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Khan A, Lindenmayer JP, Insel B, Seddo M, Demirli E, DeFazio K, Sullivan M, Hoptman MJ, Ahmed AO. Computerized cognitive and social cognition training in schizophrenia for impulsive aggression. Schizophr Res 2023; 256:117-125. [PMID: 36424289 PMCID: PMC11046975 DOI: 10.1016/j.schres.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/22/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Schizophrenia is associated with an elevated risk for impulsive aggression for which there are few psychosocial treatment options. Neurocognitive and social cognitive deficits have been associated with aggression with social cognitive deficits seemingly a more proximal contributor. The current study examined the effects of combining cognitive and social cognition treatment on impulsive aggression among inpatients with chronic schizophrenia and schizoaffective disorder and a history of aggression compared to cognitive remediation treatment alone. METHODS The two-center study randomized 130 participants to receive 36 sessions of either a combination of cognitive remediation and social cognition treatment or cognitive remediation plus a computer-based control. Participants had at least one aggressive incident within the past year or a Life History of Aggression (LHA) score of 5 or more. Participants completed measures of neurocognition, social cognition, symptom severity, and aggression at baseline and endpoint. RESULTS Study participants were mostly male (84.5 %), had a mean age 34.9 years, and 11.5 years of education. Both Cognitive Remediation Training (CRT) plus Social Cognition Training (SCT) and CRT plus control groups were associated with significant reductions in aggression measures with no group differences except on a block of the Taylor Aggression Paradigm (TAP), a behavioral task of aggression which favored the CRT plus SCT group. Both groups showed significant improvements in neurocognition and social cognition measures with CRT plus SCT being associated with greater improvements. CONCLUSION CRT proved to be an effective non-pharmacological treatment in reducing impulsive aggression in schizophrenia inpatient participants with a history of aggressive episodes. The addition of social cognitive training did not enhance this anti-aggression treatment effect but did augment the CRT effect on cognitive functions, on emotion recognition and on mentalizing capacity of our participants.
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Affiliation(s)
- Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; Manhattan Psychiatric Center, 1 Wards Island Complex, Wards Island, NY 10035, USA.
| | - Jean-Pierre Lindenmayer
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; Manhattan Psychiatric Center, 1 Wards Island Complex, Wards Island, NY 10035, USA; New York University School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Beverly Insel
- Mount Sinai Medical Center, 5 East 98th Street, New York, NY 10029, USA
| | - Mary Seddo
- Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA
| | - Ecem Demirli
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Kayla DeFazio
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Mark Sullivan
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Matthew J Hoptman
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; New York University School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Anthony O Ahmed
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
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Fendrich SJ, Koralnik LR, Bonner M, Goetz D, Joe P, Lee J, Mueller B, Robinson-Papp J, Gonen O, Clemente JC, Malaspina D. Patient-reported exposures and outcomes link the gut-brain axis and inflammatory pathways to specific symptoms of severe mental illness. Psychiatry Res 2022; 312:114526. [PMID: 35462090 DOI: 10.1016/j.psychres.2022.114526] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 02/08/2023]
Abstract
UNLABELLED We developed a "gut-brain-axis questionnaire" (GBAQ) to obtain standardized person-specific "review of systems" data for microbiome-gut-brain-axis studies. Individual items were compared to PANSS symptom measures using dimensional, transdiagnostic and traditional categorical approaches. METHOD Forty psychotic participants, independent of diagnoses, and 42 without psychosis (18 nonpsychotic affective disorders, 24 healthy controls) completed the GBAQ and underwent research diagnostic and symptom assessments. The PANSS scales and its dysphoric mood, autistic preoccupation and activation factors were computed. RESULTS Transdiagnostic analyses robustly linked psychosis severity to constipation (p<.001), and Negative (p=.045) and General Psychopathology scores (p=.016) with bowel hypomotility. Activation factor scores predicted numbers of psychiatric (p=.009) and medical conditions (p=.003), BMI (p=.003), skin (p<.001) and other conditions. Categorical analyses comparing psychotic, nonpsychotic and control groups revealed behavioral differences: cigarette smoking (p=.013), alcohol use (p=.007), diet (p's <.05), exercise (p<.001). All subjects accurately self-reported their diagnosis. CONCLUSIONS The GBAQ is a promising tool. Transdiagnostic analyses associated psychotic symptoms to gut hypomotility, indicative of low gut vagal tone, consistent with reduced cardiovagal activity in psychosis. Activation, similar to delirium symptoms, predicted medical comorbidity and systemic inflammatory conditions. Group level comparisons only showed behavioral differences. Underpinnings of psychiatric disorders may include reduced gut vagal function, producing psychosis, and systemic inflammation, impacting risks for psychotic and nonpsychotic conditions.
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Affiliation(s)
- Sarah J Fendrich
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lauren R Koralnik
- Department of Psychology, Barnard College of Columbia University, New York, New York, USA
| | - Mharisi Bonner
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deborah Goetz
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Joe
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jakleen Lee
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bridget Mueller
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica Robinson-Papp
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Oded Gonen
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dolores Malaspina
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Lavaud P, McMahon K, Sánchez Rico M, Hanon C, Alvarado JM, de Raykeer RP, Limosin F, Hoertel N. Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study. Psychiatry Res 2022; 308:114339. [PMID: 34963089 DOI: 10.1016/j.psychres.2021.114339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts. METHOD We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353). RESULTS The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]). DISCUSSION Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.
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Affiliation(s)
- Pierre Lavaud
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France.
| | - Kibby McMahon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27710, United States
| | - Marina Sánchez Rico
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Cécile Hanon
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, 28223 Pozuelo de Alarcon, Spain
| | - Rachel Pascal de Raykeer
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; Paris University, Paris, France
| | - Frédéric Limosin
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
| | - Nicolas Hoertel
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
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Yang M, Li Q, Deng C, Yao G, Bai X, Tan X, Zhang X. Prevalence and Clinical Correlation of Decayed, Missing, and Filled Teeth in Elderly Inpatients With Schizophrenia. Front Psychiatry 2021; 12:728971. [PMID: 34594252 PMCID: PMC8476810 DOI: 10.3389/fpsyt.2021.728971] [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: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Schizophrenia is a mental disease with a profound impact on human health. Patients with schizophrenia have poor oral hygiene, increasing their risk of systemic diseases, such as respiratory infections, and declining their quality of life. Therefore, this study aims to assess the oral health status of inpatients with schizophrenia, analyze its related factors, and thus provide scientific evidence for further exploration of corresponding control strategies. Methods: A total of 425 inpatients older than 50 years with a diagnosis of schizophrenia from two psychiatric hospitals (mean age 58.49 ± 5.72 years) were enrolled. The demographic data of the patients were checked on admission. Two independent dentists examined caries, missing teeth, and fillings. Mini-Mental State Examination (MMSE) and Global Deterioration Scale were performed as cognitive tests. Positive and Negative Syndrome Scale and Repeatable Battery for the Assessment of Neuropsychological Status rating scale were used to determine their mental status. Results: The average decayed, missing, and filled teeth index was 12.99 ± 8.86. Linear regression analysis showed that the decayed, missing, and filled teeth index had a significantly positive relationship with age (p < 0.001) and smoking (p < 0.001) and a negative relationship with MMSE (p = 0.029). The missing teeth index had a positive relationship with age (p < 0.001), smoking (p < 0.001), and Global Deterioration Scale (p = 0.014) and a negative relationship with MMSE (p = 0.004). Conclusion: The oral health of elderly patients with schizophrenia is poor, which may be related to the cognitive level of patients and affect their quality of life. The focus should be provided to the oral care of patients with schizophrenia, and investment in their specialized oral treatment should be increased.
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Affiliation(s)
- Mi Yang
- The Fourth People's Hospital of Chengdu, Chengdu, China.,MOE Key Laboratory for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiwen Li
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Chijun Deng
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan, University of Electronic Science and Technology of China, Chengdu, China
| | - Gang Yao
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xue Bai
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xi Tan
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Reynolds G, Portillo C, Serper MR. Predictors of residency status in chronically institutionalized and community dwelling schizophrenia patients. Compr Psychiatry 2018; 86:102-106. [PMID: 30096538 DOI: 10.1016/j.comppsych.2018.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/20/2018] [Accepted: 07/28/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This cross-sectional study contrasted chronically hospitalized schizophrenia (SZ) spectrum disorder inpatients to SZ community dwelling patients on measures of psychopathology, social competence, neuropsychological performance and real-world functioning in order to discern factors predictive of patients' residency status and to characterize the contrasting ends of the SZ outcome continuum. METHOD Subjects included 26 chronic SZ patients hospitalized continuously on average for 12.8 years, and 26 SZ patients with a history of at least 18 months tenure in community placement. RESULTS A series of multivariate analyses revealed both chronically hospitalized and community dwelling patients were similar in terms of their real world functioning abilities such as work skills, interpersonal skills, self-care skills and community engagement. Chronic SZ inpatients' manifested more severe functional competency and neurocognitive deficits relative to outpatients. Additionally, chronic inpatients were discriminated from community dwelling outpatients by their symptom severity and commitment of more socially undesirable/antisocial type behaviors. CONCLUSIONS Factors associated with chronic institutionalization are, in part, related to commission of antisocial type behaviors, as well as poor social and neurocognitive competences, and total symptom severity rather than deficits in everyday functional abilities.
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Affiliation(s)
- Graham Reynolds
- Department of Psychology, Hofstra University, Hempstead, NY, United States of America
| | - Cecily Portillo
- Department of Psychology, Hofstra University, Hempstead, NY, United States of America
| | - Mark R Serper
- Department of Psychology, Hofstra University, Hempstead, NY, United States of America; Department of Psychiatry, Ichan Mount Sinai School of Medicine, New York, NY, United States of America.
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The causal model of insight in schizophrenia based on the Positive and Negative Syndrome Scale factors and the structural equation modeling. J Nerv Ment Dis 2009; 197:79-84. [PMID: 19214041 DOI: 10.1097/nmd.0b013e318196083e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We used structural equation modeling to formulate a causal model of insight in schizophrenia patients that explains the inconsistent results of the studies on the relationship between insight and psychopathology. The Positive and Negative Syndrome Scale was used to assess 342 patients with acute stage schizophrenia and 5 factors were identified through factor analysis with which a causal model of insight was constructed. Our model, where positive, negative, and autistic preoccupation (cognitive) factors were the primary predictors of insight with the activation factor mediating between positive and autistic preoccupation factors and insight, was found to show a perfect fit by most goodness-of-fit indices and to be superior to other alternative models. Specifically, positive, negative, and autistic preoccupation factors each had some predictive power for insight and the activation factor played a partial mediating role for the positive factor and a moderating role for the autistic preoccupation factor.
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Evaluation of the use of the positive and negative syndrome scale-excited component as a criterion for administration of p.r.n. medication. J Psychiatr Pract 2008; 14:105-13. [PMID: 18360196 DOI: 10.1097/01.pra.0000314317.79544.b4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluates the use of the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) to evaluate control of agitation and aggression in inpatients with schizophrenia as a criterion for administration of p.r.n. (as needed) medication. METHODS Information was collected retrospectively from clinical records of patients diagnosed with schizophrenia who were admitted to Nakhonsawan Rajanakarindra Psychiatric Hospital, Nakhonsawan, Thailand 1) prior to the adoption of the PANSS-EC, when the decision to administer p.r.n. medication for agitation was based solely on individual judgment, and 2) during the period when the PANSS-EC was used during the first 3 days of admission and its scores were considered as one factor in the decision to administer p.r.n. medication. RESULTS The 35 patients in the group who did not receive PANSSEC assessment and the 41 patients in the group who were assessed with the PANSS-EC showed no statistically significant difference in mean number of doses of p.r.n. medication administered for agitation. However, 55.4% of all p.r.n. doses administered in the group assessed with the PANSS-EC were given during the first 3-day period (when the PANSS-EC was used), compared with 37.0% of the p.r.n. doses being administered during the first 3 days in the group not assessed with the PANSS-EC (p = 0.054). The mean number of episodes of aggression during the period of hospitalization was significantly lower in the group assessed with the PANSS-EC (p = 0.021). CONCLUSIONS Including the score on the PANSS-EC in the criteria used to decide whether to administer p.r.n. psychotropic medication to agitated patients with schizophrenia had an impact on staff decision-making and resulted in a more favorable clinical outcome. Further investigation is warranted to test these findings.
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Abstract
In spite of significant advances in treatment of patients with schizophrenia and continued efforts towards their deinstitutionalization, a considerable group of patients remain chronically hospitalized or otherwise dependent on others for basic necessities of life. It has been proposed that these patients belong to a distinct etiopathological subgroup, termed Kraepelinian, whose course of illness may be progressive and resistant to treatment. Indeed, longitudinal studies appear to show that elderly Kraepelinian patients follow a course of rapid cognitive and functional deterioration, commensurate with a dementing process, and that their poor functional status is closely correlated with the cognitive deterioration. Recent neuroimaging studies described a pattern of posteriorization of grey and white matter deficits with poor outcome in schizophrenia, and produced a constellation of findings implicating primary processing of visual and auditory information as central to the impaired functional status in this patient group. These studies are summarized in detail in this review and future directions for neuroimaging assessment of very poor outcome patients with schizophrenia are suggested.
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Affiliation(s)
- Serge A Mitelman
- Medical Center, Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
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Godbout L, Limoges F, Allard I, Braun CMJ, Stip E. Neuropsychological and activity of daily living script performance in patients with positive or negative schizophrenia. Compr Psychiatry 2007; 48:293-302. [PMID: 17445526 DOI: 10.1016/j.comppsych.2007.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 12/18/2006] [Accepted: 01/22/2007] [Indexed: 11/20/2022] Open
Abstract
Cognitive and psychiatric determinants of impairment of complex activities of daily living (ADLs) were investigated in 33 schizophrenic patients and 16 normal comparison subjects. The schizophrenic patients were cognitively impaired and were deficient in the ADL. However, the impairment of ADL could not be explained specifically by impairment of higher-order executive function or by negative symptoms: memory functions were more related to impairment of ADL and positive symptoms as much as the negative ones. Positive symptoms were significantly related to commissive errors in the ADL, whereas negative symptoms were nonsignificantly related to omissive errors. Negative symptoms were significantly more related to memory impairment than to impairment on measures of higher-order executive function (working memory). This investigation demonstrates that an ecologically oriented approach to test development and measurement of ADL is fruitful in understanding schizophrenia-especially if it is constrained by cognitive constructs compatible with the phenomenology of the disease.
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Affiliation(s)
- Lucie Godbout
- Département de Psychologie, Université du Québec à Trois-Rivières, Québec, Canada G4A 5H7
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2005; 20:600-7. [PMID: 15997511 DOI: 10.1002/gps.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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