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Hunt BAE, Liddle EB, Gascoyne LE, Magazzini L, Routley BC, Singh KD, Morris PG, Brookes MJ, Liddle PF. Attenuated Post-Movement Beta Rebound Associated With Schizotypal Features in Healthy People. Schizophr Bull 2019; 45:883-891. [PMID: 30239878 PMCID: PMC6581139 DOI: 10.1093/schbul/sby117] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Schizophrenia and schizotypal personality disorder (SPD) lie on a single spectrum of mental illness and converging evidence suggests similarities in the etiology of the 2 conditions. However, schizotypy is a heterogeneous facet of personality in the healthy population and so may be seen as a bridge between health and mental illness. Neural evidence for such a continuity would have implications for the characterization and treatment of schizophrenia. Based on our previous work identifying a relationship between symptomology in schizophrenia and abnormal movement-induced electrophysiological response (the post-movement beta rebound [PMBR]), we predicted that if subclinical schizotypy arises from similar neural mechanisms to schizophrenia, schizotypy in healthy individuals would be associated with reduced PMBR. METHODS One-hundred sixteen participants completed a visuomotor task while their neural activity was recorded by magnetoencephalography. Partial correlations were computed between a measure of PMBR extracted from left primary motor cortex and scores on the Schizotypal Personality Questionnaire (SPQ), a self-report measure of schizotypal personality. Correlations between PMBR and SPQ factor scores measuring cognitive-perceptual, interpersonal and disorganization dimensions of schizotypy were also computed. Effects of site, age, and sex were controlled for. RESULTS We found a significant negative correlation between total SPQ score and PMBR. This was most strongly mediated by variance shared between interpersonal and disorganization factor scores. CONCLUSION These findings indicate a continuum of neural deficit between schizotypy and schizophrenia, with diminution of PMBR, previously reported in schizophrenia, also measurable in individuals with schizotypal features, particularly disorganization and impaired interpersonal relations.
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Affiliation(s)
- Benjamin A E Hunt
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Program in Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- The Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Elizabeth B Liddle
- The Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Lauren E Gascoyne
- Program in Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Lorenzo Magazzini
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Bethany C Routley
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Krish D Singh
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Peter G Morris
- Program in Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Matthew J Brookes
- Program in Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Peter F Liddle
- The Institute for Mental Health, University of Nottingham, Nottingham, UK
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2
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Apthorp D, Bolbecker AR, Bartolomeo LA, O’Donnell BF, Hetrick WP. Postural Sway Abnormalities in Schizotypal Personality Disorder. Schizophr Bull 2019; 45:512-521. [PMID: 30376125 PMCID: PMC6483590 DOI: 10.1093/schbul/sby141] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Motor abnormalities are among the most robust findings in schizophrenia, and increasing evidence suggests they are a core feature of the disorder. Postural sway during balance tasks is a highly sensitive probe of sensorimotor systems including the cerebellum, basal ganglia, and motor cortices. Postural sway deficits are present in schizophrenia as well as groups at high risk for psychosis, suggesting altered postural control may be sensitive to the pathophysiological processes associated with risk and expression of schizophrenia spectrum disorders. This study examined postural sway performance in schizotypal personality disorder (SPD). Individuals with SPD have attenuated psychotic symptoms and share genetic risk with schizophrenia but are usually free from antipsychotic medication and other illness confounds, making SPD useful for assessing candidate biomarkers. We measured postural sway using force plates in 27 individuals with SPD, 27 carefully matched controls, and 27 matched patients with schizophrenia. It was predicted that postural sway in the SPD group would fall intermediate to schizophrenia and controls. In all conditions (eyes open and closed, with feet together or apart), the SPD group swayed significantly more than the controls, as measured by path length and sway area. Moreover, the magnitude of the sway deficit was comparable in the SPD and schizophrenia groups. These findings suggest that postural sway measures may represent a sensorimotor biomarker of schizophrenia spectrum disorders.
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Affiliation(s)
- Deborah Apthorp
- School of Psychology and Behavioural Science, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia,To whom correspondence should be addressed; tel: 61 2 6773 4316, fax: 61 2 6773 3820, e-mail:
| | - Amanda R Bolbecker
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | | | - Brian F O’Donnell
- Department of Psychiatry, Indiana University Medical Centre, Bloomington, IN,Program in Neuroscience, Indiana University, Bloomington, IN
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN,Program in Neuroscience, Indiana University, Bloomington, IN
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3
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Hirjak D, Meyer-Lindenberg A, Kubera KM, Thomann PA, Wolf RC. Motor dysfunction as research domain in the period preceding manifest schizophrenia: A systematic review. Neurosci Biobehav Rev 2018; 87:87-105. [DOI: 10.1016/j.neubiorev.2018.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/08/2018] [Accepted: 01/21/2018] [Indexed: 12/13/2022]
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4
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van Harten PN, Walther S, Kent JS, Sponheim SR, Mittal VA. The clinical and prognostic value of motor abnormalities in psychosis, and the importance of instrumental assessment. Neurosci Biobehav Rev 2017; 80:476-487. [PMID: 28711662 DOI: 10.1016/j.neubiorev.2017.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 01/15/2023]
Abstract
Motor abnormalities comprise several clinical signs intrinsic to psychosis. Critically, these features are of prognostic value in individuals at-risk for psychosis, and for those in early stages of psychotic disorders. Motor abnormalities such as tremor, rigidity, and neurological soft signs often go unrecognized. Currently, advances in this area are limited by a paucity of theoretical conceptions categorizing or linking these behaviours to underlying neurobiology affected in psychosis. However, emerging technological advances have significantly improved the ability to detect and assess motor abnormalities with objective instruments in a timely and reliable manner. Further, converging evidence has laid the groundwork for theoretically and empirically derived categorization and conceptualization. This review summarizes these advances, stressing the importance of motor abnormalities for understanding vulnerability across different stages of psychosis and introducing these innovative instrumental approaches. Patients, researchers and clinicians will benefit from these new developments, as better assessment aids the development of targeted interventions to ultimately improve the care for individuals experiencing psychosis.
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Affiliation(s)
- Peter N van Harten
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands; Psychiatric Centre GGz Central, Amersfoort, The Netherlands.
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | | | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Evanston/Chicago, USA
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5
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Via E, Orfila C, Pedreño C, Rovira A, Menchón JM, Cardoner N, Palao DJ, Soriano-Mas C, Obiols JE. Structural alterations of the pyramidal pathway in schizoid and schizotypal cluster A personality disorders. Int J Psychophysiol 2016; 110:163-170. [PMID: 27535345 DOI: 10.1016/j.ijpsycho.2016.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 07/21/2016] [Accepted: 08/12/2016] [Indexed: 12/14/2022]
Abstract
AIM Schizoid (ScPD) and Schizotypal (SPD) personality disorders are rare and severe disorders. They are associated with high liability to schizophrenia and present an attenuated form of its negative symptoms, which are considered a putative endophenotype for schizophrenia. The trans-diagnostic study of negative symptoms in non-psychotic populations such as ScPD/SPD might provide useful markers of a negative-symptom domain; however, little is known about their neurobiological substrates. The aim of the study was to investigate differences in gray and white matter volumes in subjects with ScPD/SPD compared to a group of healthy controls. METHODS Structural magnetic resonance images were obtained from 20 never-psychotic subjects with ScPD/SPD and 28 healthy controls. Resulting values from clusters of differences were correlated in patients with relevant clinical variables (O-LIFE scale). RESULTS ScPD/SPD presented greater bilateral white matter volume compared to healthy controls in the superior part of the corona radiata, close to motor/premotor regions, which correlated with the O-LIFE subtest of cognitive disorganization. No differences were found in regional gray matter or global gray/white matter volumes. CONCLUSION Greater volumes in motor pathways might relate to cognitive symptoms and motor alterations commonly present in schizophrenia-related disorders. Given the established link between motor signs and psychosis, structural alterations in motor pathways are suggested as a putative biomarker of a negative-symptom domain in psychosis subject to further testing.
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Affiliation(s)
- Esther Via
- Bellvitge University Hospital, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Mental Health, Parc Taulí Sabadell-CIBERSAM, University Hospital, Sabadell, Barcelona, Spain
| | - Carles Orfila
- Bellvitge University Hospital, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Carla Pedreño
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain
| | - Antoni Rovira
- UDIAT Diagnostic Center, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - José M Menchón
- Bellvitge University Hospital, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain
| | - Narcís Cardoner
- Mental Health, Parc Taulí Sabadell-CIBERSAM, University Hospital, Sabadell, Barcelona, Spain; UDIAT Diagnostic Center, Corporació Sanitària Parc Taulí, Sabadell, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Diego J Palao
- Mental Health, Parc Taulí Sabadell-CIBERSAM, University Hospital, Sabadell, Barcelona, Spain
| | - Carles Soriano-Mas
- Bellvitge University Hospital, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain.
| | - Jordi E Obiols
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain.
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6
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Roché MW, Fowler ML, Lenzenweger MF. Deeper into schizotypy and motor performance: Investigating the nature of motor control in a non-psychiatric sample. Psychiatry Res 2015; 228:20-5. [PMID: 25887054 PMCID: PMC4461439 DOI: 10.1016/j.psychres.2015.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 03/04/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
Numerous studies have demonstrated that motor control deficits are characteristic of patients diagnosed with schizophrenia and those at-risk for the development of the disorder. Recent advances in the quantification of motor dysfunction have confirmed this, but these methods fail to consider an important aspect of subject performance: the qualitative nature of their psychomotor dyscontrol. We report on a novel technique used to quantify the qualitative nature of psychomotor performance and its relation to schizotypy. Control (n = 35) and schizotypic subjects (n = 47) completed a line-drawing task that yields metrics for psychomotor control and predominant frequency. Schizotypes evidenced greater psychomotor dyscontrol and lower predominant frequencies than controls. These results are interpreted as evidence of reduced visual-motor integration, self-monitoring capacity, or adherence to basic motor principles in schizotypes. The potential use of these metrics as putative endophenotypes for the liability for schizophrenia and the implications of these findings for the relationship between schizophrenia and schizotypy are discussed.
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Affiliation(s)
- Matthew W. Roché
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY, USA,Address for the corresponding author: Matthew William Roché, Division of Schizophrenia Research, University Behavioral Health Care, Rutgers University, Biomedical and Health Sciences, Piscataway, NJ 08855, , Phone: 732-235-9257, Fax: 732-235-9293
| | - Mark L. Fowler
- Department of Electrical and Computer Engineering, State University of New York at Binghamton, Binghamton, NY, USA
| | - Mark F. Lenzenweger
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY, USA,Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
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7
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Simeonova DI, Nguyen T, Walker EF. Psychosis risk screening in clinical high-risk adolescents: a longitudinal investigation using the Child Behavior Checklist. Schizophr Res 2014; 159:7-13. [PMID: 25171857 PMCID: PMC4226220 DOI: 10.1016/j.schres.2014.07.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
This is the first study to investigate whether parent-reported social and behavioral problems on the Child Behavior Checklist (CBCL) can be used for psychosis risk screening and the identification of at-risk youth in the general population. This longitudinal investigation assessed 122 adolescent participants from three groups (at-risk, other personality disorders, non-psychiatric controls) at baseline and one year follow-up. The findings indicate that two individual CBCL rating scales, Withdrawn/Depressed and Thought Problems, have clinical and diagnostic utility as an adjunctive risk screening measure to aid in early detection of at-risk youth likely to develop psychosis. Furthermore, the findings shows that a cost-effective, general screening tool with a widespread use in community and pediatric healthcare settings has a promise to serve as a first step in a multi-stage risk screening process. This can potentially facilitate increased screening precision and reduction of high rate of false-positives in clinical high-risk individuals who present with elevated scores on psychosis-risk measures, but ultimately do not go on to develop psychosis. The findings of the present study also have significant clinical and research implications for the development of a broad-based psychosis risk screening strategy, and novel prevention and early intervention approaches in at-risk populations for the emergence of severe mental illness.
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Affiliation(s)
- Diana I. Simeonova
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Corresponding Author: Diana I. Simeonova, Dipl.-Psych., Ph.D., Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, Voice: (404) 727-5835, Fax: (404) 778-2535,
| | - Theresa Nguyen
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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8
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Bernard JA, Dean DJ, Kent JS, Orr JM, Pelletier-Baldelli A, Lunsford-Avery JR, Gupta T, Mittal VA. Cerebellar networks in individuals at ultra high-risk of psychosis: impact on postural sway and symptom severity. Hum Brain Mapp 2014; 35:4064-78. [PMID: 24464473 DOI: 10.1002/hbm.22458] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/15/2013] [Accepted: 12/18/2013] [Indexed: 01/03/2023] Open
Abstract
Despite known deficits in postural control in patients with schizophrenia, this domain has not been investigated in youth at ultra high-risk (UHR) for psychosis. This is particularly relevant as postural control implicates dysfunction in the cerebellum-a region implicated in cognitive dysmetria conceptions of schizophrenia but poorly understood in the prodrome. Here, we extended our understanding of movement abnormalities in UHR individuals to include postural control, and have linked these deficits to both symptom severity and cerebello-cortical network connectivity. UHR and healthy control participants completed an instrumentally based balance task to quantify postural control along with a resting state brain imaging scan to investigate cerebellar networks. We also quantified positive and negative symptom severity with structured clinical interviews. The UHR group showed overall increased postural sway and decreased cerebello-cortical resting state connectivity, relative to controls. The decreased cerebello-cortical connectivity was seen across multiple networks. Postural sway was also correlated with cerebellar connectivity in this population and uniquely positively correlated with the severity of negative symptoms. Finally, symptom severity was also associated with cerebellar connectivity. Together, our results point to a potential deficit in sensory integration as an underlying contributor to the increased postural sway, and provide evidence of cerebellar abnormalities in UHR individuals. These results extend our understanding of the motor abnormalities of UHR individuals beyond striatum-based dyskinesias to include postural control and sensory integration deficits, and implicate the cerebellum as a distinct neural substrate preceding the onset of psychosis. Taken together, our results extend the cognitive dysmetria framework to UHR populations.
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Affiliation(s)
- Jessica A Bernard
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
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9
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Levit-Binnun N, Davidovitch M, Golland Y. Sensory and motor secondary symptoms as indicators of brain vulnerability. J Neurodev Disord 2013; 5:26. [PMID: 24063566 PMCID: PMC3849186 DOI: 10.1186/1866-1955-5-26] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 09/04/2013] [Indexed: 01/20/2023] Open
Abstract
In addition to the primary symptoms that distinguish one disorder from the next, clinicians have identified, yet largely overlooked, another set of symptoms that appear across many disorders, termed secondary symptoms. In the emerging era of systems neuroscience, which highlights that many disorders share common deficits in global network features, the nonspecific nature of secondary symptoms should attract attention. Herein we provide a scholarly review of the literature on a subset of secondary symptoms––sensory and motor. We demonstrate that their pattern of appearance––across a wide range of psychopathologies, much before the full-blown disorder appears, and in healthy individuals who display a variety of negative symptoms––resembles the pattern of appearance of network abnormalities. We propose that sensory and motor secondary symptoms can be important indicators of underlying network aberrations and thus of vulnerable brain states putting individuals at risk for psychopathology following extreme circumstances.
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Affiliation(s)
- Nava Levit-Binnun
- Interdisciplinary Center (IDC), Sagol Unit for Applied Neuroscience, School of Psychology, POB 167, Herzliya 46150, Israel.
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10
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Correard N, Mazzola-Pomietto P, Elissalde SN, Viglianese-Salmon N, Fakra E, Azorin JM. [What perspectives for cognitive remediation in schizophrenia?]. Encephale 2012; 37 Suppl 2:S155-60. [PMID: 22212847 DOI: 10.1016/s0013-7006(11)70044-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cognitive deficits are routinely evident in schizophrenia, and are of sufficient magnitude to influence functional outcomes in work, social functioning and illness management. Cognitive remediation is an evidenced-based non-pharmacological treatment for the neurocognitive deficits seen in schizophrenia. Narrowly defined, cognitive remediation is a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning, but from the vantage of the psychiatric rehabilitation field, cognitive remediation is a therapy which engages the patient in learning activities that enhance the neurocognitive skills relevant to their chosen recovery goals. Cognitive remediation programs vary in the extent to which they reflect these narrow or broader perspectives but a metaanalytic study reports moderate range effect sizes on cognitive test performance, and daily functioning. Reciprocal interactions between baseline ability level, the type of instructional techniques used, and motivation provide some explanatory power for the heterogeneity in patient response to cognitive remediation. Recent studies indicate that intrinsic motivation mediates the relationship between neurocognition and functional outcomes. Results of these studies suggest that intrinsic motivation should be a viable treatment target in cognitive remediation intervention. In this perspective, NEAR (Neuropsychological Educational Approach to Remediation) program was created to enhance intrinsic motivation by employing more engaging and interesting software packages for cognitive practice, involving consumers in choosing the focus of training and having the NEAR leader serve as a coach to engage the consumers in active guidance of their own treatment program.
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Affiliation(s)
- N Correard
- Pôle universitaire de psychiatrie, hôpital Sainte-Marguerite, 13274 Marseille cedex 09, France.
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Levit-Binnun N, Golland Y. Finding behavioral and network indicators of brain vulnerability. Front Hum Neurosci 2012; 6:10. [PMID: 22347174 PMCID: PMC3273890 DOI: 10.3389/fnhum.2012.00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/21/2012] [Indexed: 11/13/2022] Open
Abstract
Resilience research has usually focused on identifying protective factors associated with specific stress conditions (e.g., war, trauma) or psychopathologies (e.g., post-traumatic stress disorder [PTSD]). Implicit in this research is the concept that resilience is a global construct, invariant to the unfavorable circumstances or the psychopathologies that may develop (i.e., the mechanisms underlying the resilience of an individual in all cases are expected to be similar). Here we contribute to the understanding of resilience—and its counterpart, vulnerability—by employing an approach that makes use of this invariant quality. We outline two main characteristics that we would expect from indicators of a vulnerable state: that they should appear across disorders regardless of specific circumstances, and that they should appear much before the disorder is evident. Next, we identify two sets of factors that exhibit this pattern of association with psychopathological states. The first was a set of “low-level” sensory, motor and regulatory irregularities that have been reported across the clinical literature; we suggest that these can serve as behavioral indicators of a vulnerable state. The second was the set of aberrations in network metrics that have been reported in the field of systems neuroscience; we suggest that these can serve as network indicators of a vulnerable state. Finally, we explore how behavioral indicators may be related to network indicators and discuss the clinical and research-related implications of our work.
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Affiliation(s)
- Nava Levit-Binnun
- School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel
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12
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Wickline VB, Nowicki S, Bollini AM, Walker EF. Vocal and Facial Emotion Decoding Difficulties Relating to Social and Thought Problems: Highlighting Schizotypal Personality Disorder. JOURNAL OF NONVERBAL BEHAVIOR 2011. [DOI: 10.1007/s10919-011-0125-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Mittal VA, Walker EF, Bearden CE, Walder D, Trottman H, Daley M, Simone A, Cannon TD. Markers of basal ganglia dysfunction and conversion to psychosis: neurocognitive deficits and dyskinesias in the prodromal period. Biol Psychiatry 2010; 68:93-9. [PMID: 20227679 PMCID: PMC2891189 DOI: 10.1016/j.biopsych.2010.01.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 01/17/2010] [Accepted: 01/20/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Movement abnormalities and cognitive deficits may represent external markers of an underlying neural process linked with the early etiology of psychosis. As basal ganglia function plays a governing role in both movement and cognitive processes, an understanding of the relationship between these phenomena stands to inform etiologic conceptualizations of vulnerability and psychotic disorders. METHODS In this investigation, trained raters coded movement abnormalities in videotapes from structured interviews of adolescents and young adults with a prodromal risk syndrome (n = 90). The participants were administered a neuropsychological battery including measures of verbal comprehension, perceptual organization, immediate/delayed auditory memory, and an estimate of full-scale intelligence quotient. Diagnostic status was followed for a 2-year period utilizing structured clinical interviews, during which time 24 high-risk participants (26.66%) converted to an Axis I psychotic disorder. RESULTS Elevated dyskinetic movements in the upper-body region were correlated with deficits in domains of verbal comprehension, perceptual organization, and both immediate and delayed auditory memory. Further, discriminant function analyses indicated that baseline movement abnormalities and neurocognitive deficits significantly classified those high-risk participants who would eventually convert to a psychotic disorder (72.3%). CONCLUSIONS Results support a common cortico-striato-pallido-thalamic circuit irregularity, underlying both movement abnormalities and cognitive deficits in individuals at high risk for psychosis. Models incorporating external markers of progressive basal ganglia dysfunction may enhance detection and preventive intervention for those high-risk individuals most in need of treatment.
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Affiliation(s)
- Vijay A Mittal
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA.
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14
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Abstract
Facial emotion recognition deficits have been widely investigated in individuals with schizophrenia; however, it remains unclear whether these deficits reflect a trait-like vulnerability to schizophrenia pathology present in individuals at risk for the disorder. Although some studies have investigated emotion recognition in this population, findings have been mixed. The current study uses a well-validated emotion recognition task, a relatively large sample, and examines the relationship between emotion recognition, symptoms, and overall life quality. Eighty-nine individuals with psychometrically defined schizotypy and 27 controls completed the Schizotypal Personality Questionnaire, Penn Emotion Recognition Test, and a brief version of Lehman's Quality of Life Interview. In addition to labeling facial emotions, participants rated the valence of faces using a Likert rating scale. Individuals with schizotypy were significantly less accurate than controls when labeling emotional faces, particularly neutral faces. Within the schizotypy sample, both disorganization symptoms and lower quality of life were associated with a bias toward perceiving facial expressions as more negative. Our results support previous research suggesting that poor emotion recognition is associated with vulnerability to psychosis. Although emotion recognition appears unrelated to symptoms, it probably operates by means of different processes in those with particular types of symptoms.
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van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L. A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 2009; 39:179-195. [PMID: 18606047 DOI: 10.1017/s0033291708003814] [Citation(s) in RCA: 1445] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A systematic review of all reported incidence and prevalence studies of population rates of subclinical psychotic experiences reveals a median prevalence rate of around 5% and a median incidence rate of around 3%. A meta-analysis of risk factors reveals associations with developmental stage, child and adult social adversity, psychoactive drug use, and also male sex and migrant status. The small difference between prevalence and incidence rates, together with data from follow-up studies, indicates that approximately 75-90% of developmental psychotic experiences are transitory and disappear over time. There is evidence, however, that transitory developmental expression of psychosis (psychosis proneness) may become abnormally persistent (persistence) and subsequently clinically relevant (impairment), depending on the degree of environmental risk the person is additionally exposed to. The psychosis proneness-persistence-impairment model considers genetic background factors impacting on a broadly distributed and transitory population expression of psychosis during development, poor prognosis of which, in terms of persistence and clinical need, is predicted by environmental exposure interacting with genetic risk.
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Affiliation(s)
- J van Os
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands.
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Lataster T, Wichers M, Jacobs N, Mengelers R, Derom C, Thiery E, Van Os J, Myin-Germeys I. Does reactivity to stress cosegregate with subclinical psychosis? A general population twin study. Acta Psychiatr Scand 2009; 119:45-53. [PMID: 18822092 DOI: 10.1111/j.1600-0447.2008.01263.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study assessed the relationship between stress reactivity (trait 1) and psychosis (trait 2) across genetically related persons (cross-twin, cross-trait design) to examine whether stress reactivity is an uncontaminated and unconfounded familial marker of psychosis risk. METHOD Reactivity to stress and subclinical psychotic experiences were assessed in 289 female, general population twin-pairs. Cross-trait, within-twin associations investigating the association between stress reactivity and subclinical psychotic experiences in each person, were calculated. In addition, cross-trait, cross-twin associations were calculated to assess whether stress reactivity in one twin was moderated by subclinical psychotic experiences in the co-twin. RESULTS Cross-trait, within-twin analyses showed significant associations between stress reactivity and subclinical psychotic experiences in each person. In addition, the cross-trait cross-twin analyses showed that stress reactivity in twin 1 was significantly moderated by subclinical experiences in the co-twin. CONCLUSION The results suggest that the psychosis phenotype cosegregates with increased emotional reactivity to stress in daily life.
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Affiliation(s)
- T Lataster
- Maastricht University-Psychiatry and Neuropsychology, Maastricht 6200MD, The Netherlands
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17
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Correll CU, Smith CW, Auther AM, McLaughlin D, Shah M, Foley C, Olsen R, Lencz T, Kane JM, Cornblatt BA. Predictors of remission, schizophrenia, and bipolar disorder in adolescents with brief psychotic disorder or psychotic disorder not otherwise specified considered at very high risk for schizophrenia. J Child Adolesc Psychopharmacol 2008; 18:475-90. [PMID: 18928412 PMCID: PMC2779049 DOI: 10.1089/cap.2007.110] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to examine predictors of diagnostic and symptomatic outcome in adolescents with either psychotic disorder not otherwise specified (PsyNOS) or brief psychotic disorder (BrPsy) followed in a schizophrenia prodromal program. METHODS As part of a naturalistic study of adolescents considered at clinical high risk for schizophrenia, 26 youths (mean age, 15.9 +/- 2.6 years, 65.4% male) with psychosis not fulfilling criteria for schizophrenia/schizoaffective disorder and diagnosed with PsyNOS or BrPsy were evaluated for predictors of diagnostic and symptomatic outcome after at least 6 (mean, 22.8 +/- 19.4) months follow up. RESULTS Progression to schizophrenia, schizoaffective disorder, or psychotic bipolar disorder (n = 10, 38.5%) was predicted by fulfilling criteria for schizotypal personality disorder at baseline (p = 0.046). Development of schizophrenia/schizoaffective disorder (n = 7, 27.0%) was associated with worse executive functioning (p = 0.029) and absence of anxiety disorders (p = 0.027). Conversely, progression to bipolar disorder (n = 4, 15.4%), with (n = 3, 11.5%) or without (n = 1, 3.8%) psychosis, was associated with the presence of anxiety disorders (p = 0.014). Remission of all psychotic as well as attenuated positive or negative symptoms (n = 5, 19.4%) was predicted by Hispanic ethnicity (p = 0.0047), an initial diagnosis of BrPsy (p = 0.014), longer duration of antidepressant treatment (p = 0.035), and better attention at baseline (p = 0.042). CONCLUSIONS Results from this preliminary study suggest that patients with PsyNOS, BrPsy, or schizotypal personality disorder features in adolescence should be followed as separate risk groups in prodromal studies of schizophrenia and bipolar disorder. Executive function deficits and absence of anxiety disorders may be risk markers for schizophrenia, while presence of anxiety disorders may be linked to bipolar disorder risk. After achieving full remission, patients with sudden onset of psychosis and brief episodes could once be given the option of careful, supervised treatment discontinuation. The potential salutary effect of antidepressants during the psychotic prodrome and presence of characteristics differentiating patients at risk for schizophrenia or bipolar disorder should be investigated further.
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Affiliation(s)
- Christoph U. Correll
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York.,The Albert Einstein College of Medicine, Bronx, New York
| | - Christopher W. Smith
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York
| | - Andrea M. Auther
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York
| | - Danielle McLaughlin
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York
| | | | - Carmel Foley
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York.,The Albert Einstein College of Medicine, Bronx, New York
| | - Ruth Olsen
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York
| | - Todd Lencz
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York.,The Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York, and Brookdale Hospital, Brooklyn, New York
| | - John M. Kane
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York.,The Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York, and Brookdale Hospital, Brooklyn, New York
| | - Barbara A. Cornblatt
- The Zucker Hillside Hospital, North Shore– Long Island Jewish Health System, Glen Oaks, New York.,The Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York, and Brookdale Hospital, Brooklyn, New York
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18
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Mittal VA, Hasenkamp W, Sanfilipo M, Wieland S, Angrist B, Rotrosen J, Duncan EJ. Relation of neurological soft signs to psychiatric symptoms in schizophrenia. Schizophr Res 2007; 94:37-44. [PMID: 17543502 DOI: 10.1016/j.schres.2007.04.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/18/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although several studies have identified abnormal rates of neurological soft signs (NSS) as a manifestation of CNS dysfunction in schizophrenia, differences in sample populations have contributed to a discrepancy in empirical findings. Furthermore, little is known about the potential of NSS to predict a clinical response to antipsychotic medications. The present study tests the associations between NSS and schizophrenia symptomatology and examines NSS as a potential marker for predicting treatment response. METHODS Nineteen unmedicated male schizophrenia patients were treated prospectively with haloperidol for six weeks. The subjects were assessed for pre and post-treatment NSS and schizophrenia symptomatology (Brief Psychiatric Rating Scale, BPRS). RESULTS NSS at baseline were significantly associated with baseline symptoms on the Positive, Negative, and Psychological Discomfort BPRS subscales. NSS showed a strong trend toward improvement during six weeks of a prospective haloperidol trial. Hierarchical linear regression analyses indicated that more severe baseline NSS predicted poorer response to haloperidol treatment as measured by post-treatment BPRS Total subscale scores. DISCUSSION NSS at untreated baseline are associated with baseline symptom severity, and elevated NSS are predictive of a smaller degree of improvement in symptoms after antipsychotic treatment. These findings are consistent with the hypothesis that NSS are linked to the neuropathology that underlies schizophrenia symptomatology and course.
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Affiliation(s)
- Vijay A Mittal
- Emory University, Department of Psychology, 235 Dental Building, 1462 Clifton Road, Atlanta, GA 30322, United States.
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19
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Kaymaz N, van Os J, de Graaf R, Ten Have M, Nolen W, Krabbendam L. The impact of subclinical psychosis on the transition from subclinicial mania to bipolar disorder. J Affect Disord 2007; 98:55-64. [PMID: 16934874 DOI: 10.1016/j.jad.2006.06.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 06/29/2006] [Accepted: 06/30/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the general population, symptoms of mania and psychosis are more broadly distributed than their associated clinical syndromes. Little is known, however, about how these subclinical population phenotypes co-vary with and impact on each other. METHOD In a representative population cohort of 7076 adults, prevalence of mania and psychosis symptoms and syndromes were assessed with the CIDI at baseline, at one (T1) and two years later (T2). The degree of comorbidity between subclinical mania and subclinical psychosis was examined, as well as the impact of subclinical comorbidity on social impairment and transition from subclinical mania to onset of bipolar disorder. RESULTS The lifetime prevalence of at least one manic and one psychotic symptom was 4.1% and 4.2% respectively. Excluding individuals with any lifetime DSM-III-R bipolar or psychotic disorder (n=218), these prevalences were 2.3% (subclinical mania) and 2.8% (subclinical psychosis). Individuals with subclinical mania had a 17% risk of subclinical psychosis, compared with 2.3% in those without (P<0.000). Comorbid subclinical psychosis in individuals with subclinical mania was much more predictive of a future diagnosis of bipolar disorder (positive predictive values of 3% versus 10% respectively). CONCLUSION Subclinical phenotypes of mania and psychosis are more prevalent than their clinical counterparts and cluster together. The risk factors for psychosis may facilitate the formation of more "toxic" combinations of subclinical mania and subclinical psychosis with a higher probability of transition to bipolar disorder. A better understanding of this pathway is crucial for the development of early interventions.
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Affiliation(s)
- Nil Kaymaz
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO BOX 616 (DRT 10), 6200 MD Maastricht, The Netherlands
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20
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Hanssen M, Krabbendam L, Vollema M, Delespaul P, Van Os J. Evidence for instrument and family-specific variation of subclinical psychosis dimensions in the general population. JOURNAL OF ABNORMAL PSYCHOLOGY 2006; 115:5-14. [PMID: 16492091 DOI: 10.1037/0021-843x.115.1.5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is unknown to what degree dimensions of schizotypy (subclinical psychosis) show independent, family-specific variation in the general population. Psychologists administered the Community Assessment of Psychic Experiences, the Structured Interview for Schizotypy-Revised (SIS-R), and the Brief Psychiatric Rating Scale to 257 subjects pertaining to 82 general population families. All 3 instruments showed family-specific variation for positive and negative subclinical psychosis dimensions with between-families proportions of total variance between 10% and 40%. However, only the SIS-R showed family-specific variation of the negative dimension independent of its correlation with the positive dimension. The positive dimension of subclinical psychosis shows familial-specific variation in samples unselected for psychiatric disorder, suggesting dimensional liability in the population. The SIS-R additionally captures family-specific variation in the negative domain.
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Affiliation(s)
- M Hanssen
- Department of Psychiatry and Neuropsychology, EURON, Maastricht University, Maastricht, The Netherlands
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21
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Murray GK, Jones PB, Moilanen K, Veijola J, Miettunen J, Cannon TD, Isohanni M. Infant motor development and adult cognitive functions in schizophrenia. Schizophr Res 2006; 81:65-74. [PMID: 16300931 DOI: 10.1016/j.schres.2005.08.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 08/04/2005] [Accepted: 08/08/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Childhood neuromotor dysfunction is a risk factor for schizophrenia, a disorder in which cognitive deficits are prominent. The relationship between early neurodevelopment and adult cognition in schizophrenia remains unclear. METHODS We examined the associations between infant motor development and adult cognitive functions in schizophrenia (n = 61) and the general population (n = 104) in a sample drawn from the The Northern Finland 1966 Birth Cohort. Data on ages of learning to stand and walk with or without support were obtained at age 12 months by health visitor assessment. Neurocognitive measures at age 33-35 included executive function, verbal and visual episodic memory, and visuo-spatial working memory. RESULTS The schizophrenia group achieved neuromotor milestones later and performed significantly worse than the control group on all measures of cognition. In pooled analyses there were associations between infant motor development and adult cognition in the domains of executive function, verbal learning and visuospatial working memory, but not in visual object learning. The pattern of associations between development and cognition was similar in schizophrenia and the general population. CONCLUSIONS These findings are consistent with the hypothesis that in schizophrenia mild infant motor developmental delay and adult cognitive deficits (at least in some domains) are age dependent manifestations of the same underlying neural process. Thus, they may be better considered as part of a single longitudinal syndrome.
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Affiliation(s)
- G K Murray
- Department of Psychiatry, University of Cambridge, UK.
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Seeber K, Cadenhead KS. How does studying schizotypal personality disorder inform us about the prodrome of schizophrenia? Curr Psychiatry Rep 2005; 7:41-50. [PMID: 15717986 DOI: 10.1007/s11920-005-0024-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An increasing emphasis in the schizophrenia literature has been on the prodromal phase of the illness. The study of schizophrenia spectrum illness, including schizotypal personality disorder, has added important insight into the etiology, neuropathology, and treatment of schizophrenia, which can facilitate early identification, intervention, and perhaps prevention of the illness. The heterogeneity of the schizophrenia spectrum makes its definition elusive at best. The primary aim of the Cognitive Assessment and Risk Evaluation Program at the authors' institution is to combine the current knowledge of clinical and demographic risk factors for schizophrenia with the rapidly emerging data on vulnerability markers, or endophenotypes, that are associated with schizophrenia. The use of brain-based vulnerability markers may help to identify neurobiologically and clinically meaningful subgroups within this heterogeneous population of individuals in the early stages of schizophrenia. Another important aim of the Cognitive Assessment and Risk Evaluation program is to thoroughly assess those individuals who have not converted to psychosis to understand potential protective factors, reduce the rate of false positives, and decrease disability. The current review details a strategy for researching the schizophrenia prodrome by using information gained from research in schizotypal personality disorder.
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Affiliation(s)
- Katherine Seeber
- Department of Psychiatry, 0810, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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