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Thibaudeau E, Peyroux E, Franck N, Carling H, Lepage M. Navigating Social Cognitive Impairments in Schizophrenia Spectrum Disorders: Protocol for a Pilot Pre-Post Quasi-Experimental Study for Remote Avatar-Assisted Cognitive Remediation Therapy. JMIR Res Protoc 2024; 13:e54251. [PMID: 38477975 DOI: 10.2196/54251] [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: 11/02/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Social cognitive impairments are prevalent in schizophrenia spectrum disorder (SSD) and have detrimental effects on functioning. Cognitive remediation (CR) has shown its efficacy in improving social cognitive impairments, although the transfer of these skills to daily life and the personalization of these interventions remain challenging. RC2S (Remédiation Cognitive de la Cognition Sociale dans la Schizophrénie; Cognitive remediation of social cognition in Schizophrenia) is a French CR that combines the learning of strategies and practice using paper-and-pencil exercises and digital relational simulations. This French program was designed as an in-person intervention. OBJECTIVE This project aims to culturally adapt the RC2S program, in French-Canadian and North American English and to assess the feasibility, acceptability, safety, and implementation of a remote version in people with SSD. An exploratory objective is to assess the preliminary effect of remote RC2S on goal attainment, social cognition, and psychosocial outcomes. METHODS We will use a pre-post quasi-experimental design. First, the translation and cultural adaptation in North American English and French-Canadian of RC2S is presented. Then, 20 participants aged ≥18 years with a diagnosis of SSD, presenting with a subjective or an objective impairment in social cognition, will be included to receive RC2S. In addition, 5 therapists will be included as research participants to assess their perspective on RC2S. Participants with SSD will undergo a baseline remote assessment of their social cognition, clinical symptoms, and functioning. They will then start remote RC2S for 24 biweekly individual 1-hour sessions with a therapist. Following the case formulation and goal setting, participants will complete personalized paper-and-pencil exercises to develop strategies and integrative digital relational simulations, during which they will help an avatar navigate through a variety of social contexts and relationships. The last 2 sessions are dedicated to the transfer to daily life. All participants will complete in-session questionnaires assessing therapeutic alliance, motivation, acceptability, feasibility, and implementation. Following RC2S, the participants with SSD will repeat the same assessment as the baseline. Descriptive statistics will be used to summarize the data about acceptability, feasibility, safety, and implementation. To assess the preliminary effect of RC2S, an intention-to-treat approach will be used with linear mixed models for repeated measures with fixed effects of time. RESULTS So far, 45% (9/20) of participants with SSD (mean age 37.9, SD 9.3 years) have completed the project. They received a mean of 20.5 out of 24 (SD 3.5) sessions of RC2S. A total of 5 therapists also completed the project. CONCLUSIONS Improving social cognitive impairments is an important target in SSD to promote functional recovery. Using digital technologies to address these impairments and deliver the intervention is a promising approach to increase the ecological validity of CR and access to the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05017532; https://classic.clinicaltrials.gov/ct2/show/NCT05017532. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54251.
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Affiliation(s)
- Elisabeth Thibaudeau
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Center, Montreal, QC, Canada
| | | | - Nicolas Franck
- Centre Hospitalier Le Vinatier, Lyon, France
- Université Claude-Bernard-Lyon-I, Lyon, France
| | - Hannah Carling
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Center, Montreal, QC, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Center, Montreal, QC, Canada
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Battini V, Cirnigliaro G, Leuzzi R, Rissotto E, Mosini G, Benatti B, Pozzi M, Nobile M, Radice S, Carnovale C, Dell’Osso B, Clementi E. The potential effect of metformin on cognitive and other symptom dimensions in patients with schizophrenia and antipsychotic-induced weight gain: a systematic review, meta-analysis, and meta-regression. Front Psychiatry 2023; 14:1215807. [PMID: 37502816 PMCID: PMC10370497 DOI: 10.3389/fpsyt.2023.1215807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Metformin has shown good efficacy in the management of antipsychotic-induced metabolic syndrome (MetS) in patients with schizophrenia or schizoaffective disorders. Its ability to induce antidepressant behavioural effects and improve cognitive functions has also been investigated: yet information has not been systematized. The aim of this study was therefore to investigate the effects of metformin on cognitive and other symptom dimension in schizophrenic patients treated with antipsychotics through a systematic review and meta-analysis. Methods We searched PubMed, ClinicalTrials.Gov, Embase, PsycINFO, and WHO ICTRP database up to February 2022, Randomised Controlled Trials (RCT) evaluating patients diagnosed with schizophrenia and related disorders, who were treated with metformin as add-on therapy to antipsychotics for the treatment of weight gain and in which changes in psychiatric symptoms and cognitive functions were evaluated. Results A total of 19 RCTs met the inclusion criteria. Meta-analysis was performed on 12 eligible studies. We found a positive trend after 24 weeks of treatment in schizophrenic patients with stable conditions [SMD (95%CI) = -0.40 (-0.82;0.01), OR (95%CI) = 0.5 (-2.4;3.4)]. Better performance was detected in the Brief Assessment of Cognition in Schizophrenia and Positive and Negative Syndrome Scale (PANSS) with low heterogeneity among studies. One study reported changes in BACS-verbal memory subdomain in favour of placebo [MD (95%CI) = -16.03 (-23.65;8.42)]. Gastrointestinal disorders, xerostomia, and extrapyramidal syndrome were the most reported adverse effects. Psychiatric adverse events were also described: in particular, symptoms attributable to a relapse of schizophrenia. Conclusion Some degree of efficacy was found for Metformin in improving cognitive and other symptom dimensions in patients with Schizophrenia. Given the clinical relevance of this potential pharmacological effect, longer specific studies using adequate psychometric scales are strongly recommended. Likewise, how metformin acts in this context needs to be evaluated in order to enhance its efficacy or find more efficacious drugs.
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Affiliation(s)
- Vera Battini
- Department of Biomedical and Clinical Sciences, Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences, Psychiatry Unit 2, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Rodolfo Leuzzi
- Department of Biomedical and Clinical Sciences, Psychiatry Unit 2, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Eleonora Rissotto
- Department of Biomedical and Clinical Sciences, Psychiatry Unit 2, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Giulia Mosini
- Department of Biomedical and Clinical Sciences, Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences, Psychiatry Unit 2, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
- CRC “Aldo Ravelli” for Neurotechnology & Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Maria Nobile
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Sonia Radice
- Department of Biomedical and Clinical Sciences, Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Carla Carnovale
- Department of Biomedical and Clinical Sciences, Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences, Psychiatry Unit 2, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
- CRC “Aldo Ravelli” for Neurotechnology & Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, United States
- Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, Università degli Studi di Milano, Milan, Italy
| | - Emilio Clementi
- Department of Biomedical and Clinical Sciences, Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
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Bahri J, Abbes ZS, Ben Yahia H, Halayem S, Jelili S, Hajri M, Amado I, Medalia A, Bouden A. Toward an integrative socio-cognitive approach in autism spectrum disorder: NEAR method adaptation-study protocol. Front Psychiatry 2023; 14:940066. [PMID: 37293399 PMCID: PMC10244578 DOI: 10.3389/fpsyt.2023.940066] [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: 05/09/2022] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
BackgroundThe cognitive impairments exhibited by people with ASD, threaten the development of social skills that are essential for establishing and maintaining harmonious social relationships. Cognitive remediation and social skills training are now considered as crucial therapeutic approaches in the management of these disorders. Several programs have already been validated and have shown improvements in social skills or cognitive performance. However, the effects of these training methods seem to be difficult to generalize to other everyday life. The aim of our study is to alleviate cognitive and social deficiencies by using a socio-cognitive framework to adapt the Neuropsychological Educational Approach to Remediation (NEAR) method for adolescents with ASD.Methods/designAdolescents meeting the DSM-5 criteria for ASD, older than 13 years, and following a regular school curriculum will be recruited from clinical population at the Child and Adolescent Psychiatry in Razi University Hospital-Manouba- Tunisia. Our study is an open and non-randomized controlled trial including 30 patients: NEAR group / control group. The NEAR method combines computerized cognitive exercises and bridging groups inspired from cognitive behavioral therapy. NEAR group will be divided into three groups of five patients each. The duration of the sessions will vary according to the capacities of the participants and the exchanges between them (about 60–120 min). In our study, bridging groups will be amended by adding other tasks including planning role plays and scenarios of problematic social situations in autism, taking into account cultural particularities in order to promote social skills. Computerized exercises will be enriched by adding other tasks aiming to improve the recognition and expression of facial emotions by using digital videos and photographs expressing the six basic emotions. The duration of the program will be about 6 months. All selected patients will have an assessment of cognitive function: social cognition, neurocognition and pragmatic skills, social skills, self-esteem and global functioning at baseline, 1 week after the end of the NEAR program and 6 months later.ConclusionThis adaptive program is a promising socio-cognitive intervention that create new perspectives for adolescents with autism spectrum disorder.
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Affiliation(s)
- Jihene Bahri
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Zeineb S. Abbes
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Houda Ben Yahia
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
| | - Soumeyya Halayem
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Selima Jelili
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Melek Hajri
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Isabelle Amado
- CH Sainte-Anne, C3RP & Services de Psychiatrie d'adultes HU & 75G17, Paris, France
| | - Alice Medalia
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Asma Bouden
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Quiles C, Verdoux H. Benefits of video games for people with schizophrenia: a literature review. Curr Opin Psychiatry 2023; 36:184-193. [PMID: 36939366 DOI: 10.1097/yco.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE OF REVIEW In spite of the overwhelming concerns about the deleterious impact of exposure to video games, a growing body of evidence suggests that it may be of potential interest for therapeutic purposes, particularly in schizophrenia. As literature is rapidly evolving, we carried out a systematic review of recent articles on this issue. RECENT FINDINGS We identified seven studies published from 2017 to 2022 exploring the benefits of commercial video games in people with schizophrenia and related disorders regarding symptoms, cognition and functional outcome. Six studies used an RCT design. Associations between gaming and better outcomes were found in three main areas: physical condition (walking speed, aerobic fitness), neurocognition (processing speed, memory and executive functions), and social functioning, self-efficacy in daily life activities and quality of life. SUMMARY Active use of video games is associated with better aerobic fitness and cognitive performances. Video gaming may contribute to better functional outcome and quality of life in patients suffering from cognitive impairments and difficulties in social functioning. Persons with schizophrenia may benefit from using commercial video games because of their potential therapeutic impact on functioning and cognition.
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Affiliation(s)
- Clélia Quiles
- Charles Perrens Hospital Center
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | - Hélène Verdoux
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France
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Nijman SA, Pijnenborg GHM, Vermeer RR, Zandee CER, Zandstra DC, van der Vorm D, de Wit-de Visser AC, Meins IA, Geraets CNW, Veling W. Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) versus Virtual Reality Relaxation (VRelax) for People With a Psychotic Disorder: A Single-Blind Multicenter Randomized Controlled Trial. Schizophr Bull 2023; 49:518-530. [PMID: 36413388 PMCID: PMC10016415 DOI: 10.1093/schbul/sbac166] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND HYPOTHESIS Social cognition training (SCT), an intervention for social cognition and social functioning, might be improved by using virtual reality (VR), because VR may offer better opportunities to practice in a potentially more realistic environment. To date, no controlled studies have investigated VR-SCT. This study investigated a VR-SCT, "DiSCoVR". We hypothesized that DiSCoVR would improve social cognition and social functioning. STUDY DESIGN Participants were randomized to DiSCoVR (n = 41) or VR relaxation ('VRelax', n = 40), an active control condition, and completed 16 twice-weekly sessions. Three assessments (baseline, posttreatment, and 3-month follow-up) were performed by blinded assessors. The primary outcome was social cognition (emotion perception and theory of mind). Secondary outcomes included social functioning (measured with an interview and experience sampling), psychiatric symptoms, information processing, and self-esteem. Data were analyzed using mixed-models regression analysis. Treatment effects were evaluated by the time by condition interaction terms. STUDY RESULTS No significant time by condition interactions were found for any of the outcome variables, indicating an absence of treatment effects. Between-group effect sizes ranged from negligible to moderate (Cohen's d < |0.53|). Main effects of time were found for several outcomes. CONCLUSIONS These results suggest that DiSCoVR was not effective, possibly because of inadequate simulation of emotional expressions in VR. This lack of efficacy may indicate that current SCT protocols are relatively unsuitable for improving social functioning. Previous studies showed small to moderate effects on higher order social cognition, but the SCT approach may need critical reevaluation, as it may not sufficiently lead to functional improvement.
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Affiliation(s)
- S A Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - R R Vermeer
- GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands
| | - C E R Zandee
- GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands
| | - D C Zandstra
- Zeeuwse Gronden, Axelsestraat 8/A, 4537 AJ, Terneuzen, The Netherlands
| | - D van der Vorm
- GGZ Westelijk Noord-Brabant, Hoofdlaan 8, PO Box 371, 4600AJ, Bergen op Zoom, The Netherlands
| | - A C de Wit-de Visser
- GGZ Westelijk Noord-Brabant, Hoofdlaan 8, PO Box 371, 4600AJ, Bergen op Zoom, The Netherlands.,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, PO Box 90153, 5000LE Tilburg, The Netherlands
| | - I A Meins
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - C N W Geraets
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - W Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
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Perra A, Riccardo CL, De Lorenzo V, De Marco E, Di Natale L, Kurotschka PK, Preti A, Carta MG. Fully Immersive Virtual Reality-Based Cognitive Remediation for Adults with Psychosocial Disabilities: A Systematic Scoping Review of Methods Intervention Gaps and Meta-Analysis of Published Effectiveness Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1527. [PMID: 36674283 PMCID: PMC9864668 DOI: 10.3390/ijerph20021527] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR. METHODS Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders. RESULTS We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions' development was poorly described, and few details were given on the interventions' components. CONCLUSIONS Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR.
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Affiliation(s)
- Alessandra Perra
- International PhD in Innovation Sciences and Technologies, Department of Mechanical Chemistry and Materials Engineering, University of Cagliari, 09042 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Chiara Laura Riccardo
- Department of Clinical and Biological Sciences, University of Turin, 10126 Turin, Italy
| | | | - Erika De Marco
- Azienda Sociosanitaria Ligure 2, Dipartimento di Salute Mentale e delle Dipendenze, 17100 Savona, Italy
| | | | | | - Antonio Preti
- Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
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Interviewing in virtual environments: Towards understanding the impact of rapport-building behaviours and retrieval context on eyewitness memory. Mem Cognit 2023; 51:404-421. [PMID: 36251160 PMCID: PMC9575624 DOI: 10.3758/s13421-022-01362-7] [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: 09/26/2022] [Indexed: 11/08/2022]
Abstract
Given the complexities of episodic memory and necessarily social nature of in-person face-to-face interviews, theoretical and evidence-based techniques for collecting episodic information from witnesses, victims, and survivors champion rapport-building. Rapport is believed to reduce some of the social demands of recalling an experienced event in an interview context, potentially increasing cognitive capacity for remembering. Cognitive and social benefits have also emerged in remote interview contexts with reduced anxiety and social pressure contributing to improved performance. Here, we investigated episodic memory in mock-eyewitness interviews conducted in virtual environments (VE) and in-person face-to-face (FtF), where rapport-building behaviours were either present or absent. Main effects revealed when rapport was present and where interviews were conducted in a VE participants recalled more correct event information, made fewer errors and were more accurate. Moreover, participants in the VE plus rapport-building present condition outperformed participants in all other conditions. Feedback indicated both rapport and environment were important for reducing the social demands of a recall interview, towards supporting effortful remembering. Our results add to the emerging literature on the utility of virtual environments as interview spaces and lend further support to the importance of prosocial behaviours in applied contexts.
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Cognitive Optimisation and Schizophrenia: Assembling Heterogeneity, Overcoming the Precariousness of Life, and Challenging Public Health Policies in Psychiatry in France. Cult Med Psychiatry 2022; 46:710-738. [PMID: 34390458 DOI: 10.1007/s11013-021-09745-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/26/2022]
Abstract
Cognitive remediation therapy (CRT) aims to optimise cognitive abilities of people who suffer from schizophrenia in order to improve their social adaptation. This therapeutic orientation was developed in psychiatry in the 1980s and 1990s, at a time when the disorder was being redefined as a neurocognitive deficit disorder. In this article, I describe CRT as an assemblage that lies at the intersection of multiple, overlapping theories and spaces of mental disorders and psychiatric care. To do so, I draw on 18 months of ethnographic research conducted in a French hospital unit dedicated to the development of CRT. I argue that the focus on cognitive health and cognitive abilities (or deficits) is not only redefining the logics of care and reshaping medical conceptualisations of schizophrenia, but it is also opening up to a new understanding of people's precarious life conditions, where emotional, biological, and cognitive fragility is intertwined with social and economic uncertainty. I then examine the extent to which psychiatrists have extended the goals of CRT to include psychosocial rehabilitation in order to mitigate not only the effects of cognitive deficits, but also the effects of limited social and professional integration encountered by patients. Finally, I conclude with a consideration of how CRT has become, for its proponents in France, a means to develop a policy and organisational project for French psychiatry.
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Shen ZH, Liu MH, Wu Y, Lin QQ, Wang YG. Virtual-reality-based social cognition and interaction training for patients with schizophrenia: A preliminary efficacy study. Front Psychiatry 2022; 13:1022278. [PMID: 36465308 PMCID: PMC9714325 DOI: 10.3389/fpsyt.2022.1022278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Social cognition and interaction training (SCIT) is a psychosocial intervention program for patients with psychosis, designed to improve their social functioning by improving social cognition. Although the feasibility and efficacy of SCIT have been verified, patients with schizophrenia tend to suffer from motivational deficits and low treatment adherence. It has been suggested that using virtual reality (VR) technology might be effective in addressing these issues. In this study, we aimed to develop a VR-based SCIT and compare its efficacy with that of traditional SCIT. MATERIALS AND METHODS We developed a novel VR-based social cognition and interaction training (VR-SCIT) that combines traditional SCIT (TR-SCIT) intervention with VR technology. Participants were randomly assigned in a 1:1:1 ratio to the VR-SCIT (n = 28), TR-SCIT (n = 30), or waiting-list groups (n = 29). All treatments were combined with treatment-as-usual. Assessments of social cognition (i.e., Chinese version of Face-Affective Identification Task, Chinese version of Social Cognition Screening Questionnaire) and social functioning (i.e., Chinese version of Personal and Social Performance Scale) were administered from baseline to post-intervention. RESULTS Patients receiving VR-SCIT and TR-SCIT showed a significantly greater improvement on the assessments of emotion perception (Cohen's d was 1.66, 0.55, and 0.10 for VR-SCIT, TR-SCIT, and Waiting-list, respectively), hostile attributional bias (Cohen's d was 0.48, 0.44, and 0.05 for VR-SCIT, TR-SCIT, and Waiting-list, respectively), metacognition (Cohen's d was 1.66, 0.76, and 0.06 for VR-SCIT, TR-SCIT, and waiting-list, respectively), and social functioning (Cohen's d was 1.09, 0.90, and 0.20 for VR-SCIT, TR-SCIT, and waiting-list, respectively) from baseline to post-intervention, compared to those in waiting-list group. Additionally, VR-SCIT showed an advantage over TR-SCIT in improving emotion perception and metacognition with higher treatment compliance. CONCLUSION These preliminary findings indicate that VR-SCIT is a feasible and promising method for improving social cognition and social functioning in patients with schizophrenia.
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Affiliation(s)
- Zhi-Hua Shen
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Institute of Drug Abuse Research, Hangzhou, China
| | | | - Yue Wu
- The Fifth Hospital of Ruian, Wenzhou, China
| | - Qian-Qian Lin
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Guang Wang
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Institute of Drug Abuse Research, Hangzhou, China
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Gautier M, Pabst A, Maurage P. Social decision making in severe alcohol use disorder: Scoping review and experimental perspectives. Alcohol Clin Exp Res 2021; 45:1548-1559. [PMID: 34342010 DOI: 10.1111/acer.14664] [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: 03/18/2021] [Revised: 05/21/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with severe alcohol use disorder (SAUD) demonstrate multifaceted impairments in social cognition abilities, including emotional decoding or Theory of Mind. Such impairments are associated with real-life interpersonal difficulties, which in turn could contribute to the persistence of SAUD. However, little is known regarding how patients with SAUD make decisions in a social context and this literature has not been comprehensively reviewed. OBJECTIVES The main aim of this paper was to conduct the first review specifically focusing on social decision-making abilities in SAUD. Following PRISMA guidelines for scoping reviews, we describe existing knowledge regarding the difficulties experienced by patients with SAUD during social interactions. Our second objective was to propose perspectives for future research, based on the shortcomings identified in the available literature. DESIGN We searched three online databases (PubMed, PsycINFO, and Scopus) and identified 14 papers using behavioral tasks to assess social decision making in patients with SAUD. RESULTS Included studies assessed social decision making through three paradigms: (1) economic games (four papers), (2) moral dilemmas (four papers), and (3) interpersonal problem-solving (six papers). Results indicated that patients with SAUD behave differently from controls in all three paradigms. CONCLUSIONS Previous studies suggested large-scale social decision-making impairments or biases in SAUD. However, in light of the limited number of studies available and of the restricted set of processes measured, we call for the extension of this field through more ecologically relevant and model-based paradigms in order to elucidate the underlying mechanisms of these effects.
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Affiliation(s)
- Mado Gautier
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Arthur Pabst
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
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11
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Banerjee M, Hegde S, Thippeswamy H, Kulkarni GB, Rao N. In search of the 'self': Holistic rehabilitation in restoring cognition and recovering the 'self' following traumatic brain injury: A case report. NeuroRehabilitation 2021; 48:231-242. [PMID: 33664160 DOI: 10.3233/nre-208017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Following mild-moderate traumatic brain injury (TBI), an individual experiences a range of emotional changes. It is often difficult for the patient to reconcile with their post-injury persona, and the memory of pre-injury personhood is particularly painful. Insight into one's cognitive deficits subsequent to injury can lead to an existential crisis and a sense of loss, including loss of self. OBJECTIVE Restoration of cognitive functions and reconciliation with loss of pre-traumatic personhood employing a holistic method of neuropsychological rehabilitation in a patient suffering from TBI. METHODS Ms. K.S, a 25-year-old female, presented with emotional disturbances following TBI. She reported both retrograde and anterograde amnesia. A multidimensional holistic rehabilitation was planned. Treatment addressed cognitive deficits through the basic functions approach. Cognitive behavioural methods for emotional regulation like diary writing helped reduce irritability and anger outbursts. Use of social media created new modes of memory activation and interactions. Compensatory strategies were used to recover lost skills, music-based attention training helped foster an individualised approach to the sense of one's body and self. RESULTS As a result of these differing strategies, changes were reflected in neuro-psychological tests, depression score and the patient's self-evaluation. This helped generate a coherent self-narrative. CONCLUSION Treatment challenges in such cases are increased due to patient's actual deficits caused by neuronal/biochemical changes. Innovative and multi-pronged rehabilitation strategies which involve everyday activities provided an answer to some of these problems. This method of rehabilitation may provide an optimistic context for future research.
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Affiliation(s)
- Meenakshi Banerjee
- Neuropsychology and Cognitive Neuroscience Centre, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shantala Hegde
- Neuropsychology and Cognitive Neuroscience Centre, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.,Associate Professor and Wellcome DBT India Alliance Intermediate Fellow, Clinical Neuropsychology and Cognitive Neuro Sciences Center, Music Cognition Laboratory, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.,Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Narasinga Rao
- Department of Surgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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12
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Nijman SA, Veling W, Greaves-Lord K, Vos M, Zandee CER, Aan Het Rot M, Geraets CNW, Pijnenborg GHM. Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for People With a Psychotic Disorder: Single-Group Feasibility and Acceptability Study. JMIR Ment Health 2020; 7:e17808. [PMID: 32763880 PMCID: PMC7442939 DOI: 10.2196/17808] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People with a psychotic disorder commonly experience problems in social cognition and functioning. Social cognition training (SCT) improves social cognition, but may inadequately simulate real-life social interactions. Virtual reality (VR) provides a realistic, interactive, customizable, and controllable training environment, which could facilitate the application of skills in daily life. OBJECTIVE We developed a 16-session immersive VR SCT (Dynamic Interactive Social Cognition Training in Virtual Reality [DiSCoVR]) and conducted a single-group feasibility pilot study. METHODS A total of 22 people with a psychotic disorder and reported problems in social cognition participated. Feasibility and acceptability were assessed using a survey for participants and therapists, and by examining relevant parameters (eg, dropouts). We analyzed preliminary treatment effects on social cognition, neurocognition, and psychiatric symptoms. RESULTS A total of 17 participants completed the study. Participants enjoyed DiSCoVR (mean 7.25, SD 2.05; range 3-10), thought it was useful for daily social activities (mean 7.00, SD 2.05; range 3-10), and enjoyed the combination of VR and a therapist (mean 7.85, SD 2.11; range 3-10). The most frequently mentioned strength of DiSCoVR was the opportunity to practice with personalized social situations (14/20, 70%). A significant improvement of emotion perception was observed (Ekman 60 Faces; t16=-4.79, P<.001, d=-0.67), but no significant change was found in other measures of social cognition, neurocognition, psychiatric symptoms, or self-esteem. CONCLUSIONS DiSCoVR was feasible and acceptable to participants and therapists, and may improve emotion perception.
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Affiliation(s)
- Saskia Anne Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Assen, Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kirstin Greaves-Lord
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC-Sophia, Rotterdam, Netherlands.,Autism Team Northern-Netherlands of Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands.,Department of Yulius Autism, Yulius, Dordrecht, Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Maarten Vos
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Marije Aan Het Rot
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Chris Neeltje Wil Geraets
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Assen, Netherlands.,Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
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Peyroux E, Franck N. Is social cognitive training efficient in autism? A pilot single-case study using the RC2S+ program. Neurocase 2019; 25:217-224. [PMID: 31522609 DOI: 10.1080/13554794.2019.1666877] [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] [Indexed: 10/26/2022]
Abstract
In high-functioning autism, deficits in emotional processing and theory of mind are relevant to understanding the particularities of social functioning. Here we used a multiple baseline and ABA single-case design to assess the efficacy of an individualized social cognitive training program using both pen-and-paper and computerized materials for an 18-year old patient. After the treatment phase, we found significant improvement in both emotional processes and theory of mind. These results provide further significant data showing that therapeutic tools based on digital relational simulation are a promising way for helping people with autism to compensate for their impaired social functioning.
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Affiliation(s)
- Elodie Peyroux
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital , Lyon , France.,Reference Center for Rare Diseases (GénoPsy), Le Vinatier hospital , Lyon , France
| | - Nicolas Franck
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital , Lyon , France.,Ressource Center for psychosocial rehabilitation and cognitive remediation (CRR), Le Vinatier hospital , Lyon , France.,UMR 5229, CNRS et Université Claude Bernard Lyon 1, Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod , Lyon , France
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14
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Abstract
Abstract
Purpose of Review
The aim of this article was to review current research regarding social cognition (SC) in gambling disorder (GD), to (i) compile and synthetize the current state of existing literature on this topic, and (ii) propose cognitive remediation therapy approaches focused on SC for clinicians.
Recent Findings
It is well known that disordered gamblers show impairment regarding non-social cognitive functions such as inhibition, attention, and decision-making. Furthermore, patients with substance use disorders also present certain deficits regarding social information processing which are difficult to differentiate from the intrinsic toxic effects linked to drugs or alcohol consumption.
Summary
To date, relatively little research has been undertaken to explore SC in gambling disorder (GD) with neuropsychological tasks. Preliminary results suggest impaired non-verbal emotion processing, but only one study has directly measured SC in GD. As a consequence, future research on this framework should propose diverse measures of SC, while controlling for other factors such as personality traits and subtypes of disordered gamblers.
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15
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Nijman SA, Veling W, Greaves-Lord K, Vermeer RR, Vos M, Zandee CER, Zandstra DC, Geraets CNW, Pijnenborg GHM. Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for social cognition and social functioning in people with a psychotic disorder: study protocol for a multicenter randomized controlled trial. BMC Psychiatry 2019; 19:272. [PMID: 31488103 PMCID: PMC6727396 DOI: 10.1186/s12888-019-2250-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/20/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Problems in social functioning (e.g., unemployment, social isolation), are common in people with a psychotic disorder. Social cognition is a treatment target to improve social functioning, as it is a proximal predictor of social functioning. Social Cognition Training (SCT) improves social cognition, but may not generalize (enduringly) to social functioning, perhaps due to insufficient opportunity to practice in daily-life social situations. Using virtual reality (VR) for SCT could address this problem, as VR is customizable, accessible, and interactive. We will test the effect of a VR SCT, 'DiSCoVR', on social cognition and social functioning in a randomized controlled trial (RCT). METHODS In total 100 people with a psychotic disorder and deficits in social cognition will be recruited for this multicenter randomized controlled trial (RCT). Participants will be randomized to VR SCT (DiSCoVR) or VR relaxation training (VRelax; active control). DiSCoVR is a 16-session individual SCT, consisting of three modules: 1) emotion perception (recognizing facial emotions in a virtual shopping street); 2) social perception and theory of mind (observing social interactions between virtual characters and assessing their behavior, emotions and thoughts); and 3) application of higher-order social cognition in social interaction (role-playing personalized situations in VR). People receiving VRelax complete sixteen individual sessions, in which they receive psycho-education about stress, identify personal stressors, learn relaxation techniques, and explore relaxing immersive virtual environments. Assessments will be performed at baseline, post-treatment, and 3-month follow-up. Primary outcomes are emotion perception (Ekman 60 Faces), social perception and theory of mind (The Awareness of Social Inference Test). Secondary outcomes include social functioning (Personal and Social Performance Scale), experiences and social interactions in daily life (experience sampling of emotions, social participation and subjective experience of social situations), psychiatric symptoms (e.g., depression, perceived stress, anxiety, positive and negative symptoms) and self-esteem. DISCUSSION To our knowledge, this will be the first RCT testing the efficacy of VR SCT. It will also investigate generalization to daily life social situations, the durability of treatment effects, and moderators and mediators of treatment success. TRIAL REGISTRATION On December 5, 2017, this trial was registered prospectively in the Dutch Trial Register as NTR6863 .
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Affiliation(s)
- Saskia A Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404, LA, Assen, the Netherlands.
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, the Netherlands.
- Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, The Netherlands.
| | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, the Netherlands
| | - Kirstin Greaves-Lord
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia, Wytemaweg 8, 3015, CN, Rotterdam, The Netherlands
- Autism Team Northern-Netherlands of Jonx, Department of (Youth) Mental Health and Autism of Lentis Psychiatric Institute, Laan Corpus den Hoorn 102-2, 9728, JR, Groningen, The Netherlands
- Department of Yulius Autism, Yulius, Amazone 7, 3315, WG, Dordrecht, the Netherlands
| | - Rowina R Vermeer
- Flexible Assertive Community Treatment Team, Outpatient Treatment Center, GGZ Delfland, Sint Jorisweg 2, 2612, GA, Delft, The Netherlands
| | - Maarten Vos
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, the Netherlands
| | - Catharina E R Zandee
- Flexible Assertive Community Treatment Team, Outpatient Treatment Center, GGZ Delfland, Sint Jorisweg 2, 2612, GA, Delft, The Netherlands
| | | | - Chris N W Geraets
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, the Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404, LA, Assen, the Netherlands
- Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, The Netherlands
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16
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Abstract
OBJECTIVE To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research. METHOD First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed. RESULTS Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition). CONCLUSIONS The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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17
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Horan WP, Green MF. Treatment of social cognition in schizophrenia: Current status and future directions. Schizophr Res 2019; 203:3-11. [PMID: 28712968 DOI: 10.1016/j.schres.2017.07.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
Efforts to develop psychosocial interventions that specifically target social cognition in schizophrenia spectrum disorders began nearly two decades ago. The field has matured considerably since then and has engendered a great deal of optimism about this treatment approach. Indeed, the efficacy of social cognitive interventions, especially those that address multiple domains of social cognition, has received substantial support. This article critically evaluates the current evidence for social cognitive interventions, identifies limitations and open questions, and suggests priorities and directions for further research. Limitations of available studies include a frequent lack of methodological rigor, suboptimal selection of endpoints, and sparse evidence for generalization to functional improvements. We highlight several emerging psychosocial and non-psychosocial approaches that may enhance the efficacy of social cognitive interventions and promote generalization to improvements in real world functioning. We conclude that cautious optimism is warranted as the field moves forward into the next wave of social cognitive treatment studies.
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Affiliation(s)
- William P Horan
- VA Greater Los Angeles Healthcare System, United States; University of California, Los Angeles, United States.
| | - Michael F Green
- VA Greater Los Angeles Healthcare System, United States; University of California, Los Angeles, United States
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18
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Vallat-Azouvi C, Azouvi P, Le-Bornec G, Brunet-Gouet E. Treatment of social cognition impairments in patients with traumatic brain injury: a critical review. Brain Inj 2018; 33:87-93. [PMID: 30346856 DOI: 10.1080/02699052.2018.1531309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: The aim of this study is to review published research on treatment of social cognition impairments in patients with traumatic brain injury (TBI).Methods: Following the PRISMA guidelines, a PubMed literature search was conducted, followed by a manual search in recently published papers. Main criteria for selection were that patients had sustained a TBI, and that social cognition was the main target of treatment. A total of 16 papers and three reviews were selected and included in the present review.Results: Five studies (including three randomized controlled trials (RCT)) addressed facial affect recognition, one study specifically addressed emotional prosody, two RCTs used a combination of treatment strategies addressing social perception deficits. Six studies, including two RCTs, addressed social communication skills or theory of mind. Finally, two RCTs reported the effectiveness of a more global approach, addressing multiple domains of social cognition, such as emotion perception, social skills training, and theory of mind.Discussion/conclusion: Although there has been much less research on treatment of social cognition in patients with TBI as compared with psychiatric conditions, the findings reported in the present review are encouraging. Further multicenter large-scale RCTs are needed, with special emphasis on the generalization of treatment effects to social skills in everyday life.
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Affiliation(s)
- Claire Vallat-Azouvi
- Laboratoire de Psychopathologie et Neuropsychologie, EA 2027, Université Paris 8, Saint-Denis.,Antenne UEROS- UGECAMIDF, Hôpital Raymond Poincaré, Garches, France
| | - Philippe Azouvi
- Service de Médecine Physique et de Réadaptation, APHP, Hôpital Raymond Poincaré, Garches, France.,HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Gaelle Le-Bornec
- Service de Médecine Physique et de Réadaptation, APHP, Hôpital Raymond Poincaré, Garches, France.,HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Eric Brunet-Gouet
- HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Service de Psychiatrie, Centre Hospitalier de Versailles, Le Chesnay, France
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19
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Tan BL, Lee SA, Lee J. Social cognitive interventions for people with schizophrenia: A systematic review. Asian J Psychiatr 2018; 35:115-131. [PMID: 27670776 DOI: 10.1016/j.ajp.2016.06.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
Social cognition is the mental process which underpins social interactions. Increasingly, it has been recognized to be impaired in people with schizophrenia, resulting in functional problems. Correspondingly, the past ten years have seen huge developments in the study of interventions to ameliorate social cognitive deficits among people with schizophrenia. In the present review, we systematically reviewed published studies on social cognitive interventions from 2005 to 2015. Of the 61 studies included in this review, 20 were on broad-based social cognitive interventions, which incorporated neurocognitive training, specialized learning technique or virtual reality social skills training. On the other hand, 31 studies on targeted interventions either focused on specific social cognitive domains, or a range of domains. Improvements in emotion processing and theory of mind were often reported, while social perception and attributional style were less frequently measured. Both broad-based and targeted interventions achieved gains in social functioning, albeit inconsistently. Lastly, nine studies on the use of oxytocin and one study on transcranial direct current stimulation reported positive preliminary results in higher-order cognition and facial affect recognition respectively. This review revealed that a wide range of social cognitive interventions is currently available and most have shown some promise in improving social cognition outcomes. However, there is a need to use a common battery of measurements for better comparisons across interventions. Future research should examine combination therapies and the sustainability of gains beyond the intervention period.
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Affiliation(s)
- Bhing-Leet Tan
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore; Singapore Institute of Technology, 10 Dover Drive, Singapore 138683, Singapore.
| | - Sara-Ann Lee
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
| | - Jimmy Lee
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore; Office of Clinical Sciences, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
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20
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Brun G, Verdoux H, Couhet G, Quiles C. [Computer-assisted therapy and video games in psychosocial rehabilitation for schizophrenia patients]. Encephale 2018; 44:363-371. [PMID: 29501256 DOI: 10.1016/j.encep.2017.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Video games and virtual reality have recently become used by clinicians for training or information media or as therapeutic tools. The purpose is to review the use of these technologies for therapy destined for schizophrenia patients. METHODS We conducted a review in October 2016 using Pubmed, Scopus and PsychInfo using the following Medical Subject Headings (MESH): "video games", "virtual reality" and "therapy, computer-assisted/methods", each associated with "schizophrenia". Papers were included in the review if: (a) they were published in an English, Spanish or French-language peer-reviewed journal, (b) the study enrolled patients with schizophrenia or schizo-affective disorder, (c) the patients used a therapeutic video game or therapeutic virtual reality device. RESULTS Eighteen publications were included. The devices studied are mainly therapeutic software developed specifically for therapeutic care. They can be classified according to their therapeutic objectives. These targets corresponded to objectives of psychosocial rehabilitation: improvement of residual symptomatology, cognitive remediation, remediation of cognition and social skills, improvement of everyday life activities, support for occupational integration. Very different devices were proposed. Some researchers analysed programs developed specifically for patients with schizophrenia, while others were interested in the impact of commercial games. Most of the studies were recent, preliminary and European. The impact of these devices was globally positive, particularly concerning cognitive functions. CONCLUSIONS Computer-assisted therapy, video games and virtual reality cannot replace usual care but could be used as adjunctive therapy. However, recommending their use seems premature because of the recent and preliminary character of most studies. Moreover, a link is still lacking between this field of research in psychiatry and other fields of research, particularly game studies. Finally, it might be interesting to analyse more precisely the neuropsychological impact of existing commercial games which could potentially be useful for psychosocial rehabilitation.
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Affiliation(s)
- G Brun
- Pôle universitaire de psychiatrie adulte, centre hospitalier Charles-Perrens, 33000 Bordeaux, France; Centre de réhabilitation psychosociale de la Tour-de-Gassies, 33000 Bordeaux, France
| | - H Verdoux
- Pôle universitaire de psychiatrie adulte, centre hospitalier Charles-Perrens, 33000 Bordeaux, France; Centre référent de réhabilitation psychosociale Nouvelle Aquitaine Sud, 33000 Bordeaux, France; Université de Bordeaux, 33000 Bordeaux, France; Inserm U1219, 33000 Bordeaux, France
| | - G Couhet
- Centre de réhabilitation psychosociale de la Tour-de-Gassies, 33000 Bordeaux, France; Centre référent de réhabilitation psychosociale Nouvelle Aquitaine Sud, 33000 Bordeaux, France
| | - C Quiles
- Pôle universitaire de psychiatrie adulte, centre hospitalier Charles-Perrens, 33000 Bordeaux, France; Centre référent de réhabilitation psychosociale Nouvelle Aquitaine Sud, 33000 Bordeaux, France.
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21
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Fernández-Caballero A, Navarro E, Fernández-Sotos P, González P, Ricarte JJ, Latorre JM, Rodriguez-Jimenez R. Human-Avatar Symbiosis for the Treatment of Auditory Verbal Hallucinations in Schizophrenia through Virtual/Augmented Reality and Brain-Computer Interfaces. Front Neuroinform 2017; 11:64. [PMID: 29209193 PMCID: PMC5702358 DOI: 10.3389/fninf.2017.00064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/30/2017] [Indexed: 12/02/2022] Open
Abstract
This perspective paper faces the future of alternative treatments that take advantage of a social and cognitive approach with regards to pharmacological therapy of auditory verbal hallucinations (AVH) in patients with schizophrenia. AVH are the perception of voices in the absence of auditory stimulation and represents a severe mental health symptom. Virtual/augmented reality (VR/AR) and brain computer interfaces (BCI) are technologies that are growing more and more in different medical and psychological applications. Our position is that their combined use in computer-based therapies offers still unforeseen possibilities for the treatment of physical and mental disabilities. This is why, the paper expects that researchers and clinicians undergo a pathway toward human-avatar symbiosis for AVH by taking full advantage of new technologies. This outlook supposes to address challenging issues in the understanding of non-pharmacological treatment of schizophrenia-related disorders and the exploitation of VR/AR and BCI to achieve a real human-avatar symbiosis.
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Affiliation(s)
- Antonio Fernández-Caballero
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Elena Navarro
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Patricia Fernández-Sotos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pascual González
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jorge J Ricarte
- Departamento de Psicología, Universidad de Castilla-La Mancha, Albacete, Spain
| | - José M Latorre
- Departamento de Psicología, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
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22
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Trujillo S, Trujillo N, Lopez JD, Gomez D, Valencia S, Rendon J, Pineda DA, Parra MA. Social Cognitive Training Improves Emotional Processing and Reduces Aggressive Attitudes in Ex-combatants. Front Psychol 2017; 8:510. [PMID: 28428767 PMCID: PMC5382221 DOI: 10.3389/fpsyg.2017.00510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/20/2017] [Indexed: 01/15/2023] Open
Abstract
Emotional processing (EP) is a complex cognitive function necessary to successfully adjust to social environments where we need to interpret and respond to cues that convey threat or reward signals. Ex-combatants have consistently shown atypical EP as well as poor social interactions. Available reintegration programs aim to facilitate the re-adaptation of ex-combatants to their communities. However, they do not incorporate actions to improve EP and to enhance cognitive-emotional regulation. The present study was aimed at evaluating the usefulness of an intervention focused on Social Cognitive Training (SCT), which was designed to equip ex-combatants enrolled in the Social Reintegration Route with EP and social cognition skills. A group of 31 ex-combatants (mean age of 37.2, 29 men) from Colombian illegal armed groups were recruited into this study. Of these, 16 were invited to take part in a SCT and the other continued with the conventional reintegration intervention. Both groups underwent 12 training sessions in a period 12–14 weeks. They were assessed with a comprehensive protocol which included Psychosocial, Behavioral, and Emotion Processing instruments. The scores on these instruments prior to and after the intervention were compared within and between groups. Both groups were matched at baseline. Ex-combatants receiving the SCT experienced significant improvements in EP and a reduction in aggressive attitudes, effects not observed in those continuing the conventional reintegration intervention. This is the first study that achieves such outcomes in such a population using SCT intervention. We discuss the implications of such results toward better social reintegration strategies.
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Affiliation(s)
- Sandra Trujillo
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia.,Doctoral Program in Psychology, Department of Psychology, Universidad de GranadaGranada, España.,Department of Experimental Psychology, University of GranadaGranada, Spain
| | - Natalia Trujillo
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia.,Grupo de Neurociencias, Universidad de AntioquiaMedellin, Colombia
| | - Jose D Lopez
- SISTEMIC, Facultad de Ingeniería, Universidad de AntioquiaMedellín, Colombia
| | - Diana Gomez
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia
| | - Stella Valencia
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia
| | - Jorge Rendon
- Department of Cognitive Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - David A Pineda
- Grupo de Neuropsicología y Conducta, Universidad de AntioquiaMedellin, Colombia
| | - Mario A Parra
- School of Social Sciences, Psychology, Heriot-Watt UniversityEdinburgh, UK.,Cerebro, Cognición y Procesos Sociales, Psicologia, Universidad Autónoma del CaribeBarranquilla, Colombia
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23
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Reniers RLEP, Lin A, Yung AR, Koutsouleris N, Nelson B, Cropley VL, Velakoulis D, McGorry PD, Pantelis C, Wood SJ. Neuroanatomical Predictors of Functional Outcome in Individuals at Ultra-High Risk for Psychosis. Schizophr Bull 2017; 43:449-458. [PMID: 27369472 PMCID: PMC5605267 DOI: 10.1093/schbul/sbw086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Most individuals at ultra-high risk (UHR) for psychosis do not transition to frank illness. Nevertheless, many have poor clinical outcomes and impaired psychosocial functioning. This study used voxel-based morphometry to investigate if baseline grey and white matter brain densities at identification as UHR were associated with functional outcome at medium- to long-term follow-up. Participants were help-seeking UHR individuals (n = 109, 54M:55F) who underwent magnetic resonance imaging at baseline; functional outcome was assessed an average of 9.2 years later. Primary analysis showed that lower baseline grey matter density, but not white matter density, in bilateral frontal and limbic areas, and left cerebellar declive were associated with poorer functional outcome (Social and Occupational Functioning Assessment Scale [SOFAS]). These findings were independent of transition to psychosis or persistence of the at-risk mental state. Similar regions were significantly associated with lower self-reported levels of social functioning and increased negative symptoms at follow-up. Exploratory analyses showed that lower baseline grey matter densities in middle and inferior frontal gyri were significantly associated with decline in Global Assessment of Functioning (GAF) score over follow-up. There was no association between baseline grey matter density and IQ or positive symptoms at follow-up. The current findings provide novel evidence that those with the poorest functional outcomes have the lowest grey matter densities at identification as UHR, regardless of transition status or persistence of the at-risk mental state. Replication and validation of these findings may allow for early identification of poor functional outcome and targeted interventions.
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Affiliation(s)
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Alison R. Yung
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Vanessa L. Cropley
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Patrick D. McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia;,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, University of Melbourne, Victoria, Australia;,Florey Institute for Neuroscience & Mental Health, Victoria, Australia
| | - Stephen J. Wood
- School of Psychology, University of Birmingham, Birmingham, UK;,Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia
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24
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Abstract
Social cognitive deficits are common in neuropsychiatric disorders. Given the proximity of social cognition (SC) to everyday functioning, many intervention studies (including targeted, comprehensive, and broad-based approaches) have focussed on SC. The aim of this paper was to quantitatively meta-analyse the efficacy of SC interventions in adult neuropsychiatric patients. Databases Pubmed, PsycINFO, Web of Knowledge, and Embase were searched for controlled SC intervention studies published between 01-01-2003 and 01-01-2016. Forty-one studies, comprising 1,508 patients with schizophrenia, autism spectrum disorders, or acquired brain injury were included. Outcome measures evaluated emotion perception (EP), social perception (SP), Theory of Mind (ToM), and social functioning (SF). The meta-analyses showed that interventions were effective in improving SC (Cohen'sd=.71). Interventions targeting one specific SC function were found to be most effective (d=.89), followed by broad-based interventions, targeting non-SC domains in addition to SC (d=.65), and comprehensive interventions, that target multiple SC processes (d=.61). Targeted interventions were especially effective in improving EP and ToM. Comprehensive interventions were able to ameliorate EP, ToM, and SF. Broad-based interventions were especially effective in improving SF, but also showed effects on EP and ToM.
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25
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de Timary P, Maurage P. Considering Cognitive Mentalizing Deficits as a Transient and Reversible Impairment in Alcohol Dependence: A Response to Fein's Commentary on Maurage et al.'s Paper. Alcohol Clin Exp Res 2016; 40:2692-2693. [PMID: 27709627 DOI: 10.1111/acer.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Philippe de Timary
- Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Psychiatry and Institute of Neuroscience, Saint-Luc University Hospital, Brussels, Belgium
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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26
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Leguay D. [Advocacy for the establishment of a comprehensive strategy to reduce the "burden" of schizophrenic disorders]. Encephale 2016; 42:476-483. [PMID: 27623121 DOI: 10.1016/j.encep.2016.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Abstract
This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention. In the scope of screening and early treatment, genetic risk, as well as the predictive ability of the clinical criteria for individuals at "ultra-high risk" of developing schizophrenia justify an increased vigilance for the detection of symptoms in order for treatment to begin earlier and to be more effective. These risk factors should not be neglected as the benefits of early management impact the course of illness and functional outcome. At this stage of the emergence of the disorder, it is difficult to systematize a therapeutic protocol. Two options are open to the clinician: "wait and watch" given the lack of a conclusive diagnosis and a more pro-active intervention, focused on the therapeutic alliance and enhancing insight and awareness. The second approach seems more productive but requires transparency with the patient and family regarding the uncertainty of the clinical situation, and an attitude that favors sharing information, along the lines of early psych education. Once a pathological stage is reached, early and accurate clinical care is fundamental. They depend heavily on access to care, proximity and availability to clinics or out-reach teams, capable of a thorough diagnostic work-up. Yet conversely, the availability for early and accurate clinical care faces obstacles which are closely related to the pejorative view of psychiatry held by the general public, health care professionals, and public officials. This poor image of psychiatry is partly due to cases of clinical decompensation, dangerous in some instances, underscoring why it is be important to understand and anticipate the contributory factors to these outcomes in the first place so as to avoid them. In this sense, defending a complacent and conciliatory approach can be counter-productive. Following developments of recent decades in other chronic diseases (diabetes, cancer, AIDS, severe heart disease…), the implementation of systematic clinical programs, treatment protocols, psycho-education to reinforce adherence to therapeutic measures, their simplification, the support and appreciation of the role of caregivers, destigmatizing due to proximity of contact, and therefore an increase in the use of care. Similarly, the systematic search for side-effects of medication and pro-actively managing to minimize their occurrence strengthen compliance, a recognized factor of relapse prevention. Preventable comorbidities, addictions, and common physical illnesses are not systematically screened (neoplastic diseases, diabetes, hypertension, dental health, gynecology…) in this population and thus also represent significant potential for a better life expectancy. The tools of psychosocial rehabilitation, unfortunately, are too infrequently used in France. Their goal is to improve the functional outcome of patients, a determinant of social integration and to lessen the burden shouldered by family and other carers, and ultimately to reduce exacerbations of the illness due to situations of interpersonal stress. Work has also proven its worth as a protective factor, as well as strengthening a sense of self-efficiency, of self-esteem, of empowerment, of quality of life, helping attain recovery. It is clear that not all social and health care systems are primarily geared towards these objectives, although they have at their disposal, by the means described above, strong preventive measures for relapses. Beyond the issue of the implementation of clinical programs, the existing culture would benefit from being infused with a prioritization of resource deployment, with debates of these issues regarding parity for mental health services, advocated by users, and forging a place, for example, for the intervention of "peer supports", sociologists, social workers, interested beyond the disease, in community environment, employment opportunities, and housing. Overall, this work argues for updating our conceptions of clinical care, supporting the systematic implementation of modern models of care, and expanding the scope of our concerns regarding patients' lives.
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Affiliation(s)
- D Leguay
- CESAME, secteur 4 de psychiatrie générale, BP 89, 49137 Les-Ponts-De-Ce cedex, France.
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27
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Marcos-Pablos S, González-Pablos E, Martín-Lorenzo C, Flores LA, Gómez-García-Bermejo J, Zalama E. Virtual Avatar for Emotion Recognition in Patients with Schizophrenia: A Pilot Study. Front Hum Neurosci 2016; 10:421. [PMID: 27616987 PMCID: PMC4999437 DOI: 10.3389/fnhum.2016.00421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/08/2016] [Indexed: 11/13/2022] Open
Abstract
Persons who suffer from schizophrenia have difficulties in recognizing emotions in others’ facial expressions, which affects their capabilities for social interaction and hinders their social integration. Photographic images have traditionally been used to explore emotion recognition impairments in schizophrenia patients, but they lack of the dynamism that is inherent to facial expressiveness. In order to overcome those inconveniences, over the last years different authors have proposed the use of virtual avatars. In this work, we present the results of a pilot study that explored the possibilities of using a realistic-looking avatar for the assessment of emotion recognition deficits in patients who suffer from schizophrenia. In the study, 20 subjects with schizophrenia of long evolution and 20 control subjects were invited to recognize a set of facial expressions of emotions showed by both the said virtual avatar and static images. Our results show that schizophrenic patients exhibit recognition deficits in emotion recognition from facial expressions regardless the type of stimuli (avatar or images), and that those deficits are related with the psychopathology. Finally, some improvements in recognition rates (RRs) for the patient group when using the avatar were observed for sadness or surprise expressions, and they even outperform the control group in the recognition of the happiness expression. This leads to conclude that, apart from the dynamism of the shown expression, the RRs for schizophrenia patients when employing animated avatars may depend on other factors which need to be further explored.
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Affiliation(s)
| | | | - Carlos Martín-Lorenzo
- Research Unit, Hermanas Hospitalarias Centro Sociosanitario Palencia Palencia, Spain
| | - Luis A Flores
- Cartif Foundation, Parque Tecnológico de Boecillo Valladolid, Spain
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28
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Maurage P, D'Hondt F, de Timary P, Mary C, Franck N, Peyroux E. Dissociating Affective and Cognitive Theory of Mind in Recently Detoxified Alcohol-Dependent Individuals. Alcohol Clin Exp Res 2016; 40:1926-34. [DOI: 10.1111/acer.13155] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Pierre Maurage
- Laboratory for Experimental Psychopathology; Psychological Sciences Research Institute; Université catholique de Louvain; Louvain-la-Neuve Belgium
| | - Fabien D'Hondt
- Laboratory for Experimental Psychopathology; Psychological Sciences Research Institute; Université catholique de Louvain; Louvain-la-Neuve Belgium
| | - Philippe de Timary
- Laboratory for Experimental Psychopathology; Psychological Sciences Research Institute; Université catholique de Louvain; Louvain-la-Neuve Belgium
- Department of Psychiatry; Saint-Luc University Hospital; Brussels Belgium
| | - Charlotte Mary
- Laboratory for Experimental Psychopathology; Psychological Sciences Research Institute; Université catholique de Louvain; Louvain-la-Neuve Belgium
| | - Nicolas Franck
- Centre de Neurosciences Cognitives; UMR 5229; CNRS; Bron Cedex France
- Service Universitaire de Réhabilitation; Centre Référent Lyonnais en Réhabilitation et en Remédiation Cognitive (SUR-CL3R); Centre Hospitalier Le Vinatier; Lyon France
- Université Claude Bernard Lyon 1; Villeurbanne Cedex France
| | - Elodie Peyroux
- Centre de Neurosciences Cognitives; UMR 5229; CNRS; Bron Cedex France
- Service Universitaire de Réhabilitation; Centre Référent Lyonnais en Réhabilitation et en Remédiation Cognitive (SUR-CL3R); Centre Hospitalier Le Vinatier; Lyon France
- GDR 3557; SHU-Centre Hospitalier Sainte-Anne; Paris France
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29
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Gaudelus B, Virgile J, Geliot S, Franck N. Improving Facial Emotion Recognition in Schizophrenia: a Controlled Study Comparing Specific and Attentional Focused Cognitive Remediation. Front Psychiatry 2016; 7:105. [PMID: 27445866 PMCID: PMC4914585 DOI: 10.3389/fpsyt.2016.00105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/03/2016] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairments associated with schizophrenia are very frequent. They concern both neurocognition and social cognition, including facial emotion recognition. These impairments have a negative impact on the daily functioning, in particular the social and vocational rehabilitation of people with schizophrenia. Previous studies in this area clearly demonstrated the interest of cognitive remediation to improve neurocognitive and social cognitive functioning in schizophrenia. They also established clear links between facial emotion recognition skills and attentional processes. The present study compares the GAÏA s-face program (GAÏA arm), which focuses on facial emotion recognition processes, with the RECOS program (RECOS arm), a neurocognitive remediation therapy focusing on selective attention. Forty people with schizophrenia were randomly distributed between each study arm and assessed pre- (T1) and post- (T2) therapy. The single-blind assessment focused on facial emotion recognition (the main criteria), symptoms, social and subjective functioning, and neurocognitive and social cognitive performance. Both programs were conducted by nurses after a 3-day training session. The study showed a significant improvement in facial emotion recognition performance in both groups, with a significantly larger effect in the GAÏA arm. Symptoms and social functioning also improved in the GAÏA arm, and certain neurocognitive and social cognitive processes improved in both study arms. Further studies are recommended, with larger population samples and a follow-up assessing the long-term preservation of these improvements.
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Affiliation(s)
- Baptiste Gaudelus
- Service Universitaire de Réhabilitation, CL3R, Le Vinatier Hospital, Bron, France
| | - Jefferson Virgile
- Service Universitaire de Réhabilitation, CL3R, Le Vinatier Hospital, Bron, France
- Département de Réhabilitation Psycho-sociale, St Cyr au Mont d’Or Hospital, St Cyr au Mont d’Or, France
| | - Sabrina Geliot
- Service Universitaire de Réhabilitation, CL3R, Le Vinatier Hospital, Bron, France
- Centre régional de dépistage et de prise en charge des troubles psychiatriques d’origine génétique, Le Vinatier Hospital, Bron, France
| | - Nicolas Franck
- Service Universitaire de Réhabilitation, CL3R, Le Vinatier Hospital, Bron, France
- Lyon 1 Claude Bernard University, Lyon, France
- UMR 5229, Centre National de la Recherche Scientifique (CNRS), Lyon, France
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30
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Vázquez-Campo M, Maroño Y, Lahera G, Mateos R, García-Caballero A. e-Motional Training®: Pilot study on a novel online training program on social cognition for patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2016; 4:10-17. [PMID: 28740808 PMCID: PMC5506727 DOI: 10.1016/j.scog.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 01/23/2023]
Abstract
Background Patients with schizophrenia have deficits in social cognition (SC), a construct that includes emotion perception (EP), social perception (SP), theory of mind (ToM) and attributive style (AS). The aim of our study was to assess the applicability, identify potential problems and obtain preliminary data on the efficacy of a new online training program on SC called e-Motional Training (ET®), which can be remotely administered and remotely supervised by a clinician. Materials and methods A pre/post intervention pilot study was conducted with 21 patients with schizophrenia in the healthcare area of Ourense, Spain (12 patients were assigned to the intervention group and 9 in the control group). The control group received standard treatment (TAU) (occupational therapy and leisure group). The intervention group received TAU plus 12 sessions (1 hour per week) with ET® (including training modules on emotional perception and a short animated cartoon for ToM and AS training, including automated metacognitive feedback). Endpoints: EP (Ekman 60 Faces Test), ToM (Hinting Task, Faux Pas, Happé), AS (Ambiguous Intentions Hostility Questionnaire). Results ET® was shown to be an understandable, viable and pleasant program for the participants. After the intervention, statistically significant data (p < 0.05) were obtained for the EP, ToM and AS variables. Conclusion ET® enables self-training in SC and online follow-up by the therapist, thereby covering the lack of online intervention instruments validated for patients with SC deficits. Our preliminary results demonstrate the feasibility of ET® and its possible efficacy in improving emotion recognition, ToM and AS.
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Affiliation(s)
- Miriam Vázquez-Campo
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,University Hospital Complex of Ourense, Ourense, Spain
| | - Yolanda Maroño
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialties, University of Alcalá IRyCIS, CIBERSAM, Madrid, Spain
| | - Raimundo Mateos
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alejandro García-Caballero
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,University Hospital Complex of Ourense, Ourense, Spain
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31
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Roux P, Brunet-Gouet E, Passerieux C, Ramus F. Eye-tracking reveals a slowdown of social context processing during intention attribution in patients with schizophrenia. J Psychiatry Neurosci 2016; 41:E13-21. [PMID: 26836621 PMCID: PMC4764486 DOI: 10.1503/jpn.150045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Schizophrenia is associated with poor theory of mind (ToM), particularly in the attribution of intentions to others. It is also associated with abnormal gaze behaviours and contextual processing. This study investigated to what extent impaired ToM in patients with schizophrenia is related to abnormal processing of social context. METHODS We evaluated ToM using a nonverbal intention attribution task based on comic strips depicting social/nonsocial and contextual/noncontextual events while eye movements were recorded. Eye-tracking was used to assess processing time dedicated to visual cues contained in regions of interest identified in a pilot study. We measured cognitive contextual control on a separate task. RESULTS We tested 29 patients with schizophrenia and 29 controls. Compared with controls, patients were slower in intention attribution but not in physical reasoning. They looked longer than controls at contextual cues displayed in the first 2 context pictures of the comic strips, and this difference was greater for intention attribution than for physical reasoning. We found no group difference in time spent looking at noncontextual cues. Patients' impairment in contextual control did not explain their increased reaction time and gaze duration on contextual cues during intention attribution. LIMITATIONS Difficulty may not have been equivalent between intention attribution and physical reasoning conditions. CONCLUSION Overall, schizophrenia was characterized by a delay in intention attribution related to a slowdown of social context processing that was not explained by worse executive contextual control.
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Affiliation(s)
- Paul Roux
- Correspondence to: P. Roux, Service Universitaire de Psychiatrie d’adultes, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France;
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32
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Peyroux E, Franck N. Improving Social Cognition in People with Schizophrenia with RC2S: Two Single-Case Studies. Front Psychiatry 2016; 7:66. [PMID: 27199776 PMCID: PMC4842761 DOI: 10.3389/fpsyt.2016.00066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/01/2016] [Indexed: 12/03/2022] Open
Abstract
Difficulties in social interactions are a central characteristic of people with schizophrenia, and can be partly explained by impairments of social cognitive processes. New strategies of cognitive remediation have been recently developed to target these deficits. The RC2S therapy is an individualized and partly computerized program through which patients practice social interactions and develop social cognitive abilities with simulation techniques in a realistic environment. Here, we present the results of two case-studies involving two patients with schizophrenia presenting with specific profiles of impaired social cognition. Each patient completed three baseline sessions, 14 treatment sessions, and 3 follow-up sessions at the end of the therapy - and for 1 patient, another 3 sessions 9 months later. We used a multiple baseline design to assess specific components of social cognition according to the patients' profiles. Functioning and symptomatology were also assessed at the end of the treatment and 6 months later. Results highlight significant improvements in the targeted social cognitive processes and positive changes in functioning in the long term. The RC2S program seems, thus, to be a new useful program for social cognitive remediation in schizophrenia.
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Affiliation(s)
- Elodie Peyroux
- Rehabilitation Department (CL3R), Le Vinatier Hospital, Lyon, France; UMR 5229, Center of Cognitive Neurosciences, CNRS, Lyon, France
| | - Nicolas Franck
- Rehabilitation Department (CL3R), Le Vinatier Hospital, Lyon, France; UMR 5229, Center of Cognitive Neurosciences, CNRS, Lyon, France; University Claude Bernard, University of Lyon, Lyon, France
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33
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Demily C, Rigard C, Peyroux E, Chesnoy-Servanin G, Morel A, Franck N. «Cognitus & Moi»: A Computer-Based Cognitive Remediation Program for Children with Intellectual Disability. Front Psychiatry 2016; 7:10. [PMID: 26869942 PMCID: PMC4737901 DOI: 10.3389/fpsyt.2016.00010] [Citation(s) in RCA: 10] [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: 12/03/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
Attentional, visuospatial, and social cognition deficits have a negative impact on children's adaptative and social competences and, as a result, on their ability to achieve a normal functioning and behavior. Until now and despite the frequency of those deficits, there is a lack of children's specific cognitive remediation tools specifically dedicated to attentional and visuospatial areas. The «Cognitus & Moi» program involves a variety of exercises in a paper and/or pencil (n = 30) or a computerized format (n = 29) and a strategy coaching approach. Each module of «Cognitus & Moi» targets a single impaired cognitive area, within the limits of cognitive domains' overlapping. The little cartoon character named Cognitus, who illustrates the program, is supposed to be very friendly and kind toward children. Cognitus will accompany them throughout the program for an effective and positive reinforcement. The main goal of «Cognitus & Moi» is to adjust to children's difficulties in daily life. Moreover, since the cognitive remediation benefit is complex to apply in daily life, the program is based on a metacognitive strategy. After a complete neuropsychological assessment and a psychoeducational session (with the child and the parents), 16 1-h-sessions of cognitive remediation with the therapist are proposed. Each session is composed of three parts: (1) computerized tasks focusing on specific attentional or visuospatial components (20 min). The attentional module targets hearing, visual, and divided attention. A double attention task is also proposed. The visuospatial module targets eye tracking and gaze direction, spatial orientation, visuospatial memory and construction, and mental imagery; (2) pen and paper tasks focusing on the same processes (20 min) and a facial emotion recognition task; (3) a proposal of a home-based task (during 20 min). Weekly, specific attentional and visuospatial home tasks are proposed to the child and analyzed with the parents and the therapist. Indeed, home exercises are useful to promote the transfer of strategies to daily life and their subsequent automation. The heterogeneity of cognitive deficits in intellectual deficiency necessitates an individualized cognitive remediation therapy. In this regard, «Cognitus & Moi» seems to be a promising tool.
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Affiliation(s)
- Caroline Demily
- GénoPsy, Center for the Diagnosis and Management of Genetic Psychiatric Disorders, CH Le Vinatier, Bron, France; UMR 5229, EDR-Psy, Center of Cognitive Neuroscience, CNRS, University Lyon 1, Lyon, France
| | - Caroline Rigard
- GénoPsy, Center for the Diagnosis and Management of Genetic Psychiatric Disorders, CH Le Vinatier, Bron, France; UMR 5229, EDR-Psy, Center of Cognitive Neuroscience, CNRS, University Lyon 1, Lyon, France
| | - Elodie Peyroux
- GénoPsy, Center for the Diagnosis and Management of Genetic Psychiatric Disorders, CH Le Vinatier, Bron, France; UMR 5229, EDR-Psy, Center of Cognitive Neuroscience, CNRS, University Lyon 1, Lyon, France; Centre référent lyonnais en réhabilitation psychosociale et en remédiation cognitive (CL3R), CH Le Vinatier, Bron, France
| | | | - Aurore Morel
- GénoPsy, Center for the Diagnosis and Management of Genetic Psychiatric Disorders, CH Le Vinatier, Bron, France; UMR 5229, EDR-Psy, Center of Cognitive Neuroscience, CNRS, University Lyon 1, Lyon, France
| | - Nicolas Franck
- UMR 5229, EDR-Psy, Center of Cognitive Neuroscience, CNRS, University Lyon 1, Lyon, France; Centre référent lyonnais en réhabilitation psychosociale et en remédiation cognitive (CL3R), CH Le Vinatier, Bron, France
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Rehm IC, Foenander E, Wallace K, Abbott JAM, Kyrios M, Thomas N. What Role Can Avatars Play in e-Mental Health Interventions? Exploring New Models of Client-Therapist Interaction. Front Psychiatry 2016; 7:186. [PMID: 27917128 PMCID: PMC5114267 DOI: 10.3389/fpsyt.2016.00186] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/03/2016] [Indexed: 11/13/2022] Open
Abstract
In the burgeoning field of e-mental health interventions, avatars are increasingly being utilized to facilitate online communication between clients and therapists, and among peers. Avatars are digital self-representations, which enable individuals to interact with each other in computer-based virtual environments. In this narrative review, we examine the psychotherapeutic applications of avatars that have been investigated and trialed to date. Five key applications were identified (1) in the formation of online peer support communities; (2) replicating traditional modes of psychotherapy by using avatars as a vehicle to communicate within a wholly virtual environment; (3) using avatar technology to facilitate or augment face-to-face treatment; (4) as part of serious games; and (5) communication with an autonomous virtual therapist. Across these applications, avatars appeared to serve several functions conducive to treatment engagement by (1) facilitating the development of a virtual therapeutic alliance; (2) reducing communication barriers; (3) promoting treatment-seeking through anonymity; (4) promoting expression and exploration of client identity; and (5) enabling therapists to control and manipulate treatment stimuli. Further research into the feasibility and ethical implementation of avatar-based psychotherapies is required.
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Affiliation(s)
- Imogen C Rehm
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Emily Foenander
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Klaire Wallace
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Jo-Anne M Abbott
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Michael Kyrios
- Research School of Psychology, College of Medicine, Biology and Environment, Australian National University , Canberra, ACT , Australia
| | - Neil Thomas
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
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Radke S, Pfersmann V, Derntl B. The impact of emotional faces on social motivation in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2015; 265:613-22. [PMID: 25724560 DOI: 10.1007/s00406-015-0589-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/20/2015] [Indexed: 12/22/2022]
Abstract
Impairments in emotion recognition and psychosocial functioning are a robust phenomenon in schizophrenia and may affect motivational behavior, particularly during socio-emotional interactions. To characterize potential deficits and their interplay, we assessed social motivation covering various facets, such as implicit and explicit approach-avoidance tendencies to facial expressions, in 27 patients with schizophrenia (SZP) and 27 matched healthy controls (HC). Moreover, emotion recognition abilities as well as self-reported behavioral activation and inhibition were evaluated. Compared to HC, SZP exhibited less pronounced approach-avoidance ratings to happy and angry expressions along with prolonged reactions during automatic approach-avoidance. Although deficits in emotion recognition were replicated, these were not associated with alterations in social motivation. Together with additional connections between psychopathology and several approach-avoidance processes, these results identify motivational impairments in SZP and suggest a complex relationship between different aspects of social motivation. In the context of specialized interventions aimed at improving social cognitive abilities in SZP, the link between such dynamic measures, motivational profiles and functional outcomes warrants further investigations, which can provide important leverage points for treatment. Crucially, our findings present first insights into the assessment and identification of target features of social motivation.
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Affiliation(s)
- Sina Radke
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich/Aachen, Germany.
| | | | - Birgit Derntl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich/Aachen, Germany.,Institute for Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
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Levy F, Leboucher P, Rautureau G, Jouvent R. E-virtual reality exposure therapy in acrophobia: A pilot study. J Telemed Telecare 2015; 22:215-20. [PMID: 26253746 DOI: 10.1177/1357633x15598243] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/07/2015] [Indexed: 01/18/2023]
Abstract
Virtual reality therapy is already used for anxiety disorders as an alternative to in vivo and in imagino exposure. To our knowledge, however, no one has yet proposed using remote virtual reality (e-virtual reality). The aim of the present study was to assess e-virtual reality in an acrophobic population. Six individuals with acrophobia each underwent six sessions (two sessions per week) of virtual reality exposure therapy. The first three were remote sessions, while the last three were traditional sessions in the physical presence of the therapist. Anxiety (STAI form Y-A, visual analog scale, heart rate), presence, technical difficulties and therapeutic alliance (Working Alliance Inventory) were measured. In order to control the conditions in which these measures were made, all the sessions were conducted in hospital. None of the participants dropped out. The remote sessions were well accepted. None of the participants verbalized reluctance. No major technical problems were reported. None of the sessions were cancelled or interrupted because of software incidents. Measures (anxiety, presence, therapeutic alliance) were comparable across the two conditions. e-Virtual reality can therefore be used to treat acrophobic disorders. However, control studies are needed to assess online feasibility, therapeutic effects and the mechanisms behind online presence.
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Affiliation(s)
| | - Pierre Leboucher
- Brain and Spine Institute (ICM), Pitié-Salpêtrière Hospital Group, France INSERM U975, University of Pierre & Marie Curie, France
| | - Gilles Rautureau
- Brain and Spine Institute (ICM), Pitié-Salpêtrière Hospital Group, France INSERM U975, University of Pierre & Marie Curie, France
| | - Roland Jouvent
- Pitié Salpétrière Hospital, France INSERM U975, University of Pierre & Marie Curie, France
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Franck N, Demily C. [Improving functional outcome of schizophrenia with cognitive remediation]. Presse Med 2014; 44:292-7. [PMID: 25544348 DOI: 10.1016/j.lpm.2014.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/04/2014] [Accepted: 06/17/2014] [Indexed: 01/29/2023] Open
Abstract
The functional outcome of schizophrenia is partly conditioned by cognitive disorders associated with this disease. The functional outcome of schizophrenia depends not only on psychotropic medications, but also on non-pharmacological measures and in particular on cognitive remediation. All patients suffering from schizophrenia should benefit from a multidisciplinary functional evaluation including neuropsychological assessment. The restitution of the functional evaluation's results values preserved skills rather than deficits. Cognitive remediation should be considered when cognitive disorders have a functional impact. It reduces the impact of the patient's cognitive disorders and improves the success of his/her concrete projects.
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Affiliation(s)
- Nicolas Franck
- Centre hospitalier Le Vinatier, UMR 5229, CNRS et université Lyon 1, service universitaire de réhabilitation, 69006 Lyon, France.
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