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Thibaudeau E, Bowie CR, Montreuil T, Baer L, Lecomte T, Joober R, Abdel-Baki A, Jarvis GE, Margolese HC, De Benedictis L, Schmitz N, Malla AK, Lepage M. Acceptability, engagement, and efficacy of cognitive remediation for cognitive outcomes in young adults with first-episode psychosis and social anxiety: A randomized-controlled trial. Psychiatry Res 2024; 342:116243. [PMID: 39467482 DOI: 10.1016/j.psychres.2024.116243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 10/17/2024] [Accepted: 10/19/2024] [Indexed: 10/30/2024]
Abstract
Social anxiety disorder (SAD) is a frequent comorbidity in first-episode psychosis (FEP) and may increase cognitive impairments. Cognitive remediation (CR) is an effective treatment for cognition, particularly in a group format. This study aims to assess the efficacy, acceptability and engagement of group CR on cognitive outcomes in FEP+SAD compared to group cognitive-behavioral therapy (CBT). Participants with FEP+SAD were randomized to group CR (n = 45) or CBT-SAD (n = 51). They were assessed for cognition at baseline, post-therapy and 3- and 6-month follow-up. The CR group additionally completed scale to assess perceived competency and enjoyment in CR. Linear mixed models for repeated measures were used for cognitive scores. Descriptive statistics and t-tests were used to summarize acceptability, perceived competency, and enjoyment, for CR completers and non-completers. The CR group performed significantly better than CBT on executive functions and visual memory at post-therapy compared to baseline. Twenty participants completed CR (44 %; mean 5.5 sessions). At week 1, CR non-completers presented higher levels of perceived competency. Completers reported higher enjoyment scores at the last session compared to the first session. Group CR is effective for cognitive outcomes in FEP+SAD, but acceptability and engagement present a challenge. Future studies are necessary to explore approaches promoting engagement.
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Affiliation(s)
- Elisabeth Thibaudeau
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, 6875 Bd LaSalle, Verdun, Quebec, H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
| | - Christopher R Bowie
- Department of Psychology, Department of Psychiatry, Centre for Neuroscience Studies, Queen's University, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada.
| | - Tina Montreuil
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada; Departments of Educational & Counselling Psychology and Psychiatry, McGill University, Education Bldg, 3700 McTavish St Suite 614, Montreal, Quebec, H3A 1Y2, Canada; Child Health and Human Development, Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, Quebec, H3H 2R9, Canada.
| | - Larry Baer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, 6875 Bd LaSalle, Verdun, Quebec, H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry & Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
| | - Tania Lecomte
- Department of Psychology, University of Montréal, Marie-Victorin Building, PO BOX 6128 Centre-ville STN, Montreal Quebec, H3C 3J7, Canada.
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, 6875 Bd LaSalle, Verdun, Quebec, H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
| | - Amal Abdel-Baki
- Clinique JAP-Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, Quebec, H2X3E4, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, 900 R. Saint-Denis, Montreal, Quebec, H2X0A9, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Pavillon Roger-Gaudry, 2900, boul. Édouard-Montpetit, bureau S-750, Montreal, Quebec, H3T 1J4, Canada
| | - G Eric Jarvis
- First Episode Psychosis Program, Jewish General Hospital, Department of Psychiatry, McGill University, 4333 Côte St-Catherine Road, Montreal, Quebec, H3T 1E4, Canada.
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada; Prevention and Early Intervention Program for Psychoses, McGill University Health Centre, 1025, avenue Pine Ouest, Montréal Quebec, H3A 1A1, Canada.
| | - Luigi De Benedictis
- Département de psychiatrie et d'addictologie, Université de Montréal, Pavillon Roger-Gaudry, 2900, boul. Édouard-Montpetit, bureau S-750, Montreal, Quebec, H3T 1J4, Canada; Connec-T Clinic (First Psychotic Episode and Early Intervention Program), Institut universitaire en santé mentale de Montréal, Pavillon Lahaise, 3e étage, aile 303, 7401, rue Hochelaga, Montréal, Quebec, H1N 3M5, Canada.
| | - Norbert Schmitz
- Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Postfach 2669, 72016, Tuebingen, Germany.
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, 6875 Bd LaSalle, Verdun, Quebec, H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, 6875 Bd LaSalle, Verdun, Quebec, H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
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Thai H, Audet ÉC, Koestner R, Lepage M, O'Driscoll GA. The role of motivation in clinical presentation, treatment engagement and response in schizophrenia-spectrum disorders: A systematic review. Clin Psychol Rev 2024; 113:102471. [PMID: 39111125 DOI: 10.1016/j.cpr.2024.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/28/2024] [Accepted: 07/27/2024] [Indexed: 09/09/2024]
Abstract
Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.
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Affiliation(s)
- Helen Thai
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Élodie C Audet
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Richard Koestner
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Martin Lepage
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Gillian A O'Driscoll
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Fiszdon JM, Wang K, Lê K, Parente L, Choi J. Efficacy of cognitive training on cognition, symptoms and functioning: Impact of motivation and attendance. Schizophr Res Cogn 2024; 37:100313. [PMID: 38680994 PMCID: PMC11046296 DOI: 10.1016/j.scog.2024.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
While cognitive remediation therapy (CRT) and compensatory strategy training both have large literature bases supporting their efficacy on both proximal and distal outcomes, the research base on stand-alone cognitive training (CT) is smaller and less consistent, with little information about factors associated with better outcomes. In this study, we examined the efficacy of CT on training task, cognitive, symptom, and functional ability measures as well as the impact of motivational interviewing (MI), motivation level, and session attendance on treatment outcomes. Adults with psychotic spectrum disorders (n = 114) were randomized to MI or a sham control interview (CI), followed by 4 months of computerized CT. In whole sample analyses, participants improved on training tasks, cognitive performance, and psychiatric symptoms, but self-reported cognition, self-reported depression, and functional ability did not change. Compared to CI, MI was associated with greater reductions in self-reported depressive symptoms. Motivation level and session attendance did not significantly influence outcomes. Findings support the efficacy of CT on several key outcomes, and its simplicity may be advantageous in uptake in community clinics with limited staffing. The lack of functional gains underscores the need to incorporate treatment ingredients that promote generalization and real-world implementation of learned skills. We also speculate that engagement during course of training may be a better predictor of training success than baseline task-specific motivation.
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Affiliation(s)
- Joanna M. Fiszdon
- VA Connecticut Healthcare System, Psychology Service, 116B, 950 Campbell Ave, West Haven, CT 06516, United States of America
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States of America
| | - Kaicheng Wang
- Yale School of Public Health, New Haven, CT 06511, United States of America
| | - Karen Lê
- VA Connecticut Healthcare System, Psychology Service, 116B, 950 Campbell Ave, West Haven, CT 06516, United States of America
| | - Lori Parente
- VA Connecticut Healthcare System, Psychology Service, 116B, 950 Campbell Ave, West Haven, CT 06516, United States of America
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, The Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, United States of America
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Chen CS, Vinogradov S. Personalized Cognitive Health in Psychiatry: Current State and the Promise of Computational Methods. Schizophr Bull 2024; 50:1028-1038. [PMID: 38934792 PMCID: PMC11349010 DOI: 10.1093/schbul/sbae108] [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] [Indexed: 06/28/2024]
Abstract
BACKGROUND Decades of research have firmly established that cognitive health and cognitive treatment services are a key need for people living with psychosis. However, many current clinical programs do not address this need, despite the essential role that an individual's cognitive and social cognitive capacities play in determining their real-world functioning. Preliminary practice-based research in the Early Psychosis Intervention Network early psychosis intervention network shows that it is possible to develop and implement tools that delineate an individuals' cognitive health profile and that help engage the client and the clinician in shared decision-making and treatment planning that includes cognitive treatments. These findings signify a promising shift toward personalized cognitive health. STUDY DESIGN Extending upon this early progress, we review the concept of interindividual variability in cognitive domains/processes in psychosis as the basis for offering personalized treatment plans. We present evidence from studies that have used traditional neuropsychological measures as well as findings from emerging computational studies that leverage trial-by-trial behavior data to illuminate the different latent strategies that individuals employ. STUDY RESULT We posit that these computational techniques, when combined with traditional cognitive assessments, can enrich our understanding of individual differences in treatment needs, which in turn can guide evermore personalized interventions. CONCLUSION As we find clinically relevant ways to decompose maladaptive behaviors into separate latent cognitive elements captured by model parameters, the ultimate goal is to develop and implement approaches that empower clients and their clinical providers to leverage individual's existing learning capacities to improve their cognitive health and well-being.
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Affiliation(s)
- Cathy S Chen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sophia Vinogradov
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
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Yamanushi A, Shimada T, Koizumi A, Kobayashi M. Effect of Computer-Assisted Cognitive Remediation Therapy on Cognition among Patients with Schizophrenia: A Pilot Randomized Controlled Trial. Biomedicines 2024; 12:1498. [PMID: 39062072 PMCID: PMC11274551 DOI: 10.3390/biomedicines12071498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
In schizophrenia, cognition is closely linked to social competence and influences long-term prognosis. Thus, treatment should target cognitive improvement to enhance the patient's societal adaptation. This study evaluated the effects of computer-assisted cognitive remediation therapy (CR) using RehaCom® on cognition in patients with schizophrenia. Thirty patients were randomized, with 15 assigned to the CR and treatment as usual (TAU) group and 15 to the TAU-alone group. Over 12 weeks, patients received CR twice weekly, including two computer sessions and one verbal session. The outcomes measured were cognition using the Brief Assessment of Cognition in Schizophrenia and Schizophrenia Cognition Rating Scale, intrinsic motivation using the Quality of Life Scale and Intrinsic Motivation Inventory, psychiatric symptoms using the Positive and Negative Syndrome Scale, negative symptoms using the Scale for the Assessment of Negative Symptoms, and functional level using the modified Global Assessment of Functioning scale for Functioning. The CR + TAU group demonstrated considerable improvements in cognition, intrinsic motivation, and functional level compared to the TAU-alone group. These findings indicate that the CR using RehaCom® enhances cognition and other outcomes in schizophrenia.
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Affiliation(s)
- Ayumi Yamanushi
- Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano 386-0401, Japan; (A.Y.); (T.S.); (A.K.)
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano 390-8621, Japan
| | - Takeshi Shimada
- Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano 386-0401, Japan; (A.Y.); (T.S.); (A.K.)
| | - Ami Koizumi
- Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano 386-0401, Japan; (A.Y.); (T.S.); (A.K.)
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano 390-8621, Japan
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Shimada T, Morimoto T, Nagayama H, Nakamura N, Aisu K, Kito A, Kojima R, Yamanushi A, Kawano K, Hikita N, Yotsumoto K, Ebisu T, Kawamura M, Inoue T, Orui J, Asakura T, Akazawa M, Kobayashi M. Effect of individualized occupational therapy on cognition among patients with schizophrenia: A randomized controlled trial. Schizophr Res 2024; 269:18-27. [PMID: 38718691 DOI: 10.1016/j.schres.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/30/2024] [Accepted: 04/22/2024] [Indexed: 06/17/2024]
Abstract
This study aimed to evaluate the feasibility and efficacy of individualized occupational therapy (IOT) plus group occupational therapy (GOT) as standard care for cognition compared to GOT alone, and to determine which IOT component has the greatest effect on cognitive outcome in patients with schizophrenia. This study was conducted at 14 clinical sites across Japan and enrolled recently hospitalized patients with schizophrenia. The IOT consisted of motivational interview, self-monitoring, individualized visits, craft activities, individualized psychoeducation, and discharge planning. Among the 68 patients who were randomized to the GOT + IOT group (n = 34) and GOT alone group (n = 34), 67 completed the trial (GOT + IOT group, n = 34; GOT alone group, n = 33). There were significant improvements in change from baseline to post-treatment between the groups in verbal memory, working memory, verbal fluency, attention, executive function domains, and the composite score of the Brief Assessment of Cognition in Schizophrenia (BACS). The BACS composite score was significantly associated with the number of craft activity sessions. The addition of IOT to GOT has a favorable feasibility profile and efficacy for cognition in schizophrenia. Craft activity is the most effective IOT component in improving cognition.
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Affiliation(s)
- Takeshi Shimada
- Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan.
| | - Takafumi Morimoto
- Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan
| | - Naoko Nakamura
- Specified Medical Corporation, Hayashishita Hospital, Sapporo, Japan
| | - Kaori Aisu
- Kinan Mental Medical Center, Wakayama, Japan
| | - Aki Kito
- Sakakibara Hospital, National Hospital Organization, Mie, Japan
| | - Ryo Kojima
- Medical Corporation Okakai, Okakai Clinic Day-care Center, Kyoto, Japan
| | - Ayumi Yamanushi
- Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
| | - Kojiro Kawano
- Medical Corporation Yuaikai, Tikumaso Mental Hospital, Nagano, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan
| | - Noriaki Hikita
- Iwamizawa Municipal General Hospital, Iwamizawa, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan
| | - Kayano Yotsumoto
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Tomoe Ebisu
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Masashi Kawamura
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takao Inoue
- Kinan Mental Medical Center, Wakayama, Japan; Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan; Medical Corporation Kawasakikai, Mizuma Hospital, Osaka, Japan
| | - Junya Orui
- Osaka Health Science University, Osaka, Japan; Social Medical Corporation Mikamikai, Higashikouri Hospital, Osaka, Japan; Social Medical Corporation Mikamikai, Higashikouri Second Hospital, Osaka, Japan
| | - Tatsumi Asakura
- Specified Medical Corporation Kyowakai, Kyowa Hospital, Aichi, Japan
| | | | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
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Tempia Valenta S, Rapezzi M, Marcolini F, Speciani M, Giordani G, De Panfilis C, De Ronchi D, Atti AR. Assessing motivation for treatment in eating disorders: psychometric validation of the Italian version of the Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ-ITA). Eat Weight Disord 2024; 29:23. [PMID: 38573529 PMCID: PMC10995063 DOI: 10.1007/s40519-024-01653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Treatment resistance is a significant challenge in addressing eating disorders (EDs). The Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ) has been previously validated in ED populations to assess patients' motivation for treatment. This study aimed to validate the ACMTQ in the Italian language (ACMTQ-ITA) and evaluate its psychometric properties. METHODS We recruited a clinical sample of adults aged 18 or older, diagnosed with EDs, proficient in the Italian language, and providing written informed consent. Participants with psychiatric comorbidities such as schizophrenia, bipolar disorder, and substance use disorder were excluded from the study. Validity of the ACMTQ-ITA was assessed using reliability analysis with Cronbach's α and McDonald's ω estimates, and Confirmatory Factor Analysis (CFA). RESULTS Results from the reliability analysis confirmed the internal consistency of the Autonomous Motivation (AM) factor (α = 0.82, ω = 0.82), the Controlled Motivation (CM) factor (α = 0.76, ω = 0.77), and the ACMTQ-ITA overall score (α = 0.79). The CFA confirmed the two-factor solution (i.e., AM and CM) identified in the original validation of the ACMTQ (Comparative Fit Index = 0.92, Akaike Information Criterion = 3427.26, Bayesian Information Criterion = 3486.82; Root Mean Square Error of Approximation = 0.08, Standardized Root Mean Square Residual = 0.09). CONCLUSION The ACMTQ-ITA emerged as a valid and reliable tool for measuring motivation for treatment in individuals with EDs. Its implementation may facilitate the comprehension of treatment motivation, offering valuable clinical insights and implications for health management practices. LEVEL OF EVIDENCE Level V, descriptive studies.
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Affiliation(s)
- Silvia Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - Matilde Rapezzi
- Department of Management, University of Bologna, Bologna, Italy
| | - Federica Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Maurizio Speciani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Gabriele Giordani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Chiara De Panfilis
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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León-Herrera S, Oliván-Blázquez B, Samper-Pardo M, Aguilar-Latorre A, Sánchez Arizcuren R. Motivational Interviewing as a Tool to Increase Motivation and Adherence to a Long COVID Telerehabilitation Intervention: Secondary Data Analysis from a Randomized Clinical Trial. Psychol Res Behav Manag 2024; 17:157-169. [PMID: 38234406 PMCID: PMC10793119 DOI: 10.2147/prbm.s433950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/26/2023] [Indexed: 01/19/2024] Open
Abstract
Background Although motivational interviewing was originally developed to address abuse disorders, scientific evidence confirms that it is an increasingly used and effective approach in a wide range of therapeutic interventions. To date, however, no studies have analyzed the use of this tool in patients with persistent symptoms following coronavirus disease 2019, a condition known as Long COVID. Purpose To analyze the effectiveness of motivational interviewing with regard to the adherence to telerehabilitation for Long COVID using a mobile application. As a secondary objective, factors related to greater motivation before and after the motivational interviewing techniques were analyzed. Patients and Methods This longitudinal design substudy used a sample of 52 adult patients with Long COVID participating in the intervention group of a randomized clinical trial. This trial examined the effectiveness of a telerehabilitation program for this population using a mobile application. This program included three motivational interviews to achieve maximum treatment adherence. In this study, the main variables were motivation and adherence to application use. Sociodemographic and clinical data, personal constructs, and affective state were also collected. Subsequently, a descriptive, correlational, and regression statistical analysis was performed using the SPSS Statistics program. Results The median motivation prior to the first motivational interview was 8 (IQR 2), the median at the end of the last motivational interview was 8.5 (IQR 2.75), and the change in motivation levels after the three motivational interviews was 0.5 (IQR 1). Affective state and final motivation scores were predictors of greater adherence to telerehabilitation treatment. Conclusion A high level of motivation after participating in motivational interviewing appears to be related to higher levels of adherence to telerehabilitation in patients with Long COVID. This suggests that motivational interviewing may be an effective tool in the treatment of this disease.
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Affiliation(s)
- Sandra León-Herrera
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | | | - Alejandra Aguilar-Latorre
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
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9
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Au-Yeung C, Bowie CR, Montreuil T, Baer LH, Lecomte T, Joober R, Abdel-Baki A, Jarvis GE, Margolese HC, De Benedictis L, Schmitz N, Thai H, Malla AK, Lepage M. Predictors of treatment attrition of cognitive health interventions in first episode psychosis. Early Interv Psychiatry 2023; 17:984-991. [PMID: 36653167 DOI: 10.1111/eip.13391] [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: 09/02/2022] [Revised: 11/16/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023]
Abstract
AIM Dropping out of psychological interventions is estimated to occur in up to a third of individuals with psychosis. Given the high degree of attrition in this population, identifying predictors of attrition is important to develop strategies to retain individuals in treatment. We observed a particularly high degree of attrition (48%) in a recent randomized controlled study assessing cognitive health interventions for first-episode psychosis participants with comorbid social anxiety. Due to the importance of developing interventions for social anxiety in first episode psychosis, the aim of the present study was to identify putative predictors of attrition through a secondary analysis of data. METHODS Participants (n = 96) with first episode psychosis and comorbid social anxiety were randomized to receive cognitive behavioural therapy for social anxiety or cognitive remediation. Differences between completers and non-completers (<50% intervention completed) were compared using t-tests or chi-square analyses; statistically significant variables were entered into a multivariate logistic regression model. RESULTS Non-completers tended to be younger, had fewer years of education and had lower levels of social anxiety compared to completers. Lower baseline social anxiety and younger age were statistically significant predictors of non-completion in the logistic regression model. CONCLUSIONS Age and social anxiety were predictors of attrition in cognitive health interventions in first episode psychosis populations with comorbid social anxiety. In the ongoing development of social anxiety interventions for this population, future studies should investigate specific engagement strategies, intervention formats and outcome monitoring to improve participant retention in treatment.
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Affiliation(s)
- Christy Au-Yeung
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Christopher R Bowie
- Department of Psychology, Department of Psychiatry, Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Tina Montreuil
- Departments of Educational & Counselling Psychology and Psychiatry, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Child Health and Human Development, Montreal, Quebec, Canada
| | - Larry H Baer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Tania Lecomte
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- Clinique JAP-Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, Montréal, Québec, Canada
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - G Eric Jarvis
- First Episode Psychosis Program, Jewish General Hospital, and Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychoses, McGill University Health Centre, Montreal, Quebec, Canada
| | - Luigi De Benedictis
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Connec-T Clinic (First Psychotic Episode and Early Intervention Program), Institut universitaire en santé mentale de Montréal, Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Helen Thai
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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10
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Tyssedal MK, Johnsen E, Brønstad A, Skrede S. Dog-assisted interventions for adults diagnosed with schizophrenia and related disorders: a systematic review. Front Psychiatry 2023; 14:1192075. [PMID: 37426092 PMCID: PMC10326428 DOI: 10.3389/fpsyt.2023.1192075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background Many individuals diagnosed with schizophrenia and related disorders experience insufficient symptom relief from currently available treatment options. Researching additional venues should be prioritized. This systematic review, designed in accordance with PRISMA, examined the effect of targeted and structured dog-assisted interventions as a supplementary treatment. Methods Randomized as well as non-randomized studies were included. Systematic searches were conducted in APA PsycInfo, AMED, CENTRAL, Cinahl, Embase, Medline, Web of Science, and in several sources covering "gray" (unpublished) literature. In addition, forward and backward citation searches were performed. A narrative synthesis was conducted. Quality of evidence and risk of bias were assessed in accordance with GRADE and RoB2/ROBINS-I criteria. Results 12 publications from 11 different studies met eligibility criteria. Overall, studies showed diverging results. General psychopathology, positive and negative symptoms of psychosis, anxiety, stress, self-esteem, self-determination, lower body strength, social function, and quality of life were among the outcome measures with significant improvement. Most documentation for significant improvement was found for positive symptoms. One study indicated significant deterioration of non-personal social behavior. The risk of bias was high or serious for most of the outcome measures. Three outcome measures were associated with some concerns regarding risk of bias, and three with low risk of bias. Quality of evidence was graded low or very low for all outcome measures. Conclusions The included studies indicate potential effects of dog-assisted interventions for adults diagnosed with schizophrenia and related disorders, mostly beneficial. Nevertheless, low number of participants, heterogeneity, and risk of bias complicate the interpretation of results. Carefully designed randomized controlled trials are needed to determine causality between interventions and treatment effects.
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Affiliation(s)
| | - Erik Johnsen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Aurora Brønstad
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Silje Skrede
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Section of Clinical Pharmacology, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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11
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Kusiak E, Johnson K. Shifts in Motivation to Seek Substance Use Disorder Treatment in Adolescents, Emerging Adults, and Older Adults. JOURNAL OF SUBSTANCE USE 2023; 29:295-299. [PMID: 38919831 PMCID: PMC11196021 DOI: 10.1080/14659891.2022.2157771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Ethan Kusiak
- University of South Florida, College of Behavioral and Community Sciences, Department of Mental Health Law and Policy 13301 Bruce B. Downs Blvd. Tampa, FL 33612, USA
| | - Kimberly Johnson
- University of South Florida, College of Behavioral and Community Sciences, Department of Mental Health Law and Policy 13301 Bruce B. Downs Blvd. Tampa, FL 33612, USA
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12
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Olstad K, Sørensen T, Lien L, Danbolt LJ. Adolescents with developmental traumas in therapy in a child and adolescent mental health service, outpatient unit: experiences of daily living and expectations for therapy - a qualitative study. Front Psychol 2023; 14:946394. [PMID: 37213362 PMCID: PMC10196012 DOI: 10.3389/fpsyg.2023.946394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Background Developmental trauma has a profound effect on people's lives. There are few studies of the perceived difficulties and treatment needs of adolescents with developmental trauma. More studies are called for to explore the perspectives and experiences of these patients, especially adolescents. Method Semi-structured interviews were conducted with eight adolescents with developmental trauma aged 14-18 years in a Child and Adolescent Mental Health Service, Outpatient Unit. The interviews were analyzed using systematic text condensation. Results A main finding in this study regards the participants' understanding of why they needed therapy: symptom alleviation and coping tools. They expressed a need for talking with a safe and reliable adult who understood their situation. Their stories of daily functioning and bodily sensations align mainly with symptoms described for adolescents with developmental trauma. The study also shows that the participants' experiences of trauma affected their lives to a greater or lesser extent, in the form of ambivalence, avoidance, regulation, and coping strategies. They also described various physical problems, especially insomnia and inner restlessness. Their subjective stories revealed insights into their experiences. Conclusion Based on the results, we recommend that adolescents with developmental trauma be allowed to express their understandings of their difficulties and their treatment expectations at an early stage of their therapy. An emphasis on patient involvement and the therapeutic relationship can increase their autonomy and control over their own lives and treatment.
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Affiliation(s)
- Kjerst Olstad
- Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health Science, VID Specialized University, Oslo, Norway
- *Correspondence: Kjersti Olstad,
| | - Torgeir Sørensen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway
| | - Lars Lien
- MF Norwegian School of Theology, Religion and Society, Majorstuen, Oslo, Norway
| | - Lars Johan Danbolt
- Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health Science, VID Specialized University, Oslo, Norway
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13
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Mororó LG, Guimarães AL, Costa AC, Genaro L, Cavalcanti MT, Scoriels L, Panizzutti R. Association between motivation and engagement with changes in cognition and symptoms after digital cognitive training in schizophrenia. Schizophr Res 2023; 251:1-9. [PMID: 36527953 DOI: 10.1016/j.schres.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/14/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Digital cognitive training can remediate cognitive deficits present in schizophrenia. However, limited motivation and engagement may impact adherence to training. Therefore, identifying factors that may enhance (facilitators) or decrease (barriers) engagement in digital cognitive training and possibly modulate its effects are of great clinical relevance. METHODS We measured cognition, symptom severity, motivation (semi-structured interview), and engagement (adapted Utrecht Work Engagement Scale - UWES) of 27 patients with schizophrenia after a 40-h digital cognitive training. The interview transcript quotes were coded and categorized into facilitators and barriers. Thereafter, we tested the association of motivation and engagement with changes in cognition and symptoms after training. RESULTS The facilitator 'good performance' and the barrier 'difficult exercise' were associated with larger gains in attention (p = 0.03) and reasoning and problem solving (p = 0.02), respectively. 'Poor performance' was associated with smaller gains in global cognition (p < 0.01), attention (p = 0.03), and working memory (p = 0.02). The facilitator 'welcoming setting' was associated with larger reductions in the negative (p = 0.01) and total (p = 0.01) symptoms measured by the Positive and Negative Syndrome Scale. The UWES engagement scale was associated with different facilitators and barriers that emerged from the interview, an indication of consistency among both qualitative and quantitative assessments. DISCUSSION Using a mixed quantitative and qualitative research design, we showed associations between motivation and engagement and the response to digital cognitive training in schizophrenia. Facilitators and barriers were associated with engagement, gains in cognition, and reduced symptoms after the intervention, providing insights on how to increase engagement in the digital cognitive training delivered to subjects with schizophrenia.
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Affiliation(s)
- Luana G Mororó
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Anna Luiza Guimarães
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Ana Carolina Costa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Larissa Genaro
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Maria T Cavalcanti
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Linda Scoriels
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris, Inserm 1266, Paris, France
| | - Rogerio Panizzutti
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
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14
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Fakorede OO, Ogunwale A, Akinhanmi AO. Disability and premorbid adjustment in schizophrenia: A retrospective analysis. S Afr J Psychiatr 2022; 28:1853. [PMID: 36569810 PMCID: PMC9773004 DOI: 10.4102/sajpsychiatry.v28i0.1853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Schizophrenia is highly disabling. Though efforts at genetic mapping to identify those at risk of the illness have been promising but same cannot be said about predicting its associated disability before illness-onset (i.e., during premorbid phase). It is envisaged that Schizophrenia-related disability may be ameliorated if premorbid clinical markers are adequately predictive enough to identify those at risk and worked upon them. Aim This study aimed to determine whether there is a relationship between schizophrenia-related disability and premorbid adjustment. Setting This cross-sectional study was conducted at the out-patient clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria. Methods Three hundred patients with the diagnosis of schizophrenia and within the age range of 18-64 years were eligible for the study. Results Mean age of the participants was 41.9 ± 10.05 years with a slight female dominance (50.7%). Spearman's correlation revealed a direct correlation between disability and premorbid adjustment, albeit rather weak (r s = 0.130, p = 0.025). Conclusion Pre-diagnostic factors such as premorbid functioning may play a role in the subsequent functioning of an individual post-diagnosis. Other research efforts may focus on yet-to-be identified premorbid factors that may be targets of prevention to reduce disability in schizophrenia. Contribution This research serves as a pioneer work on disability and premorbid adjustment and has provided a template for the early identification of those at risk of schizophrenia by providing an intervention opportunity at the premorbid stage.
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Affiliation(s)
- Omokehinde O. Fakorede
- Department of Clinical Services, Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria,Department of Mental Health and Behavioural Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Adegboyega Ogunwale
- Department of Clinical Services, Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria
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15
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The relative contributions of insight and neurocognition to intrinsic motivation in schizophrenia. SCHIZOPHRENIA 2022; 8:18. [PMID: 35260585 PMCID: PMC8904546 DOI: 10.1038/s41537-022-00217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
Intrinsic motivation was described as the mental process of pursuing a task or an action because it is enjoyable or interesting in itself and was found to play a central role in the determination of the functional outcome of schizophrenia. Neurocognition is one of the most studied determinants of intrinsic motivation in clinically stable schizophrenia while little is known about the role of insight. Following this need we decided to focus on the contribution of different aspects of insight and of neurocognition to intrinsic motivation in a large sample (n = 176) of patients with stable schizophrenia. We performed three hierarchical linear regressions from which resulted that, among different insight aspects, the ability to correctly attribute signs and symptoms to the mental disorder made the strongest contribution to intrinsic motivation. Neurocognition, also, was significantly related to intrinsic motivation when analyzed simultaneously with insight. Moreover, even after accounting for sociodemographic and clinical variables significantly correlated with intrinsic motivation, the relationship between insight and neurocognition and intrinsic motivation remained statistically significant. These findings put the emphasis on the complex interplay between insight, neurocognition, and intrinsic motivation suggesting that interventions targeting both insight and neurocognition might possibly improve this motivational deficit in stable schizophrenia should.
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16
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Siddiqui I, Remington G, Saperia S, Da Silva S, Fletcher PJ, Voineskos AN, Zakzanis KK, Foussias G. Behavioural phenotypes of intrinsic motivation in schizophrenia determined by cluster analysis of objectively quantified real-world performance. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:85. [PMID: 36271094 PMCID: PMC9587030 DOI: 10.1038/s41537-022-00294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
Intrinsic motivation deficits are a prominent feature of schizophrenia that substantially impacts functional outcome. This study used cluster analysis of innate real-world behaviours captured during two open-field tasks to dimensionally examine heterogeneity in intrinsic motivation in schizophrenia patients (SZ) and healthy controls (HC). Wireless motion capture quantified participants' behaviours aligning with distinct aspects of intrinsic motivation: exploratory behaviour and effortful activity in the absence of external incentive. Cluster analysis of task-derived measures identified behaviourally differentiable subgroups, which were compared across standard clinical measures of general amotivation, cognition, and community functioning. Among 45 SZ and 47 HC participants, three clusters with characteristically different behavioural phenotypes emerged: low exploration (20 SZ, 19 HC), low activity (15 SZ, 8 HC), and high exploration/activity (10 SZ, 20 HC). Low performance in either dimension corresponded with similar increased amotivation. Within-cluster discrepancies emerged for amotivation (SZ > HC) within the low exploration and high performance clusters, and for functioning (SZ < HC) within all clusters, increasing from high performance to low activity to low exploration. Objective multidimensional characterization thus revealed divergent behavioural expression of intrinsic motivation deficits that may be conflated by summary clinical measures of motivation and overlooked by unidimensional evaluation. Deficits in either aspect may hinder general motivation and functioning particularly in SZ. Multidimensional phenotyping may help guide personalized remediation by discriminating between intrinsic motivation impairments that require amelioration versus unimpaired tendencies that may facilitate remediation.
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Affiliation(s)
- Ishraq Siddiqui
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Gary Remington
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Sarah Saperia
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto Scarborough, Toronto, ON Canada
| | - Susana Da Silva
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Paul J. Fletcher
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto, Toronto, ON Canada
| | - Aristotle N. Voineskos
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Konstantine K. Zakzanis
- grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto Scarborough, Toronto, ON Canada
| | - George Foussias
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Lindström M, Lindholm L, Liv P. Study protocol for a pragmatic cluster RCT on the effect and cost-effectiveness of Everyday Life Rehabilitation versus treatment as usual for persons with severe psychiatric disability living in sheltered or supported housing facilities. Trials 2022; 23:657. [PMID: 35971130 PMCID: PMC9377097 DOI: 10.1186/s13063-022-06622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model—a person-centred activity- and recovery-oriented intervention—has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness. Methods The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff. Discussion This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness. Trial registration ClinicalTrials.gov NCT05056415. Registered on 24 September 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06622-0.
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Affiliation(s)
- Maria Lindström
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Per Liv
- Department of Public Health and Clinical Medicine, Umeå university, 901 87, Umeå, Sweden
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18
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Aerobic exercise and cognitive functioning in schizophrenia: An updated systematic review and meta-analysis. Psychiatry Res 2022; 314:114656. [PMID: 35659670 DOI: 10.1016/j.psychres.2022.114656] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022]
Abstract
This study serves as an update to a recent systematic review and meta-analysis to summarize the effect of aerobic exercise on cognition in schizophrenia and determine the most effective method of aerobic exercise. We searched for controlled studies investigating the effect of aerobic exercise on cognition in schizophrenia published until January 2021. Fifteen studies were included. A random-effects model was used to estimate the standardized mean differences (SMDs) between cognitive outcomes of aerobic exercises and controls. Compared with controls, aerobic exercises resulted in significant improvements in global cognition (SMD = 0.21), attention/vigilance (SMD = 0.32), working memory (SMD = 0.27), and verbal learning (SMD = 0.30). Significant improvements in global cognition were observed with group exercise (SMD = 0.28), exercise supervised by exercise professionals (SMD = 0.27), as well as with ≥ 90 min/week (SMD = 0.26) and ≥ 12 weeks duration (SMD = 0.22). Our findings provide information beneficial for determining the most effective aerobic exercise method to improve cognition in schizophrenia.
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19
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Fiszdon JM, Choi J, Wang K, Parente LT, Hallinan S, Burton E, Bell MD, Martino S. Motivational interviewing to enhance psychosocial treatment attendance in people with SMI. Schizophr Res 2022; 246:165-171. [PMID: 35779328 DOI: 10.1016/j.schres.2022.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND While there is increasing support for the efficacy of psychosocial interventions for people with SMI, the real-world effectiveness of such treatments is diminished by lack of motivation for treatment, leading to poor treatment engagement/dropout. We sought to evaluate the efficacy of motivational interviewing (MI) in improving attendance in a full course of cognitive training, examine motivation level as a potential mechanism of action, and examine variables associated with initial engagement in the training. METHODS One hundred fourteen participants with SMI were randomized to MI or sham control interview (CI), both of which were followed by a 4-month active phase during which participants could attend up to 50 unpaid cognitive training sessions. RESULTS Fidelity to the MI intervention was high, and MI condition was associated with increases in perceived value of training tasks and, to a lesser extent, how enjoyable/interesting they were rated. Twenty-nine percent of the full sample did not attend any training sessions. In ITT analyses, there was no significant between-group impact of MI on treatment attendance, though one emerged when participants who did not attend any sessions were excluded. Treatment attendance was predicted by the level of motivation achieved after the MI/CI intervention. Those who attended at least one training session (regardless of randomization) were more likely to believe they had cognitive impairments, had higher IQ and had less severe general psychiatric symptoms. CONCLUSIONS MI showed some promise and may be a worthwhile addition to more comprehensive, robust efforts to promote initial treatment engagement and subsequent adherence.
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Affiliation(s)
- Joanna M Fiszdon
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Hartford Healthcare Behavioral Health Network, Hartford, CT, United States of America
| | - Kaicheng Wang
- Yale School of Public Health, United States of America
| | - Lori T Parente
- VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Sean Hallinan
- VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Emma Burton
- VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Morris D Bell
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
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20
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Cognitive remediation for people with bipolar disorder: The contribution of session attendance and therapy components to cognitive and functional outcomes. J Psychiatr Res 2022; 152:144-151. [PMID: 35724496 DOI: 10.1016/j.jpsychires.2022.06.021] [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: 10/19/2021] [Revised: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive remediation (CR) can reduce cognitive and functional difficulties in people with bipolar disorder (BD). To date, there is limited evidence on the contribution of session attendance and therapy components to treatment outcomes. This study explores whether attendance and core CR components contribute to treatment outcomes. METHODS This is a secondary analysis using data from a randomized controlled trial comparing CR plus treatment-as-usual (TAU; n = 40) to TAU only (n = 40) in euthymic people with BD. Session attendance was measured by number of sessions and by achieving therapy completion, pre-defined as attending ≥20 sessions. We used instrumental variable analysis to examine the effect of attendance on treatment outcomes. We then considered the association between core therapy components (i.e., massed practice, errorless learning, strategy use, therapist contact) and post-treatment outcome changes using correlation. RESULTS The CR group improved significantly in measure of global cognition, psychosocial functioning, and goal attainment. Therapy recipients attended 27.1 sessions on average, with 32 (80%) completing the minimum number of 20 sessions. Attending more sessions and achieving therapy completion were associated with improved treatment outcomes, but this relationship was not significant within the subgroup of CR completers. Improvement in psychosocial functioning was associated with therapist contact and goal attainment with selecting useful strategies during therapy. CONCLUSIONS Our findings highlight the relevance of session attendance, specifically the importance of achieving a minimum threshold of CR sessions, for outcome improvement. Strategy use and therapist contact might facilitate improvements in psychosocial functioning and personal recovery goals.
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21
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Trapp W, Heid A, Röder S, Wimmer F, Hajak G. Cognitive Remediation in Psychiatric Disorders: State of the Evidence, Future Perspectives, and Some Bold Ideas. Brain Sci 2022; 12:683. [PMID: 35741569 PMCID: PMC9221116 DOI: 10.3390/brainsci12060683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
Many people with psychiatric disorders experience impairments in cognition. These deficits have a significant impact on daily functioning and sometimes even on the further course of their disease. Cognitive remediation (CR) is used as an umbrella term for behavioral training interventions to ameliorate these deficits. In most but not all studies, CR has proven effective in improving cognition and enhancing everyday functional outcomes. In this paper, after quickly summarizing the empirical evidence, practical advice to optimize the effects of CR interventions is provided. We advocate that CR interventions should be as fun and motivating as possible, and therapists should at least consider using positively toned emotional stimuli instead of neutral stimuli. Participants should be screened for basic processing deficits, which should be trained before CR of higher-order cognitive domains. CR should stimulate metacognition and utilize natural settings to invoke social cognition. Wherever possible, CR tasks should link to tasks that participants face in their everyday life. Therapists should consider that participants might also benefit from positive side effects on symptomatology. Finally, the CR approach might even be utilized in settings where the treatment of cognitive impairments is not a primary target.
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Affiliation(s)
- Wolfgang Trapp
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany
- Fachhochschule des Mittelstands, Department of Psychology, University of Applied Sciences, 96050 Bamberg, Germany
| | - Andreas Heid
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany
| | - Susanne Röder
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany
| | - Franziska Wimmer
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany
| | - Göran Hajak
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany
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Nishida Y, Yamada S, Nakagawa Y, Aoyama T. The influence of interest in tasks on the autonomic nervous system. Heliyon 2022; 8:e09553. [PMID: 35663761 PMCID: PMC9160470 DOI: 10.1016/j.heliyon.2022.e09553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/02/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Although prior studies have indicated the relationships among decreased parasympathetic activity, schizophrenia, and depression, the physiological effects of psychiatric occupational therapy tasks have not been adequately explored. Therefore, it is necessary to quantitatively examine the physiological changes in the autonomic nervous system when performing such tasks to devise more individualized therapies. Accordingly, we examined the influence of task interest and its relationship with psychological characteristics. The participants included in this study were 22 healthy individuals. They completed the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, and the Social Phobia Scale. Participants selected the most and least interesting bookmarks from a set of 19 different color options, and indicated their degree of interest on a visual analog scale. An electrocardiogram was used during each task to record participants' cardiac sympathetic index (CSI) and cardiac vagal index (CVI) as they performed two tasks (interesting and uninteresting). The correlations between the degree of interest and CSI/CVI, and between the scores of the questionnaires and CSI/CVI were examined. There was a negative correlation between the degree of interest and CSI during the uninteresting task. Task interest may have contributed to suppressing sympathetic dominance and reducing mental and physiological loads, even if the tasks differed only color-wise. Physiological effects emerged from participants’ degree of task interest. Further identification of objective and therapeutic mechanisms may lead to wider applications of activities in different areas.
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Affiliation(s)
- Yurika Nishida
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Occupational Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sumie Yamada
- Department of Occupational Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiro Nakagawa
- Department of Occupational Therapy, Chubu University, Kasugai, Aichi, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Corresponding author.
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Higgins A, Downes C, Murphy R, Barry J, Monahan M, Doyle L, Gibbons P. Factors Influencing Attendees' Engagement with Group Psychoeducation: A Multi-stakeholder Perspective. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:539-551. [PMID: 34989933 PMCID: PMC9233715 DOI: 10.1007/s10488-021-01182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/05/2022]
Abstract
Few studies have explored the problem of engagement in relation to group psychoeducation from a multi-site and multi-stakeholder perspective. The aim of the study was to explore the factors influencing service user and family engagement with group psychoeducation programmes. The study design was qualitative descriptive. Data were collected through individual and focus group interviews with key stakeholders (n = 75) involved with the programme within 14 mental health sites in the Republic of Ireland. Enablers and barriers to engagement were identified at participant, provider, programme and organization level. Motivated participants and engaged clinicians, peer co-facilitation and support, and skilled and responsive facilitators were some of the factors which enhanced engagement. Barriers to engagement included readiness among participants, concerns related to stigma and confidentiality, desire to distance oneself from mental health services, a lack of support for programme participation within families, group discomfort, the time and length of the programme, issues with transport, visibility of the programme, and structural supports for clinicians. Findings from the study illustrate the multifaceted nature of engagement as well as provide a greater understanding of the multifactorial influences on engagement. Strategies to enhance engagement should therefore reflect a multipronged approach. At the outset of programme implementation, organizations should address their readiness to engage, conduct local needs assessments to anticipate individuals’ needs and plan accordingly in order to maximize engagement, and bolster facilitators’ engagement skills through the provision of training and mentoring opportunities.
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Affiliation(s)
- Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland.
| | - Carmel Downes
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Rebecca Murphy
- Department of Psychology, National University of Ireland, Maynooth, Kildare, Ireland
| | - Jennifer Barry
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Mark Monahan
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Louise Doyle
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
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Wölwer W, Frommann N, Lowe A, Kamp D, Weide K, Bechdolf A, Brockhaus-Dumke A, Hurlemann R, Muthesius A, Klingberg S, Hellmich M, Schmied S, Meyer-Lindenberg A. Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study). Front Psychiatry 2022; 13:909370. [PMID: 35800017 PMCID: PMC9253387 DOI: 10.3389/fpsyt.2022.909370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although clinically effective treatment is available for schizophrenia, recovery often is still hampered by persistent poor psychosocial functioning, which in turn is limited by impairments in neurocognition, social cognition, and social behavioral skills. Although cognitive remediation has shown general efficacy in improving cognition and social functioning, effects still need to be improved and replicated in appropriately powered, methodologically rigorous randomized controlled trials (RCTs). Existing evidence indicates that effects can most likely be optimized by combining treatment approaches to simultaneously address both social cognitive and social behavioral processes. OBJECTIVES To assess whether Integrated Social Cognitive and Behavioral Skill Therapy (ISST) is more efficacious in improving functional outcome in schizophrenia than the active control treatment Neurocognitive Remediation Therapy (NCRT). METHODS The present study is a multicenter, prospective, rater-blinded, two-arm RCT being conducted at six academic study sites in Germany. A sample of 180 at least partly remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST is a compensatory, strategy-based program that targets social cognitive processes and social behavioral skills. NCRT comprises mainly drill and practice-oriented neurocognitive training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause discontinuation over the 12-month study period; psychosocial functioning, quality of life, neurocognitive and social cognitive performance, and clinical symptoms are assessed as secondary outcomes at baseline before randomization (V1), at the end of the six-month treatment period (V6), and at the six-month follow-up (V12). DISCUSSION This RCT is part of the German Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) research network, which aims at using innovative treatments to enhance prevention and recovery in patients with schizophrenia. Because this study is one of the largest and methodologically most rigorous RCTs on the efficacy of cognitive remediation approaches in schizophrenia, it will not only help to identify the optimal treatment options for improving psychosocial functioning and thus recovery in patients but also allow conclusions to be drawn about factors influencing and mediating the effects of cognitive remediation in these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02678858, German Study Register DRKS 00010033.
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Affiliation(s)
- Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and Soulspace, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Alzey, Germany.,Department of Psychiatry and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Rene Hurlemann
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Oldenburg, Oldenburg, Germany
| | - Ana Muthesius
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Clinical Trials Center, University of Cologne, Cologne, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Carre A, Shankland R, Flaudias V, Morvan Y, Lamboy B. Les psychologues dans le champ de la santé mentale : les perspectives en promotion de la santé mentale positive. PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Chong NIM, Maniam Y, Chua YC, Tang C. The Implementation and Review of Cognitive Remediation Training for First Episode Psychosis in Singapore. Front Psychiatry 2021; 12:784935. [PMID: 34916979 PMCID: PMC8669156 DOI: 10.3389/fpsyt.2021.784935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed. Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05. Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding. Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.
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Affiliation(s)
- Nigel Ian Ming Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yogeswary Maniam
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore, Singapore
| | - Yi Chian Chua
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore, Singapore
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Maria AS, Barry C, Ringuenet D, Falissard B, Group T, Berthoz S. Subjective cognitive rigidity and attention to detail: A cross-cultural validation of the Detail and Flexibility Questionnaire (DFlex) in a French clinical sample. J Clin Exp Neuropsychol 2020; 42:1059-1071. [PMID: 33274668 DOI: 10.1080/13803395.2020.1842333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: People diagnosed with Anorexia Nervosa (AN) are at risk for poor cognitive flexibility and excessive attention to detail. These difficulties are traditionally quantified using neuropsychological tests. These tests do not capture the subjective repercussions of these cognitive styles. The Detail and Flexibility Questionnaire (DFlex) has been specifically developed to measure these repercussions. The aim of this study was to evaluate the psychometric properties of the French version of this scale (F-DFlex) and to adapt it if needed. Methods: The instrument factor structure, internal consistency, convergent, and discriminant validity were assessed in a sample of 107 French women AN inpatients. For convergent validity, associations between F-DFlex scores, perceived levels of autistic traits (Autism Quotient questionnaire - AQ) and eating disorders symptomatology (Eating Disorder Examination Questionnaire - EDE-Q), as well as neuropsychological evaluations (Wisconsin Card Sorting Test - WCST, Rey Complex Figure - RCF) were tested. Discriminant validity was assessed by comparing F-DFlex scores of the patients with a chronic versus non-chronic illness. Results: The results of the exploratory factorial analysis led to the removal of four items. Internal consistency indices of this shortened version were good. Correlation coefficients directions and values between F-DFlex factors and relevant AQ Switching and Detail subscores were satisfactory, indicating good convergent validity. F-DFlex Rigidity scores were associated with the WCST percentage of perseverative errors, but the F-DFlex Attention to Detail scores were not associated with the RCF central coherence index. F-DFlex scores were associated with the severity of eating disorders symptomatology independently of BMI, illness duration, or anxiety, and depression. Conclusion: This study indicates good psychometric properties of this new version of the DFlex. The F-DFlex appears as a promising self-report screening tool of important cognitive dimensions for use in clinical management of people diagnosed with AN.
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Affiliation(s)
- Anne-Solène Maria
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | - Caroline Barry
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | - Damien Ringuenet
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France.,Unité de Traitement des Troubles des Conduites Alimentaires, Département de Psychiatrie et d'Addictologie, Hôpital Paul Brousse , Villejuif, France
| | - Bruno Falissard
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | | | - Sylvie Berthoz
- Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris , Paris, France.,Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287 , Bordeaux, France
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Targeting Cognitive Control Deficits With Neuroplasticity-Based Computerized Cognitive Remediation in Patients With Geriatric Major Depression: A Randomized, Double-Blind, Controlled Trial. Am J Geriatr Psychiatry 2020; 28:971-980. [PMID: 32591170 DOI: 10.1016/j.jagp.2020.05.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022]
Abstract
Late life major depression (LLD) is often accompanied by cognitive deficits. When patients have specific deficits in cognitive control functions (CCD), they are not only distressing and debilitating, they often predict poor clinical outcomes such as reduced response to SSRI/SNRI antidepressants, increased disability, suicide and all-cause mortality. We recently reported that in an open label trial, our treatment designed to target these specific CCD with neuroplasticity-based computerized cognitive remediation (nCCR) improved depression and CCD in patients who failed to remit with conventional antidepressant treatment. This study tested the hypothesis that in patients with LLD who have failed at least one trial of an SSRI/SNRI antidepressant at an adequate dose for at least 8 weeks, nCCR will improve both depressive symptoms and the CCD associated with poor antidepressant response (i.e. semantic strategy, inhibition of prepotent responses) more than an active control group. Participants were randomized (1:1) to receive either 30 hours/ 4 weeks of neuroplasticity based computerized cognitive remediation (nCCR) designed to target CCD, or the active control condition matched for duration, engagement, reward, computer presentation, and contact with study staff. All participants and raters were blinded. Mixed effects model analysis the time effect (week) (F(1,71.22)=25.2, p<0.0001) and treatment group X time interaction (F(1,61.8)=11.37, p=.002) reached significance indicating that the slope of decline in MADRS was steeper in the nCCR-GD group. Further, the nCCR group improved their semantic clustering strategy(t(28)=9.5; p=.006), as well as performance on the Stroop interference condition, and cognitive flexibility (Trails B). Further, results transferred to memory performance, which was not a function trained by nCCR. clinicaltrials.gov.
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Allott K, Steele P, Boyer F, de Winter A, Bryce S, Alvarez-Jimenez M, Phillips L. Cognitive strengths-based assessment and intervention in first-episode psychosis: A complementary approach to addressing functional recovery? Clin Psychol Rev 2020; 79:101871. [DOI: 10.1016/j.cpr.2020.101871] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
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Yıldız E, Aylaz R. How Counseling Based on Acceptance and Commitment Therapy and Supported with Motivational Interviewing Affects Levels of Functional Recovery in Patients Diagnosed with Schizophrenia: A Quasi-Experimental Study. Clin Nurs Res 2020; 30:599-615. [PMID: 32545996 DOI: 10.1177/1054773820935592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to determine how counseling based on acceptance and commitment therapy (ACT) and supported with motivational interviewing (MIs) affected functional recovery in individuals diagnosed with schizophrenia (IDSs). A quasi-experimental design was used. The participants of this study were 87 individuals diagnosed with schizophrenia (36 in the experimental group and 51 in the control group). The experimental group received counseling based on ACT and supported with MIs. The data were collected between September 2018 and May 2019 using a Descriptive Information Form and the Functional Remission of General Schizophrenia Scale (FROGS). The participants in the experimental group were given a group counseling program of eight sessions at community mental health centers in downtown Malatya, Turkey. The results revealed a statistically significant difference in the mean scores on FROGS between those in the IDS experimental group and those in the control group. The scores increased on both groups.
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Saperstein AM, Lynch DA, Qian M, Medalia A. How does awareness of cognitive impairment impact motivation and treatment outcomes during cognitive remediation for schizophrenia? Schizophr Res 2020; 218:70-75. [PMID: 32156497 PMCID: PMC7299790 DOI: 10.1016/j.schres.2020.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is concern that awareness of cognitive deficit among people with schizophrenia receiving Cognitive Remediation (CR) might undermine motivation, engagement, and CR outcomes. We therefore examined the relationship of subjective awareness of cognitive deficit to aspects of motivation and cognitive learning during an efficacious CR program. METHODS Individuals with schizophrenia/schizoaffective disorder who completed 30 sessions of CR (N = 67) were evaluated on cognitive performance, self-reported cognitive difficulties, intrinsic motivation and perceived competency for cognitive training tasks at the beginning and end of treatment. RESULTS We found no relationship between actual and perceived cognitive functioning when measured cross-sectionally or as difference scores, pre/post treatment. Greater awareness of cognitive problems was associated with lower perceived competency for cognitive tasks at treatment beginning and end-point (p-values < .05). The significant relationship between awareness of cognitive problems and perceived value of the treatment at end-point was fully mediated by perceived competency. While greater perceived competency was associated with shorter time to treatment completion (p = .0025), it was intrinsic motivation measured at end-point that was associated with cognitive change (p = .02). DISCUSSION While awareness of cognitive problems may not be a prerequisite for cognitive improvement during CR, it could impact engagement in, and how one values treatment via its effect on perceived competency. Results also highlighted the importance of intrinsic motivation for doing cognitive learning activities, given its relationship to cognitive gain. Further study is needed to understand how best to assess and address awareness of cognitive abilities within the CR setting.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States.
| | - David A Lynch
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, United States.
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, New York, NY 10032, United States.
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Lin CY, Broström A, Årestedt K, Mårtensson J, Steinke EE, Pakpour AH. Using extended theory of planned behavior to determine factors associated with help-seeking behavior of sexual problems in women with heart failure: a longitudinal study. J Psychosom Obstet Gynaecol 2020; 41:54-61. [PMID: 30829094 DOI: 10.1080/0167482x.2019.1572743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Introduction: This study used extended theory of planned behavior (extended TPB) to understand the underlying factors related to help-seeking behavior for sexual problems among Iranian women with heart failure (HF).Methods: We recruited 758 women (mean age = 61.21 ± 8.92) with HF at three university-affiliated heart centers in Iran. Attitude, subjective norms, perceived behavioral control, behavioral intention, self-stigma of seeking help, perceived barriers, frequency of planning, help-seeking behavior, and sexual function were assessed at baseline. Sexual function was assessed again after 18 months. Structural equation modeling was used to explain change in sexual functioning after 18 months.Results: Attitude and perceived behavioral control were positively correlated to behavioral intention. Behavioral intention was negatively and self-stigma in seeking help was positively correlated to perceived barriers. Behavioral intention was positively and self-stigma in seeking help was negatively correlated to frequency of planning. Perceived behavioral control, behavior intention, and frequency of planning were positively and self-stigma in seeking help and perceived barriers were negatively correlated to help-seeking behavior. Help-seeking behavior was positive correlated to the change of FSFI latent score.Conclusions: The extended TPB could be used by healthcare professionals to design an appropriate program to treat sexual dysfunction in women with HF.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Kalmar County Hospital, Kalmar, Sweden
| | - Jan Mårtensson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | | | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Shimada T, Ito S, Makabe A, Yamanushi A, Takenaka A, Kawano K, Kobayashi M. Aerobic exercise and cognitive functioning in schizophrenia: Results of a 1-year follow-up from a randomized controlled trial. Psychiatry Res 2020; 286:112854. [PMID: 32078891 DOI: 10.1016/j.psychres.2020.112854] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 11/20/2022]
Abstract
We previously reported that adding combined, individual, and group aerobic exercise (AE) interventions to the treatment as usual (TAU) for schizophrenia showed significant improvements in cognition and other outcomes compared to those with TAU alone in a randomized controlled trial. Following the promising results of our previous study, this 1-year follow-up study evaluated the improvements in cognition and other outcomes with TAU + AE compared to those with TAU alone. Of 41 randomized patients, 40 were included in the intent-to-treat population-20 in the TAU + AE and 20 in the TAU alone; all patients completed the 1-year follow-up. Mixed models were applied to assess changes in outcome measures over time from baseline to 1-year follow-up. At 1-year follow-up, the TAU + AE demonstrated significant group by time interaction effects in several cognitive domains, intrinsic motivation, negative symptom, interpersonal relations, and functional outcome compared with the TAU alone. Our results demonstrate that the improvements in cognition and other outcomes with TAU + AE were maintained and that functional outcome improved over 1-year follow-up. These findings show that the improvements sustained for each outcome over 1 year have the potential to offer opportunities for greater transitions to improvement of functional outcome.
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Affiliation(s)
- Takeshi Shimada
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan.
| | - Shoko Ito
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Aya Makabe
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Ayumi Yamanushi
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Ami Takenaka
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Kojiro Kawano
- Medical Corparation Yuaikai Tikumaso Mental Hospital, Nagano, Japan
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
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Hanssen E, Balvert S, Oorschot M, Borkelmans K, van Os J, Delespaul P, Fett AK. An ecological momentary intervention incorporating personalised feedback to improve symptoms and social functioning in schizophrenia spectrum disorders. Psychiatry Res 2020; 284:112695. [PMID: 31831201 DOI: 10.1016/j.psychres.2019.112695] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 12/22/2022]
Abstract
This study examined the feasibility and effectiveness of an interactive smartphone application that aimed to improve daily-life social functioning and symptoms in schizophrenia spectrum disorders (SZ) with Experience Sampling Method (ESM) derived personalised feedback.Two groups of outpatients with a diagnosis of SZ were included (one receiving ESM-derived personalised feedback (n = 27) and one without feedback (n = 23)) and used the interactive smartphone application for three weeks. Main outcomes were momentary symptoms and social functioning, as assessed by ESM questionnaires. Additionally, feasibility and user-friendliness of the application were assessed. The response rate was 64% for the ESM questionnaires. In the feedback group, participants indicated that on 49% of the ESM days they acted on at least one personalised feedback prompt per day. Momentary psychotic symptoms significantly decreased over time only in the feedback group. Momentary loneliness and questionnaire-assessed psychotic symptoms decreased over time, irrespective of feedback. Participants evaluated the app as user-friendly and understandable. Momentary personalised feedback may impact momentary psychosis in daily life. Feelings of loneliness and questionnaire-based measured psychotic symptoms may be more responsive to non-specific effects of daily-life self-monitoring, not requiring specific feedback. Ecological momentary interventions offer opportunities for accessible and effective interventions in SZ.
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Affiliation(s)
- Esther Hanssen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, and Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, the Netherlands.
| | - Sanne Balvert
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, and Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Karel Borkelmans
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands; Mondriaan Mental Health Trust, Heerlen, The Netherlands
| | - Anne-Kathrin Fett
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, and Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychology, City University of London, London, United Kingdom; CSI Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
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Haut KM, Dodell-Feder D, Guty E, Nahum M, Hooker CI. Change in Objective Measure of Empathic Accuracy Following Social Cognitive Training. Front Psychiatry 2019; 10:894. [PMID: 31920748 PMCID: PMC6914938 DOI: 10.3389/fpsyt.2019.00894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/13/2019] [Indexed: 01/27/2023] Open
Abstract
Background: The capacity for empathy plays an important role in interpersonal relationships and social functioning, and impairments in empathy can have negative effects on social interactions and overall social adjustment. This suggests that empathy may be a critical target for intervention in individuals who struggle with social interactions, yet it is unclear if the skills required for empathy are malleable. This study investigates the efficacy of targeted social cognitive training for improving empathic skills. Methods: Forty-five individuals (mean age = 24) were included in this study. Twenty-four individuals were allocated to the active social cognition training group and 21 individuals were allocated to a computer games control condition. Subjects completed approximately 10.5 h of training over two weeks. Pre- and post- training, they completed measures of empathy and emotion recognition, including the Interpersonal Reactivity Inventory (IRI) and an empathic accuracy task. ANOVA and regression analyses tested changes in participants' performance on the empathic accuracy task and scores on the IRI subscales were used to assess the effect of the social cognitive training. Results: Repeated measures ANOVA show that there is a significant group by timepoint interaction on the Empathic Accuracy task, with individuals who completed the social cognition training showing a significant improvement in performance following training. There were no significant changes for either group on any of the self-report IRI subscales. Individuals in the active training group show significant improvement on negative valence videos and a trend towards improvement on positive valence videos. In addition, individuals in social cognition active training group who reported higher intrinsic motivation demonstrated greater improvement on the Empathic Accuracy task. Conclusions: Individuals who completed a computerized social cognition training program demonstrated improved performance on a rater objective measure of empathic accuracy while individuals who completed a computer game control condition did not demonstrate any significant changes in their performance on the empathic accuracy task. These results suggest that targeted training in social cognition may increase empathic abilities, even in healthy individuals, and that this training may be beneficial to individuals with social cognitive deficits.
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Affiliation(s)
- Kristen M. Haut
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, Rochester, NY, United States
| | - Erin Guty
- Department of Psychology, Pennsylvania State University, State College, PA, United States
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem,Israel
| | - Christine I. Hooker
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Shankar S, Miller WC, Roberson ND, Hubley AM. Assessing Patient Motivation for Treatment: A Systematic Review of Available Tools, Their Measurement Properties, and Conceptual Definition. J Nurs Meas 2019; 27:177-209. [PMID: 31511404 DOI: 10.1891/1061-3749.27.2.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Motivation is often reported by clinicians and researchers as a key factor related to treatment and health outcomes. This systematic review aims to (a) Identify and critically appraise tools that measure patient motivation for treatment and (b) determine how these tools define and evaluate motivation. METHODS Library databases and the search engine Google Scholar were examined. Identified tools measuring patient motivation for treatment and reported measurement properties were selected. RESULTS 14 peer-reviewed articles covering 12 different tools made the final selection. Quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and a new measure checklist. Reliability evidence was predominantly estimated using internal consistency; validity evidence was limited, and responsiveness was seldom examined. Overall, quality ratings were poor or inadequately reported and serious methodological limitations were identified. A lack of conceptual foundation quality ratings as tools did not apply a theory related to motivation or have a clear definition of the construct of patient motivation. CONCLUSIONS A significant gap exists of available tools with adequate measurement properties that use relevant theoretical frameworks.
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Affiliation(s)
- Sneha Shankar
- Measurement, Evaluation and Research Methodology, Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British, Vancouver, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada
| | - Nathan D Roberson
- Measurement, Evaluation and Research Methodology, Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Anita M Hubley
- Measurement, Evaluation and Research Methodology, Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, Canada
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Best MW, Milanovic M, Tran T, Leung P, Jackowich R, Gauvin S, Leibovitz T, Bowie CR. Motivation and engagement during cognitive training for schizophrenia spectrum disorders. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100151. [PMID: 31828022 PMCID: PMC6889769 DOI: 10.1016/j.scog.2019.100151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/21/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022]
Abstract
Background Motivation and engagement are important factors associated with therapeutic outcomes in cognitive training for schizophrenia. The goals of the present report were to examine relations between objective treatment engagement (number of sessions attended, amount of homework completed) and self-reported motivation (intrinsic motivation and perceived competence to complete cognitive training) with neurocognitive and functional outcomes from cognitive training. Methods Data from a clinical trial comparing two cognitive training approaches in schizophrenia-spectrum disorders were utilized in the current report (n = 38). Relations were examined between baseline intrinsic motivation, perceived competence, homework completion, and session attendance with improvements in neurocognition, functional competence, and community functioning. Results Number of sessions attended (r = 0.38) and time doing homework (r = 0.51) were significantly associated with improvements in neurocognition. Homework completion was associated with change in community functioning at a trend-level (r = 0.30). Older age was associated with greater treatment engagement (β = 0.37) and male biological sex was associated with greater self-reported motivation (β = 0.43). Homework completion significantly mediated the relationship between session attendance and neurocognitive treatment outcomes. Conclusions Objective measures of treatment engagement were better predictors of treatment outcomes than subjective measures of motivation. Homework completion was most strongly related to treatment outcomes and mediated the relationship between session attendance and treatment outcomes, suggesting continued engagement with cognitive stimulation may be an especially important component of cognitive remediation programs. Future research should examine methods to improve homework completion and session attendance to maximize therapeutic outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Christopher R. Bowie
- Corresponding author at: Department of Psychology, Queen's University, K7L 3N6 Kingston, ON, Canada.
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van de Weijer SC, Kuijf ML, de Vries NM, Bloem BR, Duits AA. Do-It-Yourself Gamified Cognitive Training: Viewpoint. JMIR Serious Games 2019; 7:e12130. [PMID: 31066713 PMCID: PMC6528436 DOI: 10.2196/12130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/06/2018] [Accepted: 01/20/2019] [Indexed: 12/21/2022] Open
Abstract
Cognitive decline is an important nonmotor symptom in Parkinson disease (PD). Unfortunately, very few treatment options are available. Recent research pointed to small positive effects of nonpharmacological cognitive training in PD. Most of these trainings are performed under supervision and solely computerized versions of (traditional) paper-pencil cognitive training programs, lacking rewarding gamification stimulants that could help to promote adherence. By describing 3 different self-invented ways of cognitive gaming in patients with PD, we aimed to raise awareness for the potential of gamified cognitive training in PD patients. In addition, we hoped to inspire the readers with our case descriptions, highlighting the importance of both personalization and cocreation in the development of games for health. In this viewpoint, we have presented 3 PD patients with different ages, with different disease stages, and from various backgrounds, who all used self-invented cognitive training, including elements of personalization and gamification. To indicate generalization into a larger PD population, the recruitment results from a recent cognitive game trial are added. The presented cases show similarities in terms of awareness of their cognitive decline and the ways this process could potentially be counteracted, by looking for tools to train their cognition. On the basis of the response of the recruitment procedure, there seems to be interest in gamified cognitive training in a larger PD population too. Gamification may add to traditional therapies in terms of personalization and adherence. Positive results have already been found with gamified trainings in other populations, and the cases described here suggest that PD is also an attractive area to develop and test gamified cognitive trainings. However, no results of gamified cognitive trainings in PD have been published to date. This suggests an unmet need in this area and may justify the development of gamified cognitive training and its evaluation, for which our considerations can be used.
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Affiliation(s)
| | - Mark L Kuijf
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Nienke M de Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Annelien A Duits
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, Netherlands
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Validation of the MUSIC Model of Motivation Inventory for use with cognitive training for schizophrenia spectrum disorders: A multinational study. Schizophr Res 2019; 206:142-148. [PMID: 30580895 PMCID: PMC6525643 DOI: 10.1016/j.schres.2018.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/26/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
Abstract
AIM Low motivation is a core symptom of schizophrenia which significantly impacts successful engagement in and benefit from psychosocial treatments. Therefore, it is important for clinicians to design psychosocial treatments to effectively motivate and engage patients during the treatment. The MUSIC® Model of Academic Motivation Inventory (MMI) is an 18-item instrument with five scales that assess students' motivation during academic tasks. The objective of the current study was to validate the MMI for use with schizophrenia-spectrum patients undergoing cognitive training. METHODS Participants included 181 people with schizophrenia spectrum disorders enrolled in cognitive training in four countries. A confirmatory factor analysis (CFA) assessed construct validity. Quality of fit was determined using the Comparative Fit Index (CFI), the Standardized Root Mean Square Residual (SRMR), and the Root Mean Square Error of Approximation (RMSEA). Pearson's correlation coefficients assessed construct validity and Cronbach's alphas assessed reliability. Furthermore, we examined factor loadings for each inventory item and assessed predictive validity by analyzing MMI scales with attendance outcomes. RESULTS Consistent with the original MMI validation studies used in academic settings, we found CFI values indicated a good fit, as did the SRMR and RMSEA values. The scales were correlated yet distinct. Cronbach's alpha values ranged from good to excellent and factor loadings showed that all items loaded very well onto their intended factors. The MMI had a positive relationship to treatment intensity. CONCLUSION The MMI is a valid and reliable tool to use with individuals with schizophrenia spectrum disorders undergoing a cognitive training intervention.
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Abstract
UNLABELLED IntroductionWith the increasing enthusiasm to provide cognitive remediation (CR) as an evidence-based practice, questions arise as to what is involved in implementing CR in a large system of care. This article describes the first statewide implementation of CR in the USA, with the goal of documenting the implementation issues that care providers are likely to face when bringing CR services to their patients. METHODS In 2014, the New York State Office of Mental Health set up a Cognitive Health Service that could be implemented throughout the state-operated system of care. This service was intended to broadly address cognitive health, to assure that the cognitive deficits commonly associated with psychiatric illnesses are recognized and addressed, and that cognitive health is embedded in the vocabulary of wellness. It involved creating a mechanism to train staff to recognize how cognitive health could be prioritized in treatment planning as well as implementing CR in state-operated adult outpatient psychiatry clinics. RESULTS By 2017, CR was available at clinics serving people with serious mental illness in 13 of 16 adult Psychiatric Centers, located in rural and urban settings throughout New York state. The embedded quality assurance program evaluation tools indicated that CR was acceptable, sustainable, and effective. CONCLUSIONS Cognitive remediation can be feasibly implemented in large systems of care that provide a multilevel system of supports, a training program that educates broadly about cognitive health and specifically about the delivery of CR, and embedded, ongoing program evaluation that is linked to staff supervision.
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Fulford D, Treadway M, Woolley J. Social motivation in schizophrenia: The impact of oxytocin on vigor in the context of social and nonsocial reinforcement. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 127:116-128. [PMID: 29369669 DOI: 10.1037/abn0000320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Experiential negative symptoms-including diminished motivation-have a profound impact on functional outcomes in schizophrenia. Animal research suggests that abnormalities in dopaminergic regulation can negatively impact effort exertion, a translational model that has been applied to individuals with schizophrenia. Paradigms that assess effort-based decision making, for example, suggest less likelihood of choosing high effort tasks that are high in probability of success, and this preference varies with negative symptoms and impaired functioning. Although asociality is another well-documented component of experiential negative symptoms, it is unclear whether diminished motivation for monetary reward extends to the social domain. To test this question, the authors designed the Social Vigor Task (SVT)-a measure of effort exertion in the context of live social encouragement. They further examined the effect of oxytocin, a neuropeptide implicated in social behavior, on vigor. Forty-two individuals with schizophrenia and 43 healthy controls completed the SVT twice: once after intranasal administration of saline placebo and again after oxytocin. Both groups showed similar increases in vigor in response to social encouragement, suggesting effort in the social context is spared in schizophrenia. Group differences in the effect of social encouragement on vigor varied by point-based reward rate and trial length. Oxytocin did not increase vigor during social encouragement in either group. Within the schizophrenia group, clinician-rated passive social withdrawal, but not active social avoidance, was negatively associated with vigor. Results suggest that people with schizophrenia show normative levels of effort in the context of social encouragement; low approach motivation, however, relates to lower effort. (PsycINFO Database Record
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Affiliation(s)
- Daniel Fulford
- Departments of Occupational Therapy and Psychological & Brain Sciences, Boston University
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Bryce SD, Lee SJ, Ponsford JL, Lawrence RJ, Tan EJ, Rossell SL. The impact of intrinsic motivation on session attendance and reliable cognitive improvement in cognitive remediation in schizophrenia. Schizophr Res 2018; 202:354-360. [PMID: 29935884 DOI: 10.1016/j.schres.2018.06.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/09/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cognitive remediation (CR) is considered a potentially effective method of improving cognitive function in people with schizophrenia. Few studies, however, have explored the role of intrinsic motivation on treatment utilization or training outcomes in CR in this population. This study explored the impact of task-specific intrinsic motivation on attendance and reliable cognitive improvement in a controlled trial comparing CR with a computer game (CG) playing control. METHODS Forty-nine participants with schizophrenia or schizoaffective disorder, allocated to 10 weeks of group-based CR (n = 25) or CG control (n = 24), provided complete outcome data at baseline. Forty-three participants completed their assigned intervention. Cognition, psychopathology and intrinsic motivation were measured at baseline and end-treatment. Regression analyses explored the relative contribution of baseline motivation and other clinical factors to session attendance as well as the association of baseline and change in intrinsic motivation with the odds of reliable cognitive improvement (calculated using reliable change indices). RESULTS Baseline reports of perceived program value were the only significant multivariable predictor of session attendance when including global cognition and psychiatric symptomatology. The odds of reliable cognitive improvement significantly increased with greater improvements in program interest and value from baseline to end-treatment. Motivational changes over time were highly variable between participants. CONCLUSION Task-specific intrinsic motivation in schizophrenia may represent an important patient-related factor that contributes to session attendance and cognitive improvements in CR. Regular evaluation and enhancement of intrinsic motivation in cognitively enhancing interventions may optimize treatment engagement and the likelihood of meaningful training outcomes.
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Affiliation(s)
- S D Bryce
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia.
| | - S J Lee
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Department of Psychiatry, Alfred Health, Melbourne, VIC, Australia
| | - J L Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - R J Lawrence
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - E J Tan
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - S L Rossell
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
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Jalali F, Hashemi SF. The Effect of Saffron on Depression among Recovered Consumers of Methamphetamine Living with HIV/AIDS. Subst Use Misuse 2018. [PMID: 29543538 DOI: 10.1080/10826084.2018.1447583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND From one hand, depression is one of the symptoms that occur after abstinence from methamphetamine. On the other people living with HIV/AIDS are in isolation due to the nature of their illness and depression is one of the most common mental health problems they experience. OBJECTIVES This study was aimed at determining the effectiveness of saffron on reducing depression among recovered consumers of methamphetamine living with HIV/AIDS. METHODS The design of this study was semi-experimental with pre-test, post-test and control (placebo) groups. The statistical population consisted of all recovered consumers of methamphetamine living with HIV/AIDS who were referred to the Positive Club. Fifty-seven (57) recovered consumers of methamphetamine, living with HIV/AIDS, were selected by convenience sampling method. They were randomly assigned to an experimental (saffron) group and a control (placebo) group. The experimental group received 30 ml of saffron per day for 8 weeks, whereas the control (placebo) group received placebo the same way. BDI-II was used in this study as a measurement instrument. ANCOVA models were used for statistical inference. RESULTS The findings showed that saffron and its ingredients had been effective in reducing depression among this group (P < 0.05). CONCLUSION In fact, saffron with its active ingredients (Crusin and Saffranal) by serotonin and dopamine secretion in the brain, help in reducing depression among recovered consumers of methamphetamine living with HIV/AIDS.
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Affiliation(s)
- Farzad Jalali
- a Research Center , Negahe Mosbat Social Health Institute , Mashhad , Iran
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The Relationship of Motivation and Neurocognition with Functionality in Schizophrenia: A Meta-analytic Review. Community Ment Health J 2018; 54:1019-1049. [PMID: 29605875 DOI: 10.1007/s10597-018-0266-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/21/2018] [Indexed: 01/10/2023]
Abstract
The role that neurocognition plays in functionality in schizophrenia has been widely examined, although in recent years increasing attention has been paid to the influence of motivation instead. This study provides a review of the relationship of neurocognition and motivation with functionality in schizophrenia, taking into account objective/subjective functionality assessment, demographic variables, and the different terms used when referring to motivation. A search of electronic databases identified 34 studies that met the inclusion criteria for review. Correlation coefficients between motivation and functionality and between neurocognition and functionality were extracted. For a better understanding, potential moderator variables were also extracted. Meta-analysis showed that both motivation and neurocognition assessments were strongly associated with functioning, with correlations between motivation and functional outcomes being stronger. However, more than three-quarters of the variance in outcome remained unexplained by the moderating factors examined. The paper concludes with recommendations for clinical practice and future research.
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Siddiqui I, Remington G, Fervaha G, Fletcher PJ, Voineskos AN, Saperia S, Zakzanis KK, Foussias G. Objective investigation of activity preference in schizophrenia: A pilot study. Psychiatry Res 2018; 267:551-559. [PMID: 29980136 DOI: 10.1016/j.psychres.2018.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/23/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
Amotivation and reduced goal-directed activity engagement are prominent features of schizophrenia. Previous investigations of patients' activities have relied on accounts of daily living activities, rather than objective measures. This study used wireless motion capture to objectively evaluate activity preference when individuals are provided an explicit choice between an active versus passive engagement option. Twenty outpatients with schizophrenia and twenty matched healthy controls completed the Activity Preference Task, in which participants play a motion-based game (active) or watch a film (passive), and were administered clinical and cognitive assessments. Schizophrenia participants' duration, intensity, and persistence of active engagement were associated with apathy and community functioning. No group differences emerged from comparisons of task measures; however, exploratory cluster analysis identified a distinct subgroup of schizophrenia patients with reduced engagement and increased apathy compared to other patients and controls. The Task provides a means of quantifying activity engagement, which may be particularly valuable given the lack of objective measures for intrinsically motivated behaviours. Our initial findings suggest that schizophrenia patients as a group are equally inclined as healthy individuals towards actively engaging activities when presented an explicit choice, but such provision may be insufficient for initiation and maintenance of functional behaviours among amotivated patients.
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Affiliation(s)
- Ishraq Siddiqui
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada..
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Paul J Fletcher
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada; Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychology, University of Toronto, Sidney Smith Hall, 100 St. George St., Toronto, Ontario M5S 3G3, Canada
| | - Aristotle N Voineskos
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Sarah Saperia
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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Shimada T, Ohori M, Inagaki Y, Shimooka Y, Sugimura N, Ishihara I, Yoshida T, Kobayashi M. A multicenter, randomized controlled trial of individualized occupational therapy for patients with schizophrenia in Japan. PLoS One 2018; 13:e0193869. [PMID: 29621261 PMCID: PMC5886394 DOI: 10.1371/journal.pone.0193869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
The individualized occupational therapy (IOT) program is a psychosocial program that we developed to facilitate proactive participation in treatment and improve cognitive functioning and other outcomes for inpatients with acute schizophrenia. The program consists of motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. This multicenter, open-labeled, blinded-endpoint, randomized controlled trial evaluated the impact of adding IOT to a group OT (GOT) program as usual for outcomes in recently hospitalized patients with schizophrenia in Japanese psychiatric hospitals setting compared with GOT alone. Patients with schizophrenia were randomly assigned to the GOT+IOT group or the GOT alone group. Among 136 randomized patients, 129 were included in the intent-to-treat population: 66 in the GOT+IOT and 63 in the GOT alone groups. Outcomes were administered at baseline and discharge or 3 months following hospitalization including the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J), the Schizophrenia Cognition Rating Scale Japanese version, the Social Functioning Scale Japanese version, the Global Assessment of Functioning scale, the Intrinsic Motivation Inventory Japanese version (IMI-J), the Morisky Medication Adherence Scale-8 (MMAS-8), the Positive and Negative Syndrome Scale (PANSS), and the Japanese version of Client Satisfaction Questionnaire-8 (CSQ-8J). Results of linear mixed effects models indicated that the IOT+GOT showed significant improvements in verbal memory (p <0.01), working memory (p = 0.02), verbal fluency (p < 0.01), attention (p < 0.01), and composite score (p < 0.01) on the BACS-J; interest/enjoyment (p < 0.01), value/usefulness (p < 0.01), perceived choice (p < 0.01), and IMI-J total (p < 0.01) on the IMI-J; MMAS-8 score (p < 0.01) compared with the GOT alone. Patients in the GOT+IOT demonstrated significant improvements on the CSQ-8J compared with the GOT alone (p < 0.01). The present findings provide support for the feasibility in implementing an IOT program and its effectiveness for improving cognitive impairment and other outcomes in patients with schizophrenia.
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Affiliation(s)
- Takeshi Shimada
- Department of Occupational Therapy, Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
| | - Manami Ohori
- Department of Occupational Therapy, North Alps Medical Center, Azumi Hospital, Nagano, Japan
| | - Yusuke Inagaki
- Department of Occupational Therapy, Nagano Prefectural Mental Wellness Center Komagane, Nagano, Japan
| | - Yuko Shimooka
- Department of Occupational Therapy, Social Medical Corporation Ritsuzankai, Iida Hospital, Nagano, Japan
| | - Naoya Sugimura
- Department of Occupational Therapy, Medical Corporation Akitsukai, Nanshin Hospital, Nagano, Japan
| | - Ikuyo Ishihara
- Department of Occupational Therapy, Medical Corporation Aiseikai, Matsuoka Hospital, Nagano, Japan
| | - Tomotaka Yoshida
- Department of Occupational Therapy, Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
- * E-mail:
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Katsumi A, Hoshino H, Fujimoto S, Yabe H, Ikebuchi E, Nakagome K, Niwa SI. Effects of cognitive remediation on cognitive and social functions in individuals with schizophrenia. Neuropsychol Rehabil 2017; 29:1475-1487. [PMID: 29212415 DOI: 10.1080/09602011.2017.1409639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Individuals with schizophrenia exhibit cognitive impairments, which are related to impairments in social functions. This study investigated the effects of cognitive remediation on cognitive, social, and daily living impairment. Participants were individuals with schizophrenia between 20 and 60 years old (N = 44). Participants were randomly assigned to two groups: a cognitive remediation intervention group and a non-intervention control group. The control group was provided with conventional drug therapy and either day care or occupational therapy. The intervention group was provided with the "neuropsychological educational approach to cognitive remediation" developed by Medalia and co-workers. We assessed cognitive functions using the brief assessment of cognition in schizophrenia (BACS), and evaluated social and daily living functions using the global assessment of functioning (GAF) scale. Significant group by time interaction effects indicated that verbal memory, working memory, attention, and executive function showed significantly greater improvement at post-intervention for the intervention group than the control group. Social and daily living function also improved in the intervention group and improvements were maintained one year after intervention. These preliminary findings indicate that the combination of cognitive remediation and psychiatric rehabilitation is effective for facilitating improvements in cognitive function and social and daily living functions in individuals with schizophrenia.
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Affiliation(s)
- Akihiko Katsumi
- Katsumi Clinic , Niigata , Japan.,Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Hiroshi Hoshino
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Satoshi Fujimoto
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Emi Ikebuchi
- Department of Psychiatry, Teikyo University School of Medicine , Tokyo , Japan
| | - Kazuyuki Nakagome
- National Center Hospital, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Shin-Ichi Niwa
- Department of Psychiatry, Aizu Medical Center, Fukushima Medical University , Aizuwakamatsu , Japan
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Lincoln TM, Riehle M, Pillny M, Helbig-Lang S, Fladung AK, Hartmann-Riemer M, Kaiser S. Using Functional Analysis as a Framework to Guide Individualized Treatment for Negative Symptoms. Front Psychol 2017; 8:2108. [PMID: 29259567 PMCID: PMC5723417 DOI: 10.3389/fpsyg.2017.02108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/17/2017] [Indexed: 12/19/2022] Open
Abstract
Although numerous interventions are available for negative symptoms, outcomes have been unsatisfactory with pharmacological and psychological interventions producing changes of only limited clinical significance. Here, we argue that because negative symptoms occur as a complex syndrome caused and maintained by numerous factors that vary between individuals they are unlikely to be treated effectively by the present "one size fits all" approaches. Instead, a well-founded selection of those interventions relevant to each individual is needed to optimize both the efficiency and the efficacy of existing approaches. The concept of functional analysis (FA) can be used to structure existing knowledge so that it can guide individualized treatment planning. FA is based on stimulus-response learning mechanisms taking into account the characteristics of the organism that contribute to the responses, their consequences and the contingency with which consequences are tied to the response. FA can thus be flexibly applied to the level of individual patients to understand the factors causing and maintaining negative symptoms and derive suitable interventions. In this article we will briefly introduce the concept of FA and demonstrate-exemplarily-how known psychological and biological correlates of negative symptoms can be incorporated into its framework. We then outline the framework's implications for individual assessment and treatment. Following the logic of FA, we argue that a detailed assessment is needed to identify the key factors causing or maintaining negative symptoms for each individual patient. Interventions can then be selected according to their likelihood of changing these key factors and need to take interactions between different factors into account. Supplementary case vignettes exemplify the usefulness of functional analysis for individual treatment planning. Finally, we discuss and point to avenues for future research guided by this model.
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Affiliation(s)
- Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Marcel Riehle
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Sylvia Helbig-Lang
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Anne-Katharina Fladung
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Matthias Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospital, Geneva, Switzerland
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Lee HS, Jang SK, Lee GY, Park SC, Medalia A, Choi KH. Informationally administered reward enhances intrinsic motivation in schizophrenia. Psychiatry Res 2017; 256:290-297. [PMID: 28662466 DOI: 10.1016/j.psychres.2017.06.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/26/2017] [Accepted: 06/14/2017] [Indexed: 01/09/2023]
Abstract
Even when individuals with schizophrenia have an intact ability to enjoy rewarding moments, the means to assist them to translate rewarding experiences into goal-directed behaviors is unclear. The present study sought to determine whether informationally administered rewards enhance intrinsic motivation to foster goal-directed behaviors in individuals with schizophrenia (SZ) and healthy controls (HCs). Eighty-four participants (SZ=43, HCs=41) were randomly assigned to conditions involving either a performance-contingent reward with an informationally administered reward or a task-contingent reward with no feedback. Participants were asked to play two cognitive games of equalized difficulty. Accuracy, self-reported intrinsic motivation, free-choice intrinsic motivation (i.e., game play during a free-choice observation period), and perceived competency were measured. Intrinsic motivation and perceived competency in the cognitive games were similar between the two participant groups. The informationally administered reward significantly enhanced self-reported intrinsic motivation and perceived competency in both the groups. The likelihood that individuals with schizophrenia would play the game during the free-choice observation period was four times greater in the informationally administered reward condition than that in the no-feedback condition. Our findings suggest that, in the context of cognitive remediation, individuals with schizophrenia would benefit from informationally administered rewards.
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Affiliation(s)
- Hyeon-Seung Lee
- Department of Psychology, Korea University, Liberal Arts Building, Sungbuk-Ku, Anam-Dong, Seoul 136-701, Republic of Korea
| | - Seon-Kyeong Jang
- Department of Psychology, Korea University, Liberal Arts Building, Sungbuk-Ku, Anam-Dong, Seoul 136-701, Republic of Korea
| | - Ga-Young Lee
- Department of Psychology, Korea University, Liberal Arts Building, Sungbuk-Ku, Anam-Dong, Seoul 136-701, Republic of Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, South Korea
| | - Alice Medalia
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Liberal Arts Building, Sungbuk-Ku, Anam-Dong, Seoul 136-701, Republic of Korea.
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Biagianti B, Fisher M, Howard L, Rowlands A, Vinogradov S, Woolley J. Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets. SCHIZOPHRENIA RESEARCH-COGNITION 2017; 10:7-14. [PMID: 28824850 PMCID: PMC5544490 DOI: 10.1016/j.scog.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 01/13/2023]
Abstract
Background Limited access to Cognitive Training (CT) for people with schizophrenia (SZ) prevents widespread adoption of this intervention. Delivering CT remotely via tablets may increase accessibility, improve scheduling flexibility, and diminish patient burden. Methods In this reanalysis of data from a larger trial of CT, we compared two samples of individuals with SZ who chose to complete 40 h of CT either on desktop computers in the laboratory (N = 33) or remotely via iPads (N = 41). We examined attrition rates and adherence to training, and investigated whether remote iPad-based CT and in-person desktop-based CT induced significantly different improvements in cognitive and real-world functioning. Results The attrition rate was 36.6%. On average, participants completed 3.06 h of CT per week. There were no significant between-group differences in attrition and adherence to CT requirements. Participants who completed iPad-based CT were significantly younger and had lower symptoms at baseline compared to participants who completed CT on the lab desktops. Controlling for age and symptom severity, rANCOVA showed that iPad-based and desktop-based CT similarly and significantly improved verbal learning and problem solving. Main effects of time, at trend level significance, were evident in global cognition, verbal memory, quality of life, and social functioning. All group by time interactions were non-significant except for verbal memory, where iPad users showed greater gains. Within-group effect sizes for changes in outcomes were in the small range. Conclusion Although underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychiatry, University of California, San Francisco, USA.,Posit Science, Inc., USA
| | | | - Lisa Howard
- Department of Psychiatry, University of California, San Francisco, USA
| | - Abby Rowlands
- Department of Psychiatry, University of California, San Francisco, USA
| | | | - Joshua Woolley
- Department of Psychiatry, University of California, San Francisco, USA
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