shown individually; however, as a complex phenomenon, a global approach to identify the most relevant as well as possible interactions is needed. METHODS 102 patients with type I BD in euthymia were invited for evaluation of demographic, clinical, and cognitive characteristics as well as genotype for Val66Met polymorphism of BDNF gene to determine those associated with poor functioning according to the FAST scale cut-off score. Clinical evaluation included assessment of residual affective symptoms and anxiety. Cognitive evaluation included the COBRA scale, verbal memory, and executive functions testing. RESULTS Residual depressive symptoms, anxiety, cognitive complaints and being a Met carrier were more frequent in the poor functioning group and were entered in a logistic regression model. Being a Met carrier (OR=4.46, CI=1.19-16.67) and cognitive complaints (OR=1.29, CI= 1.13-1.46) were the most important predictors of poor functioning in type I BD. LIMITATIONS Cross-sectional study, with select population limiting generalizability of findings. CONCLUSIONS A better understanding of underlying factors affecting cognition, including the possible involvement of BDNF Val66Met polymorphism, its systematic evaluation and a continued search for targeted treatment, along with recognition and attention of residual affective and anxious symptoms might improve psychosocial outcomes such as functioning in this population.
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Affiliation(s)
- María Yoldi-Negrete
- Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Lino Palacios-Cruz
- Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Elsa Tirado-Durán
- Departamento de Neuropsicología, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Laura Ivonne Jiménez-Rodríguez
- Departamento de Neuropsicología, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Joanna Jiménez-Pavón
- Clínica de Trastornos Afectivos, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Sandra Hernández
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Alejandro Aguilar
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Ingrid Pamela Morales-Cedillo
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | | | - Ana Fresán-Orellana
- Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Francisco Juárez García
- Dirección de Investigaciones Epidemiológicas y Sociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Claudia Becerra-Palars
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Beatriz Camarena-Medellin
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico.
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Tercero BA, Perez MM, Mohsin N, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Using a Meta-cognitive Wisconsin Card Sorting Test to measure introspective accuracy and biases in schizophrenia and bipolar disorder. J Psychiatr Res 2021; 140:436-442. [PMID: 34147931 PMCID: PMC8319124 DOI: 10.1016/j.jpsychires.2021.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 01/22/2023]
Abstract
People with schizophrenia (SCZ) and bipolar disorder (BD) have challenges in self-evaluation of their cognitive and functional performance (introspective accuracy). They also manifest response biases, with tendencies toward overestimation. This study aimed to examine objective test performance, momentary judgments of performance, momentary confidence, and subsequent global judgments of performance on a metacognitive version of the Wisconsin Card Sorting Test (WCST). This sample included 99 participants with SCZ and 67 with BD. After each of the 64 WCST trials, participants reported whether they believed their sort was correct and how confident they were in that judgment, they then received performance feedback. After completion of the entire task, participants generated a global performance judgment. On average, the SCZ group got 31 sorts correct, reporting being correct on 49 whereas the BD group got 37 trials correct but reported being correct on 53. For participants with BD, sorting performance correlated with trial x trial accuracy judgments, confidence, and predicted global judgments. For SCZ participants, performance minimally correlated with trial x trial accuracy judgments, confidence, and global judgments, while trial x trial confidence was strongly associated with trial x trial accuracy judgments (r = 0.58). Our findings suggest that confidence in participants with BD is correlated with task performance, whereas in SCZ confidence was entirely associated with self-generated performance judgments. SCZ participants manifested challenges with utilization of feedback. Global judgments of performance were predicted by task performance and confidence for BD participants, with performance and confidence judgments occurring prior to generation of the global performance judgments.
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Affiliation(s)
- Bianca A. Tercero
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Michelle M. Perez
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Noreen Mohsin
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California, San Diego, California, USA,VA San Diego Healthcare System, San Diego, California, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, California, USA,VA San Diego Healthcare System, San Diego, California, USA
| | - Robert A. Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA,Research Service, Miami VA Healthcare System, Miami, FL, USA
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Beunders AJM, Kok AAL, Kosmas PC, Beekman ATF, Sonnenberg CM, Schouws SNTM, Kupka RW, Stek ML, Dols A. Physical comorbidity in Older-Age Bipolar Disorder (OABD) compared to the general population - a 3-year longitudinal prospective cohort study. J Affect Disord 2021; 288:83-91. [PMID: 33845328 DOI: 10.1016/j.jad.2021.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to examine the accumulation of chronic physical diseases in Older-Age Bipolar Disorder (OABD) as well as in individuals from the general aging population over a 3-year period. METHODS This prospective longitudinal study compared 101 patients with OABD receiving outpatient care (DOBi cohort) with 2545 individuals from the general aging population (LASA cohort). The presence of eight major chronic diseases was asked at baseline and 3-year follow-up. Total number of diseases was the main outcome measure. Self-rated health (SRH, scale 1-5) was examined as a secondary outcome. Multilevel linear modelling of change was performed to estimate and test the observed change in both samples. RESULTS At baseline, the number of chronic diseases was lower (b= -0.47, p<0.01) and self-rated health comparable (b=0.27, p=0.13) in DOBi than in LASA. Over 3 years the number of chronic diseases increased faster in DOBi than in LASA (b=0.51 versus b=0.35, p(interaction)=0.03). When corrected for employment, depressive symptoms, waist circumference, smoking, and alcohol use, this difference was no longer significant. SRH decreased faster in DOBi than in LASA (b=-0.24 versus b=-0.02, p(interaction)=0.04). LIMITATIONS Information on chronic diseases was collected using self-report. CONCLUSIONS A faster accumulation of chronic physical diseases and a faster decline in health perception was observed in OABD than in participants from the general population. The observed differences could partly be attributed to baseline differences in psychosocial, lifestyle, and health behaviour factors. Our findings urgently call for the use of integrated care in BD.
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Affiliation(s)
- Alexandra J M Beunders
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Almar A L Kok
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Panagiotis C Kosmas
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Caroline M Sonnenberg
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sigfried N T M Schouws
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Max L Stek
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Annemiek Dols
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Strassnig MT, Miller ML, Moore R, Depp CA, Pinkham AE, Harvey PD. Evidence for avolition in bipolar disorder? A 30-day ecological momentary assessment comparison of daily activities in bipolar disorder and schizophrenia. Psychiatry Res 2021; 300:113924. [PMID: 33848963 PMCID: PMC8141033 DOI: 10.1016/j.psychres.2021.113924] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Disability is common in bipolar disorder (BD) and predicted by persistent sadness. We used ecological momentary assessment (EMA) to examine daily activities in people with BD and schizophrenia. We classified activities as productive, unproductive, or passive recreation, relating them to momentary sadness, location, and social context. METHODS 71 people with BD and 102 people with schizophrenia were sampled 3 times/day for 30 days with an EMA survey. Each survey asked where they were, with whom, what they were doing, and if they were sad. RESULTS People with BD were home more than 50% of the time. There were no differences in prevalence of activity types across diagnoses. People with BD were less likely to report only one activity since the prior survey, but the most surveys still reported only one. For both groups, sadness and being home and alone since the last survey was associated with less productive activity and more passive recreation. CONCLUSIONS Participants with BD and schizophrenia manifested high levels of unproductive and passive activities, predicted by momentary sadness. These activity patterns are consistent with descriptions of avolition and they minimally differentiated people with BD and schizophrenia. Previous reports of negative symptoms in BD may have been identifying these behaviors.
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Affiliation(s)
| | - Michelle L Miller
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Raeanne Moore
- UCSD Health Sciences Center, La Jolla, CA, United States
| | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA, United States; San Diego VA Medical Center La Jolla, CA, United States
| | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX, United States; University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, United States; Bruce W. Carter VA Medical Center, Miami, FL, United States.
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Bernhardt M, Schwert C, Aschenbrenner S, Weisbrod M, Schröder A. Subjective cognitive and neurocognitive functions over the course of CBT. Psychiatry Res 2021; 300:113895. [PMID: 33799194 DOI: 10.1016/j.psychres.2021.113895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
The aim of the study was to investigate changes in both subjectively and objectively measured cognitive functions as well as their discrepancy in outpatients with major depression disorder in the course of cognitive-behavioural therapy (CBT). A neuropsychological test battery with cognitive tests measuring the domains of attention, memory, and executive functions as well as a questionnaire for the self-assessment of cognitive functions (FLei) in these domains were administered to depressed outpatients (n = 46) at the beginning of CBT, post-treatment after on average 40 sessions, as well as six months after the end of treatment. We found that subjectively as well as objectively measured cognitive functions did not change. The discrepancy between subjective and objective cognitive functions found at the beginning of therapy was no longer significant at post-treatment and six months later. The results indicate, that self-perceived and neuropsychologically measured cognitive impairments show stability despite improved depression. Specific interventions such as cognitive remediation therapy should be additionally applied to depressed patients who suffer from cognitive deficits.
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Affiliation(s)
- Maren Bernhardt
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Germany.
| | - Christine Schwert
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Germany
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Germany; Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Germany
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Perez MM, Tercero BA, Penn DL, Pinkham AE, Harvey PD. Overconfidence in social cognitive decision making: Correlations with social cognitive and neurocognitive performance in participants with schizophrenia and healthy individuals. Schizophr Res 2020; 224:51-57. [PMID: 33097367 PMCID: PMC7722219 DOI: 10.1016/j.schres.2020.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/20/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
It has been reported that people with schizophrenia are frequently overconfident relative to their performance, a trait observed in healthy individuals as well. In schizophrenia, impaired self-assessments have been found to be associated with functional impairments in various domains. Previous studies examining the correlation of overconfidence and task performance within domains (e.g., social cognition) had found overconfidence was associated with particularly poor performance. This study examines how overconfidence on a social cognitive emotion recognition task is correlated with performance on other social cognitive tests, measures of neurocognition, and intelligence. The sample includes 154 healthy controls and 218 outpatient individuals diagnosed with schizophrenia. For the healthy controls, overconfidence was a significant predictor of poorer performance on social cognitive, but not neurocognitive tasks. For the participants with schizophrenia, overconfidence was a predictor of poorer performance on every performance-based task. In addition, overconfidence in healthy controls was more strongly correlated with intelligence than it was in participants with schizophrenia. The data suggest that a bias toward overestimation of performance aligns with poorer performance social cognitive domains, as well as neurocognitive domains in participants with schizophrenia. In healthy individuals, consistent with previous results, lower general intelligence seems to be a substantial predictor of overconfidence. These data suggest that attention to the accuracy of self-assessment is an area for future clinical interventions in people with schizophrenia.
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Affiliation(s)
- Michelle M. Perez
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Bianca A. Tercero
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA,School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA,Research Service, Miami VA Healthcare System, Miami, FL, USA,Corresponding Author: Philip D. Harvey, PhD, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 US (telephone: 305-243-4094; fax: 305-243-1619;
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12
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Jones MT, Deckler E, Laurrari C, Jarskog LF, Penn DL, Pinkham AE, Harvey PD. Confidence, performance, and accuracy of self-assessment of social cognition: A comparison of schizophrenia patients and healthy controls. Schizophr Res Cogn 2020; 19:002-2. [PMID: 31832336 PMCID: PMC6889550 DOI: 10.1016/j.scog.2019.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/21/2022]
Abstract
Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that reduced awareness of performance may be associated with disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on a social cognitive test, confidence in performance, effort allocated to the task, and correlates of confidence in patients with schizophrenia and healthy controls (HC). Measures included self-reports of depression, social cognitive ability, and social functioning. A performance-based emotion recognition test assessed social cognitive performance and provided the basis for confidence judgments. Although schizophrenia patients had reduced levels of overall confidence, there was a substantial subset of schizophrenic patients who manifested extreme overconfidence and these people had the poorest performance and reported the least depression. Further, a substantial number of HC over-estimated their performance as well. Patients with schizophrenia, in contrast to HC, did not adjust their effort to match task difficulty. Confidence was minimally related to task performance in patients but was associated with more rapid decisions in HC, across both correct and incorrect responses. Performance on social cognitive measures was minimally related to self-reports of social functioning in both samples. These data suggest global self-assessments are based on multiple factors, with confidence affecting self-assessments in the absence of feedback about performance.
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Affiliation(s)
- Mackenzie T. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Elizabeth Deckler
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Carlos Laurrari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, United States of America
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States of America
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States of America
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Research Service, Miami VA Healthcare System, United States of America
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13
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Oliveri LN, Awerbuch AW, Jarskog LF, Penn DL, Pinkham A, Harvey PD. Depression predicts self assessment of social function in both patients with schizophrenia and healthy people. Psychiatry Res 2020; 284:112681. [PMID: 31740212 PMCID: PMC7012719 DOI: 10.1016/j.psychres.2019.112681] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Impairments in social functioning are central to Schizophrenia (SCZ). Patients with SCZ have challenges in the ability to evaluate their functioning. A correlate of self-assessments in SCZ is depression, wherein negligible depression predicts overestimation. Healthy individuals misestimate their functioning, but mild dysthymia predicts accuracy. We examined depression, gender, and schizophrenia as predictors of self-reported everyday functioning. METHODS 218 people with SCZ and 154 healthy controls self-reported their social functioning. They self-reported their depression with the Beck Depression Inventory (BDI) and their social cognitive ability on the Observable Social Cognition Rating Scale (OSCARS). RESULTS 64% of subjects were male. Schizophrenia patients reported more depression, poorer social functioning, and worse social cognition. Linear regression analyses revealed significant correlations between self-reported social functioning and BDI scores, which also predicted self-reported social cognition. There was no significant effect of sex on self-reports of social functioning or social cognition. Finally, when BDI and OSCARS were directly compared to diagnosis and sex for prediction of self-reported social functioning, there was no impact of diagnosis or sex. IMPLICATIONS Self-reported interpersonal functioning is determined by current depression. Both healthy people and people with schizophrenia index their social functioning and their social cognitive by their level of depression.
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Affiliation(s)
- Lisa N. Oliveri
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Adam W. Awerbuch
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC
| | - Amy Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL,Research Service, Miami VA Healthcare System, Miami, FL
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14
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Gould F, Dunlop BW, Rosenthal JB, Iosifescu DV, Mathew SJ, Neylan TC, Rothbaum BO, Nemeroff CB, Harvey PD. Temporal Stability of Cognitive Functioning and Functional Capacity in Women with Posttraumatic Stress Disorder. Arch Clin Neuropsychol 2019; 34:539-547. [PMID: 30124744 DOI: 10.1093/arclin/acy064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/27/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE In addition to clinical symptoms, patients with posttraumatic stress disorder (PTSD) often experience considerable disability and may evidence minor impairments in performance on measures of cognition and functional capacity (FC). The objective of the present study was to determine if cognitive and functional skills manifest temporal stability as observed in other neuropsychiatric conditions in the presence of greater fluctuations in clinical symptoms. METHOD Assessments of cognition, FC, and clinical symptoms were conducted over two time points as part of a pre- and post-treatment assessment in a placebo-controlled clinical trial in 96 women with PTSD. The goal of these analyses was to examine the relative stability of scores and intercorrelations of measures of cognition, FC, and clinical symptoms. RESULTS Cognitive and FC performance manifested considerably greater cross-temporal stability compared to clinical symptoms. FC performance did not change over time. Similar to previous findings in patients with schizophrenia and bipolar disorder measures of symptoms and self-reported disability did not correlate with measures of functional skills or cognitive performance. CONCLUSIONS Cognitive performance and functional capacity were temporally stable in women with PTSD. In contrast, clinical symptoms had much more cross-temporal fluctuation. Self-reported disability was correlated with current symptomatology but unrelated to objective measures of performance. Similar to other neuropsychiatric conditions, mood symptoms likely influence estimates of current level of functioning more than cognitive or functional skills.
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Affiliation(s)
- Felicia Gould
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Boadie W Dunlop
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer B Rosenthal
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Dan V Iosifescu
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Sanjay J Mathew
- Michael E. Debakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Thomas C Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.,Mental Health Services, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Barbara O Rothbaum
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B Nemeroff
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Philip D Harvey
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.,Bruce W. Carter VA Medical Center, Miami, FL, USA
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15
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Kaufmann CN, Nakhla MZ, Lee EE, Yoon HK, Wing D, Depp CA, Eyler LT. Inaccuracy between subjective reports and objective measures of sleep duration and clinical correlates in bipolar disorder. J Affect Disord 2019; 250:226-230. [PMID: 30870772 PMCID: PMC6662606 DOI: 10.1016/j.jad.2019.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/25/2019] [Accepted: 03/03/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sleep disturbances are common in bipolar disorder (BD) and are often assessed by self-report at clinic visits over the course of BD treatment. Self-report may be subject to recall bias based upon current mood/affect states. This study sought to identify the degree of inaccuracy between subjective and objective measures of sleep duration in those with and without BD, and to assess the demographic and clinical correlates of this inaccuracy. METHODS Thirty-one individuals with BD and 54 healthy control (HC) participants reported on the number of hours slept a night over the past month and subsequently completed up to 14 days/nights of wrist actigraphy which provided an objective measure of sleep duration. We compared the subjective rating to the average of all nights of objective sleep duration, and correlated the magnitude of inaccuracy with demographic and clinical characteristics in the BD and HC groups. RESULTS On average, both BD and HC groups overestimated their sleep, and there were no differences in inaccuracy between groups. In the BD group, greater inaccuracy was associated with lower functioning, even after controlling individually for objective and subjective sleep measures. LIMITATIONS Cross-sectional study, only focus on sleep duration, and less severe bipolar symptoms of sample. CONCLUSIONS Inaccuracy in reports of sleep duration was associated with lower functioning among BD patients. Better identifying discrepancies in reports of sleep duration in clinical practice could help in more efficient monitoring and management of BD symptoms.
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Affiliation(s)
- Christopher N. Kaufmann
- Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Marina Z. Nakhla
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology
| | - Ellen E. Lee
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, South Korea
| | - David Wing
- Center for Wireless and Population Health Systems, University of California San Diego, La Jolla, CA
| | - Colin A. Depp
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Lisa T. Eyler
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Department of Psychiatry, University of California San Diego, La Jolla, CA
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16
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Petersen JZ, Porter RJ, Miskowiak KW. Clinical characteristics associated with the discrepancy between subjective and objective cognitive impairment in depression. J Affect Disord 2019; 246:763-774. [PMID: 30623822 DOI: 10.1016/j.jad.2018.12.105] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/17/2018] [Accepted: 12/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with unipolar disorder (UD) commonly experience cognitive dysfunction during symptomatic and remitted phases. However, it is not necessarily the patients with the greatest subjective complaints, who display the largest objectively-measured deficits on neuropsychological tests. OBJECTIVE This report investigated the demographic and clinical factors associated with the discrepancy between subjective and objective measures of cognition in two separate depressed patient populations in Denmark and New Zealand, respectively, using a new methodology. METHODS Data from 137 depressed patients and 103 healthy controls including neuropsychological test scores, self-reported cognitive difficulties, and ratings of mood were pooled from two studies conducted in Copenhagen, Denmark, and Christchurch, New Zealand, respectively. Cognitive discrepancy scores were calculated using a novel methodology, with positive values indicating disproportionately more subjective than objective difficulties (i.e., "sensitivity") and negative values indicating more objective than subjective impairments (i.e., "stoicism"). RESULTS In the Danish partially remitted patient sample, greater 'sensitivity' was associated with more subsyndromal depression severity (standardized Beta (std. β )= 0.4, p < 0.01)), illness duration (std. β = 0.4, p < 0.01), and younger age (std. β = 0.6, p < 0.001). This association was replicated in the New Zealand sample of more symptomatic patients (p-values ≤ 0.05). LIMITATIONS The cross-sectional design hampered causal inferences. We had obtained different measures of objective and subjective cognition from the two studies. CONCLUSIONS Patients with more depressive symptoms and younger age overreported cognitive impairments across all illness states. The use of an objective cognition screener thus seems particularly relevant for these patients to assess whether subjective complaints are accompanied by measurable cognitive deficits.
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Affiliation(s)
- J Z Petersen
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet Dep. 6233, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353, Copenhagen, Denmark.
| | - R J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
| | - K W Miskowiak
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet Dep. 6233, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353, Copenhagen, Denmark.
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17
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Olsson-Tall M, Hjärthag F, Marklund B, Kylén S, Carlström E, Helldin L. The Impact of Repeated Assessments by Patients and Professionals: A 4-Year Follow-Up of a Population With Schizophrenia. J Am Psychiatr Nurses Assoc 2019; 25:189-199. [PMID: 29862857 DOI: 10.1177/1078390318777785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The needs of people with schizophrenia are great, and having extensive knowledge of this patient group is crucial for providing the right support. The aim of this study was to investigate, over 4 years, the importance of repeated assessments by patients with schizophrenia and by professionals. Data were collected from evidence-based assessment scales, interviews, and visual self-assessment scales. The data processing used descriptive statistics, correlation and regression analyses. The results showed that the relationships between several of the patients' self-rating assessments were stronger at the 4-year follow-up than at baseline. In parallel, the concordance rate between patient assessments and case manager assessments increased. The conclusions drawn are that through repeated assessments the patients' ability to assess their own situation improved over time and that case managers became better at understanding their patients' situation. This, in turn, provides a safer basis for assessments and further treatment interventions, which may lead to more patients achieving remission, which can lead to less risk for hospitalization and too early death.
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Affiliation(s)
- Maivor Olsson-Tall
- 1 Maivor Olsson-Tall, PhD student, RN, NU-Health Care Hospital, Trollhättan, Sweden; University of Gothenburg, Gothenburg, Sweden
| | | | - Bertil Marklund
- 3 Bertil Marklund, Professor, PhD, MD, University of Gothenburg, Gothenburg, Sweden; Primary Health Care Research Development and Education Centre, Vänersborg, Sweden
| | - Sven Kylén
- 4 Sven Kylén, PhD, RP, Primary Health Care Research Development and Education Centre, Vänersborg, Sweden; Fyrbodal Health Academy, County Administration of West Sweden, Sweden; Chalmers University of Technology, Gothenburg, Sweden
| | - Eric Carlström
- 5 Eric Carlström, Professor, PhD, RN, University of Gothenburg, Gothenburg, Sweden
| | - Lars Helldin
- 6 Lars Helldin, Associate Professor, PhD, MD, NU-Health Care Hospital, Trollhättan, Sweden; Karlstad University, Karlstad, Sweden
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18
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Schwert C, Stohrer M, Aschenbrenner S, Weisbrod M, Schröder A. Biased neurocognitive self-perception in depressive and in healthy persons. J Affect Disord 2018; 232:96-102. [PMID: 29481997 DOI: 10.1016/j.jad.2018.02.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/11/2018] [Accepted: 02/16/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cognitive deficits across several domains and subjective complaints about cognition are prevalent in major depression disorder (MDD). Nevertheless, subjective and objective cognitive functions show no associations. However, research concerning the extent and direction of discrepancy is rare. The present study examined the relationship and discrepancy between subjective and objective cognitive deficits both in patients with MDD and healthy individuals. METHOD Outpatients with MDD (n = 102) and a healthy control group (n = 88) were assessed with a neuropsychological test battery and completed a questionnaire for the self-assessment of cognitive performance (FLei) concerning the domains of attention, memory, and executive functions. RESULTS There were no associations between subjective and objective cognitive deficits in any domain in both the MDD group and the healthy control group. The groups did not differ regarding the extent of the discrepancy between subjective and objective cognition. However, depressed outpatients' subjective cognitive complaints significantly exceeded their neuropsychological deficits, whereas healthy individuals reported significantly higher subjective cognitive functioning than objectively measured. LIMITATIONS The cross-sectional study design does not allow for causal conclusions. Due to concerns regarding the suitability of the subjective measure of cognitive deficits used in this study, the findings should be interpreted cautiously. CONCLUSIONS The current study reveals a discrepancy between subjective and objective cognitive function not only in the MDD group, but also in the control group. Whereas depressed outpatients tend to underestimate their objective cognitive abilities, healthy individuals tend to overestimate them.
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Affiliation(s)
| | | | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Germany; Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
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19
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Harvey PD, Twamley EW, Pinkham AE, Depp CA, Patterson TL. Depression in Schizophrenia: Associations With Cognition, Functional Capacity, Everyday Functioning, and Self-Assessment. Schizophr Bull 2017; 43:575-582. [PMID: 27440672 PMCID: PMC5463852 DOI: 10.1093/schbul/sbw103] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Depressed mood has a complex relationship with self-evaluation of personal competence in multiple populations. The absence of depression may be associated with overestimation of abilities, while mild depression seems to lead to accurate self-assessment. Significant depression may lead to underestimation of functioning. In this study, we expand on our previous work by directly comparing the association between different levels of depression, everyday functioning, cognitive and functional capacity performance, and self-assessment of everyday functioning in a large (n = 406) sample of outpatients with schizophrenia. Participants with very low self-reported depression overestimated their everyday functioning compared with informant reports. Higher levels of depression were associated with more accurate self-assessment, but no subgroup of patients underestimated their functioning. Depressive symptom severity was associated with poorer informant-rated social functioning, but there were no differences in vocational functioning, everyday activities, cognitive performance, and functional capacity associated with the severity of self-reported depression. There was minimal evidence of impact of depression on most aspects of everyday functioning and objective test performance and a substantial relationship between depression and accuracy of self-assessment.
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Affiliation(s)
- Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL;,Research Service, Bruce W. Carter VA Medical Center, Miami, FL
| | - Elizabeth W. Twamley
- Department of Psychiatry, University of California, San Diego, La Jolla, CA;,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX;,Department of Psychiatry, The University of Texas Southwestern Medical School, Dallas, TX
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA;,Psychology Service, San Diego VA Healthcare System, La Jolla, CA
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20
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Depp CA, Dev S, Eyler LT. Bipolar Depression and Cognitive Impairment: Shared Mechanisms and New Treatment Avenues. Psychiatr Clin North Am 2016; 39:95-109. [PMID: 26876321 PMCID: PMC4758200 DOI: 10.1016/j.psc.2015.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depression and cognitive impairment are pervasive and highly disabling aspects of bipolar disorder. Although cognitive impairment is partially independent from mood episodes, depressive symptoms may increase the risk of cognitive impairment in bipolar disorder through inflammatory processes as well as health risks such as obesity and sedentary behavior. Novel treatment avenues at the intersection of bipolar depression and cognitive impairment target inflammation directly or indirectly health behaviors such as diet, physical activity, and sleep hygiene.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| | - Sheena Dev
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; SDSU-UCSD Joint Doctoral Program, Clinical Psychology, San Diego, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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21
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Malhi GS, McAulay C, Gershon S, Gessler D, Fritz K, Das P, Outhred T. The Lithium Battery: assessing the neurocognitive profile of lithium in bipolar disorder. Bipolar Disord 2016; 18:102-15. [PMID: 27004564 DOI: 10.1111/bdi.12375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of the present study was to characterize the neurocognitive effects of lithium in bipolar disorder to inform clinical and research approaches for further investigation. METHODS Key words pertaining to neurocognition in bipolar disorder and lithium treatment were used to search recognized databases to identify relevant literature. The authors also retrieved gray literature (e.g., book chapters) known to them and examined pertinent articles from bibliographies. RESULTS A limited number of studies have examined the effects of lithium on neurocognition in bipolar disorder and, although in some domains a consistent picture emerges, in many domains the findings are mixed. Lithium administration appears to reshape key components of neurocognition - in particular, psychomotor speed, verbal memory, and verbal fluency. Notably, it has a sophisticated neurocognitive profile, such that while lithium impairs neurocognition across some domains, it seemingly preserves others - possibly those vulnerable to the effects of bipolar disorder. Furthermore, its effects are likely to be direct and indirect (via mood, for example) and cumulative with duration of treatment. Disentangling the components of neurocognition modulated by lithium in the context of a fluctuating and complex illness such as bipolar disorder is a significant challenge but one that therefore demands a stratified and systematic approach, such as that provided by the Lithium Battery. CONCLUSIONS In order to delineate the effects of lithium therapy on neurocognition in bipolar disorder within both research and clinical practice, a greater understanding and measurement of the relatively stable neurocognitive components is needed to examine those that indeed change with lithium treatment. In order to achieve this, we propose a Lithium Battery-Clinical and a Lithium Battery-Research that can be applied to these respective settings.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Claire McAulay
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Samuel Gershon
- Emeritus Professor of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Danielle Gessler
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Kristina Fritz
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
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Gould F, Kaplan S, Harvey PD. Latest Developments in Cognitive Functioning in Mood and Anxiety Disorders. Curr Behav Neurosci Rep 2015. [DOI: 10.1007/s40473-015-0045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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