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Frau F, Cerami C, Dodich A, Bosia M, Bambini V. Weighing the role of social cognition and executive functioning in pragmatics in the schizophrenia spectrum: A systematic review and meta-analysis. Brain Lang 2024; 252:105403. [PMID: 38593743 DOI: 10.1016/j.bandl.2024.105403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/06/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
Pragmatic impairment is diffused in schizophrenia spectrum disorders, but the literature still debates its neurocognitive underpinnings. This systematic review and meta-analysis aimed to investigate the neurocognitive correlates of pragmatic disorders in schizophrenia and determine the weight of social cognition and executive functioning on such disorders. Of the 2,668 records retrieved from the literature, 16 papers were included in the systematic review, mostly focused on non-literal meanings and discourse production in schizophrenia. Ten studies were included in the meta-analysis: pragmatics was moderately associated with both social cognition and executive functions (especially inhibition), but the link with social cognition was stronger. The mediation analysis showed that social cognition mediated the relationship between executive functions and pragmatics. Based on this, we proposed a hierarchical neurocognitive model where pragmatics stems from social cognition, while executive functions are the fertile ground supporting the other two domains, and we discuss its theoretical and clinical implications.
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Affiliation(s)
- Federico Frau
- Laboratory of Neurolinguistics and Experimental Pragmatics (NEP), Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy.
| | - Chiara Cerami
- IUSS Cognitive Neuroscience (ICoN) Center, University School for Advanced Studies IUSS, Pavia, Italy; Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Alessandra Dodich
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Marta Bosia
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Schizophrenia Research and Clinical Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Valentina Bambini
- Laboratory of Neurolinguistics and Experimental Pragmatics (NEP), Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy
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Morales-Pillado C, Fernández-Castilla B, Sánchez-Gutiérrez T, González-Fraile E, Barbeito S, Calvo A. Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis. Psychol Med 2023; 53:6304-6315. [PMID: 36472150 PMCID: PMC10520607 DOI: 10.1017/s0033291722003610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/26/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. METHODS Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. RESULTS Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. CONCLUSIONS TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.
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Affiliation(s)
- Carla Morales-Pillado
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Belén Fernández-Castilla
- Department of Methodology of Behavioral and Health Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | | | | | - Sara Barbeito
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Khan A, Lindenmayer JP, Insel B, Seddo M, Demirli E, DeFazio K, Sullivan M, Hoptman MJ, Ahmed AO. Computerized cognitive and social cognition training in schizophrenia for impulsive aggression. Schizophr Res 2023; 256:117-125. [PMID: 36424289 PMCID: PMC11046975 DOI: 10.1016/j.schres.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/22/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Schizophrenia is associated with an elevated risk for impulsive aggression for which there are few psychosocial treatment options. Neurocognitive and social cognitive deficits have been associated with aggression with social cognitive deficits seemingly a more proximal contributor. The current study examined the effects of combining cognitive and social cognition treatment on impulsive aggression among inpatients with chronic schizophrenia and schizoaffective disorder and a history of aggression compared to cognitive remediation treatment alone. METHODS The two-center study randomized 130 participants to receive 36 sessions of either a combination of cognitive remediation and social cognition treatment or cognitive remediation plus a computer-based control. Participants had at least one aggressive incident within the past year or a Life History of Aggression (LHA) score of 5 or more. Participants completed measures of neurocognition, social cognition, symptom severity, and aggression at baseline and endpoint. RESULTS Study participants were mostly male (84.5 %), had a mean age 34.9 years, and 11.5 years of education. Both Cognitive Remediation Training (CRT) plus Social Cognition Training (SCT) and CRT plus control groups were associated with significant reductions in aggression measures with no group differences except on a block of the Taylor Aggression Paradigm (TAP), a behavioral task of aggression which favored the CRT plus SCT group. Both groups showed significant improvements in neurocognition and social cognition measures with CRT plus SCT being associated with greater improvements. CONCLUSION CRT proved to be an effective non-pharmacological treatment in reducing impulsive aggression in schizophrenia inpatient participants with a history of aggressive episodes. The addition of social cognitive training did not enhance this anti-aggression treatment effect but did augment the CRT effect on cognitive functions, on emotion recognition and on mentalizing capacity of our participants.
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Affiliation(s)
- Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; Manhattan Psychiatric Center, 1 Wards Island Complex, Wards Island, NY 10035, USA.
| | - Jean-Pierre Lindenmayer
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; Manhattan Psychiatric Center, 1 Wards Island Complex, Wards Island, NY 10035, USA; New York University School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Beverly Insel
- Mount Sinai Medical Center, 5 East 98th Street, New York, NY 10029, USA
| | - Mary Seddo
- Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA
| | - Ecem Demirli
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Kayla DeFazio
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Mark Sullivan
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Matthew J Hoptman
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; New York University School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Anthony O Ahmed
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lo PMT, Lui SSY, Law CKM, Roberts DL, Siu AMH. A randomized controlled trial of social cognition and interaction training for persons with first episode psychosis in Hong Kong. Front Psychiatry 2023; 14:1098662. [PMID: 36960452 PMCID: PMC10029102 DOI: 10.3389/fpsyt.2023.1098662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Social cognitive impairment is a core limiting factor of functional recovery among persons with first episode psychosis (FEP). Social Cognition and Interaction Training (SCIT) is a group-based, manualized training with demonstrated evidence in improving social cognitive performance among people with schizophrenia. However, there are few studies on the effect of SCIT for people with FEP and for people in non-Western societies. This study evaluated the feasibility, acceptability and initial effectiveness of the locally-adapted SCIT in improving social cognitive functioning in Chinese people with FEP. The SCIT was delivered two sessions per week over a 10-weeks period, each session lasted for 60-90 min. A total of 72 subjects with FEP were recruited from an outpatient clinic and randomized to conventional rehabilitation ("Rehab") and experimental ("SCIT and Rehab") groups. Primary outcome measures included four social cognitive domains including emotion perception, theory-of-mind, attributional bias and jumping-to-conclusion, and secondary measures included neurocognition, social competence and quality of life. Participants were assessed at baseline, post-treatment, and 3-months post-treatment. Repeated measures ANCOVAs, with baseline scores as covariates, were used to compare the group differences in various outcomes across time. The results showed that the SCIT was well-accepted, with a satisfactory completion rate and subjective ratings of relevance in the experimental group. Moreover, treatment completers (n = 28) showed evidence of an advantage, over conventional group (n = 31), in reduced attributional bias and jumping-to-conclusions at treatment completion, lending initial support for the SCIT in Chinese people with FEP. Future research should address the limitations of this study, using more refined outcome measurements and higher treatment intensity of the SCIT.
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Affiliation(s)
- Panmi M. T. Lo
- Department of Occupational Therapy, Castle Peak Hospital, Hong Kong, Hong Kong SAR, China
| | - Simon S. Y. Lui
- Department of Occupational Therapy, Castle Peak Hospital, Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Colin K. M. Law
- Department of Occupational Therapy, Castle Peak Hospital, Hong Kong, Hong Kong SAR, China
| | - David L. Roberts
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, United States
| | - Andrew M. H. Siu
- Department of Health Sciences, Brunel University, London, United Kingdom
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Lohaus T, Rogalla S, Thoma P. Use of Technologies in the Therapy of Social Cognition Deficits in Neurological and Mental Diseases: A Systematic Review. Telemed J E Health 2023; 29:331-351. [PMID: 35532968 DOI: 10.1089/tmj.2022.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: This article systematically reviews the effects of technology-based (TB) treatments on impaired social cognition (SC) in neurological and mental disorders. Methods: Strictly adhering to the PRISMA guidelines, a systematic search was carried out in PsycINFO, PubMed, and Web of Science (last search: April 22, 2021) to identify studies that, implementing a control group design, evaluated TB treatments targeting deficits in emotion recognition, Theory of Mind (ToM) and social behavior in adult patients with nondevelopmental and nonprogressive neurological or mental disorders. Risk of bias was assessed using the PEDro Scale, certainty assessment followed the GRADE approach. Results: Sixteen studies involving 857 patients, all focusing on psychotic disorders, were retrieved. The most pronounced effects were observed concerning emotion recognition with all studies revealing overall improvements. Regarding ToM and social behavior, results were mixed. However, the number of studies including outcome measures for these domains, is significantly lower compared to the domain of emotion recognition, limiting the validity of the results. Risk of bias and certainty assessment revealed further limitations of evidence. Conclusion: TB treatment achieves positive effects especially with regard to emotion recognition impairments, at least for patients with schizophrenia. Future research should expand the evaluation of TB training of other SC domains, ought to be carried out in more diverse patient populations, rely on different devices, and include follow-up measurements.
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Affiliation(s)
- Tobias Lohaus
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Sally Rogalla
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Patrizia Thoma
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Mandal MK, Habel U, Gur RC. Facial expression-based indicators of schizophrenia: Evidence from recent research. Schizophr Res 2023; 252:335-344. [PMID: 36709656 DOI: 10.1016/j.schres.2023.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/28/2023]
Abstract
Impaired ability to recognize emotion in other's face (decoding) or to express emotion through the face (encoding) are considered critical in schizophrenia. The topic of research draws considerable attention since clinicians rely heavily on the patient's facial expressions for diagnosis and on the patient's ability to understand the clinician's communicative intent. While most researchers argue in favor of a generalized emotion deficit, others indicate an emotion-specific deficit in schizophrenia. An early review (Mandal et al., 1998) indicated a possible breakdown in perception-expression-experience link of emotion; later reviews (Kohler et al., 2010; Chan et al., 2010) pointed to a generalized emotion processing deficit due to perceptual deficits in schizophrenia. The present review (2010-2022) revisits this controversy with 47 published studies (37 decoding, 10 encoding) conducted on 2364 patients in 20 countries. Schizophrenia is characterized by reduced emotion processing ability, especially with negative symptoms and at an acute state of illness. It is however still unclear whether this dysfunction is independent of a generalized face perception deficit or of subjective experience of emotion in schizophrenia.
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Affiliation(s)
- Manas K Mandal
- Department of Humanities & Social Sciences, Indian Institute of Technology-Kharagpur, India.
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Ruben C Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
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Mororó LG, Guimarães AL, Costa AC, Genaro L, Cavalcanti MT, Scoriels L, Panizzutti R. Association between motivation and engagement with changes in cognition and symptoms after digital cognitive training in schizophrenia. Schizophr Res 2023; 251:1-9. [PMID: 36527953 DOI: 10.1016/j.schres.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/14/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Digital cognitive training can remediate cognitive deficits present in schizophrenia. However, limited motivation and engagement may impact adherence to training. Therefore, identifying factors that may enhance (facilitators) or decrease (barriers) engagement in digital cognitive training and possibly modulate its effects are of great clinical relevance. METHODS We measured cognition, symptom severity, motivation (semi-structured interview), and engagement (adapted Utrecht Work Engagement Scale - UWES) of 27 patients with schizophrenia after a 40-h digital cognitive training. The interview transcript quotes were coded and categorized into facilitators and barriers. Thereafter, we tested the association of motivation and engagement with changes in cognition and symptoms after training. RESULTS The facilitator 'good performance' and the barrier 'difficult exercise' were associated with larger gains in attention (p = 0.03) and reasoning and problem solving (p = 0.02), respectively. 'Poor performance' was associated with smaller gains in global cognition (p < 0.01), attention (p = 0.03), and working memory (p = 0.02). The facilitator 'welcoming setting' was associated with larger reductions in the negative (p = 0.01) and total (p = 0.01) symptoms measured by the Positive and Negative Syndrome Scale. The UWES engagement scale was associated with different facilitators and barriers that emerged from the interview, an indication of consistency among both qualitative and quantitative assessments. DISCUSSION Using a mixed quantitative and qualitative research design, we showed associations between motivation and engagement and the response to digital cognitive training in schizophrenia. Facilitators and barriers were associated with engagement, gains in cognition, and reduced symptoms after the intervention, providing insights on how to increase engagement in the digital cognitive training delivered to subjects with schizophrenia.
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Affiliation(s)
- Luana G Mororó
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Anna Luiza Guimarães
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Ana Carolina Costa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Larissa Genaro
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Maria T Cavalcanti
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Linda Scoriels
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris, Inserm 1266, Paris, France
| | - Rogerio Panizzutti
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
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Escolà-Gascón Á, Wright AC, Houran J. 'Feeling' or 'sensing' the future? Testing for anomalous cognitions in clinical versus healthy populations. Heliyon 2022; 8:e11303. [PMID: 36387525 PMCID: PMC9641201 DOI: 10.1016/j.heliyon.2022.e11303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/04/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
In the study and treatment of psychosis, emotional intelligence (EI) and thinking styles are important patient characteristics for successful outcomes in clinical intervention. Anticipation of unpredictable stimuli (AUS) may be understood as an anomalous perception and anomalous cognition in which an individual supposedly senses and recognizes future stimuli in an unexpected way, also referred to as “hunches or premonitions.” This examined the roles of EI and thinking styles in AUSs in convenience samples of healthy participants (n = 237) versus patients diagnosed with psychosis (n = 118). We adjusted several quadratic and exponential regression models according to the obtained functions. Group means were also compared to examine differences in EI scores for participants with psychosis compared to healthy participants. In the healthy group, EI predicted AUSs with a weight between 42% and 58%. Thinking styles were not correlated with AUSs. However, EI was not correlated with AUSs in the clinical group. Patients with psychosis tended to score higher on AUSs and lower on EI and thinking styles compared to participants in the healthy group. We discuss EI as a variable that can contextualize some anomalous perceptions which are otherwise difficult to classify or measure within the classic psychosis continuum model.
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Amadeo MB, Esposito D, Escelsior A, Campus C, Inuggi A, Pereira Da Silva B, Serafini G, Amore M, Gori M. Time in schizophrenia: a link between psychopathology, psychophysics and technology. Transl Psychiatry 2022; 12:331. [PMID: 35961974 PMCID: PMC9374791 DOI: 10.1038/s41398-022-02101-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
It has been widely demonstrated that time processing is altered in patients with schizophrenia. This perspective review delves into such temporal deficit and highlights its link to low-level sensory alterations, which are often overlooked in rehabilitation protocols for psychosis. However, if temporal impairment at the sensory level is inherent to the disease, new interventions should focus on this dimension. Beyond more traditional types of intervention, here we review the most recent digital technologies for rehabilitation and the most promising ones for sensory training. The overall aim is to synthesise existing literature on time in schizophrenia linking psychopathology, psychophysics, and technology to help future developments.
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Affiliation(s)
- Maria Bianca Amadeo
- U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy. .,Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa - Clinica Psichiatrica ed SPDC-Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE), Italy.
| | - Davide Esposito
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.5606.50000 0001 2151 3065Department of Informatics, Bioengineering, Robotics and Systems Engineering, Università degli Studi di Genova, Genoa, Italy
| | - Andrea Escelsior
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Campus
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Alberto Inuggi
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Beatriz Pereira Da Silva
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Gianluca Serafini
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Gori
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
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Fitapelli B, Lindenmayer J. Advances in Cognitive Remediation Training in Schizophrenia: A Review. Brain Sci 2022; 12:129. [PMID: 35203893 PMCID: PMC8870375 DOI: 10.3390/brainsci12020129] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive Remediation Training (CRT) in schizophrenia has made great strides since its introduction in the 1990s. CRT was developed with the aim of improving the everyday functioning of individuals living with cognitive impairment. MEDLINE, PsychINFO, and Google Scholar were searched to extract peer-reviewed randomized controlled trials to produce the current review article. The aim of the present review is to summarize CRT effects on addressing cognitive changes in patients undergoing CRT as defined by the Cognitive Remediation Experts Workshop and to describe the areas of greatest impact in specific cognitive domains. Another area of this review aims to summarize the modalities of intervention (paper and pencil; computerized; home bound), the persistence of improvements, and their generalization to other domains of functioning. Finally, this review delineates barriers for wider dissemination of CRT, such as the transfer of research findings into clinical everyday practice and future developments of CRT.
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Zhilyaeva T, Kasyanov E, Pyatoikina A, Blagonravova A, Mazo G. The association of serum folate levels with schizophrenia symptoms. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:128-135. [DOI: 10.17116/jnevro2022122081128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zhu X, Fan H, Zou Y, Tan Y, Yang F, Wang Z, Zhao Y, Fan F, Reeder C, Zhou D, Tan S, Wykes T. Computerized or manual? Long term effects of cognitive remediation on schizophrenia. Schizophr Res 2022; 239:47-54. [PMID: 34839074 DOI: 10.1016/j.schres.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cognitive remediation therapy (CRT) and Computerized CRT (CCRT) improve cognition and functioning, but there is no direct evidence of whether there is an advantage of using a computer. This study fills this gap and extends research evidence to the long-term effect of these two treatments in a large sample of Chinese inpatients with a diagnosis of schizophrenia. METHOD We conducted a randomized single-blind, follow-up study with participants randomized to receive CCRT (n = 144), CRT (n = 72) or Active control (n = 54) for 12 weeks with 4-5 sessions per week. The main outcome was cognition (MATRICS Consensus Cognitive Battery total score, MCCB), and secondary outcomes were cognitive domains, symptoms and functioning assessed at baseline (0 month), post-treatment (3 months) and follow-up (6, 12 and 18 months). RESULTS The primary outcome (MCCB total score) improved in both treatment groups which was maintained at 18 months but did not differ between treatment groups. Post hoc analysis demonstrated that the CRT group had an advantage over CCRT for the Trail Making and Symbol Coding Tests (all p < 0.05), which lasted for almost 18 months. CONCLUSIONS Both CCRT and CRT contribute to general cognitive improvements in schizophrenia and the overall efficacy was similar. The effects were maintained for 18th months. Exploratory analyses revealed few differences except that CRT had a processing speed advantage.
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Affiliation(s)
- Xiaolin Zhu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Yizhuang Zou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China.
| | - Yunlong Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Yanli Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Fengmei Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Dongfeng Zhou
- Institute of Mental Health, Peking University, Beijing 100191, PR China
| | - Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China.
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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Palumbo D, Caporusso E, Piegari G, Mencacci C, Torriero S, Giuliani L, Fabrazzo M, Pinto D, Galderisi S. Social Cognition Individualized Activities Lab for Social Cognition Training and Narrative Enhancement in Patients With Schizophrenia: A Randomized Controlled Study to Assess Efficacy and Generalization to Real-Life Functioning (Prot. n°: NCT05130853). Front Psychiatry 2022; 13:833550. [PMID: 35444577 PMCID: PMC9015661 DOI: 10.3389/fpsyt.2022.833550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Subjects affected by schizophrenia present significant deficits in various aspects of social cognition, such as emotion processing, social perception and theory of mind (ToM). These deficits have a greater impact than symptoms on occupational and social functioning. Therefore, social cognition represents an important therapeutic target in people with schizophrenia. Recent meta-analyses showed that social cognition training (SCT) is effective in improving social cognition in subjects with schizophrenia; however, real-life functioning is not always ameliorated. Integration of SCT with an intervention targeting metacognitive abilities might improve the integration of social cognitive skills to daily life functioning. Our research group has implemented a new individualized rehabilitation program: the Social Cognition Individualized Activities Lab, SoCIAL, which integrates SCT with a module for narrative enhancement, an intervention targeting metacognitive abilities. The present multi-center randomized controlled study will compare the efficacy of SoCIAL and treatment as usual (TAU) in subjects diagnosed with a schizophrenia-spectrum disorder. The primary outcome will be the improvement of social cognition and real-life functioning; while the secondary outcome will be the improvement of symptoms, functional capacity and neurocognition. The results of this study will add empirical evidence to the benefits and feasibility of SCT and narrative enhancement in people with schizophrenia-spectrum disorders.
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Affiliation(s)
- Davide Palumbo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giuseppe Piegari
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Claudio Mencacci
- Department of Psychiatry and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sara Torriero
- Department of Psychiatry and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Dario Pinto
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
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15
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Wölwer W, Frommann N, Lowe A, Kamp D, Weide K, Bechdolf A, Brockhaus-Dumke A, Hurlemann R, Muthesius A, Klingberg S, Hellmich M, Schmied S, Meyer-Lindenberg A. Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study). Front Psychiatry 2022; 13:909370. [PMID: 35800017 PMCID: PMC9253387 DOI: 10.3389/fpsyt.2022.909370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although clinically effective treatment is available for schizophrenia, recovery often is still hampered by persistent poor psychosocial functioning, which in turn is limited by impairments in neurocognition, social cognition, and social behavioral skills. Although cognitive remediation has shown general efficacy in improving cognition and social functioning, effects still need to be improved and replicated in appropriately powered, methodologically rigorous randomized controlled trials (RCTs). Existing evidence indicates that effects can most likely be optimized by combining treatment approaches to simultaneously address both social cognitive and social behavioral processes. OBJECTIVES To assess whether Integrated Social Cognitive and Behavioral Skill Therapy (ISST) is more efficacious in improving functional outcome in schizophrenia than the active control treatment Neurocognitive Remediation Therapy (NCRT). METHODS The present study is a multicenter, prospective, rater-blinded, two-arm RCT being conducted at six academic study sites in Germany. A sample of 180 at least partly remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST is a compensatory, strategy-based program that targets social cognitive processes and social behavioral skills. NCRT comprises mainly drill and practice-oriented neurocognitive training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause discontinuation over the 12-month study period; psychosocial functioning, quality of life, neurocognitive and social cognitive performance, and clinical symptoms are assessed as secondary outcomes at baseline before randomization (V1), at the end of the six-month treatment period (V6), and at the six-month follow-up (V12). DISCUSSION This RCT is part of the German Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) research network, which aims at using innovative treatments to enhance prevention and recovery in patients with schizophrenia. Because this study is one of the largest and methodologically most rigorous RCTs on the efficacy of cognitive remediation approaches in schizophrenia, it will not only help to identify the optimal treatment options for improving psychosocial functioning and thus recovery in patients but also allow conclusions to be drawn about factors influencing and mediating the effects of cognitive remediation in these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02678858, German Study Register DRKS 00010033.
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Affiliation(s)
- Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and Soulspace, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Alzey, Germany.,Department of Psychiatry and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Rene Hurlemann
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Oldenburg, Oldenburg, Germany
| | - Ana Muthesius
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Clinical Trials Center, University of Cologne, Cologne, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Giordano GM, Giuliani L, Perrottelli A, Bucci P, Di Lorenzo G, Siracusano A, Brando F, Pezzella P, Fabrazzo M, Altamura M, Bellomo A, Cascino G, Comparelli A, Monteleone P, Pompili M, Galderisi S, Maj M. Mismatch Negativity and P3a Impairment through Different Phases of Schizophrenia and Their Association with Real-Life Functioning. J Clin Med 2021; 10:5838. [PMID: 34945138 PMCID: PMC8707866 DOI: 10.3390/jcm10245838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Impairment in functioning since the onset of psychosis and further deterioration over time is a key aspect of subjects with schizophrenia (SCZ). Mismatch negativity (MMN) and P3a, indices of early attention processing that are often impaired in schizophrenia, might represent optimal electrophysiological candidate biomarkers of illness progression and poor outcome. However, contrasting findings are reported about the relationships between MMN-P3a and functioning. The study aimed to investigate in SCZ the influence of illness duration on MMN-P3a and the relationship of MMN-P3a with functioning. Pitch (p) and duration (d) MMN-P3a were investigated in 117 SCZ and 61 healthy controls (HCs). SCZ were divided into four illness duration groups: ≤ 5, 6 to 13, 14 to 18, and 19 to 32 years. p-MMN and d-MMN amplitude was reduced in SCZ compared to HCs, independently from illness duration, psychopathology, and neurocognitive deficits. p-MMN reduction was associated with lower "Work skills". The p-P3a amplitude was reduced in the SCZ group with longest illness duration compared to HCs. No relationship between P3a and functioning was found. Our results suggested that MMN amplitude reduction might represent a biomarker of poor functioning in SCZ.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Paola Bucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.D.L.); (A.S.)
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.D.L.); (A.S.)
| | - Francesco Brando
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Mario Altamura
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Antonello Bellomo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, 84133 Salerno, Italy; (G.C.); (P.M.)
| | - Anna Comparelli
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (A.C.); (M.P.)
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, 84133 Salerno, Italy; (G.C.); (P.M.)
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (A.C.); (M.P.)
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
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Iozzino L, Harvey PD, Canessa N, Gosek P, Heitzman J, Macis A, Picchioni M, Salize HJ, Wancata J, Koch M, Ferrari C, de Girolamo G. Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study. Transl Psychiatry 2021; 11:620. [PMID: 34880208 PMCID: PMC8651972 DOI: 10.1038/s41398-021-01749-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Neurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence. METHODS Overall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery. RESULTS Education and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group. CONCLUSIONS These results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice.
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Affiliation(s)
- Laura Iozzino
- grid.419422.8Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Philip D. Harvey
- grid.26790.3a0000 0004 1936 8606Department of Psychiatry and Behavioral Sciences; Research Service, University of Miami Miller School of Medicine, Miami, FL USA
| | - Nicola Canessa
- grid.30420.350000 0001 0724 054XScuola Universitaria Superiore IUSS, IUSS Cognitive Neuroscience (ICoN) Center, Pavia, Italy ,grid.511455.1Cognitive Neuroscience Laboratory of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Pawel Gosek
- grid.418955.40000 0001 2237 2890Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Heitzman
- grid.418955.40000 0001 2237 2890Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Ambra Macis
- grid.419422.8Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marco Picchioni
- grid.13097.3c0000 0001 2322 6764Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,St Magnus Hospital, Haslemere, Surrey UK
| | - Hans Joachim Salize
- grid.413757.30000 0004 0477 2235Medical Faculty Mannheim/Heidelberg University, Central Institute of Mental Health Mannheim, Mannheim, Germany
| | - Johannes Wancata
- grid.22937.3d0000 0000 9259 8492Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Marlene Koch
- grid.22937.3d0000 0000 9259 8492Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Clarissa Ferrari
- grid.419422.8Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Nuño L, Guilera G, Rojo E, Gómez-Benito J, Barrios M. An Integrated Account of Expert Perspectives on Functioning in Schizophrenia. J Clin Med 2021; 10:jcm10184223. [PMID: 34575332 PMCID: PMC8465628 DOI: 10.3390/jcm10184223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022] Open
Abstract
An integrated and interdisciplinary care system for individuals with schizophrenia is essential, which implies the need for a tool that assesses the difficulties and contextual factors of relevance to their functioning, and facilitates coordinated working across the different professions involved in their care. The International Classification of Functioning, Disability and Health Core Sets (ICF-CS) cover these requirements. This study aimed to evaluate the content validity of the ICF-CSs for schizophrenia from the perspective of experts. Six three-round Delphi studies were conducted with expert panels from different professional backgrounds which have played a significant role in the treatment of individuals with schizophrenia (psychiatry, psychology, nursing, occupational therapy, social work and physiotherapy). In total, 790 experts from 85 different countries participated in the first round. In total, 90 ICF categories and 28 Personal factors reached expert consensus (reached consensus from four or more professional perspectives). All the categories in the brief version of the ICF-CS for schizophrenia reached consensus from all the professional perspectives considered. As for the comprehensive version, 89.7% of its categories reached expert consensus. The results support the worldwide content validity of the ICF-CSs for schizophrenia from an expert perspective and underline the importance of assessing functioning by considering all the components implied.
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Affiliation(s)
- Laura Nuño
- Clinical Institute of Neuroscience (ICN), Hospital Clinic, 08036 Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, 08007 Barcelona, Spain; (G.G.); (J.G.-B.); (M.B.)
- Correspondence:
| | - Georgina Guilera
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, 08007 Barcelona, Spain; (G.G.); (J.G.-B.); (M.B.)
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, 08007 Barcelona, Spain
| | - Emilio Rojo
- Hospital Benito Menni CASM, Sisters Hospitallers, 08830 Sant Boi de Llobregat, Spain;
- Department of Psychiatry, International University of Catalonia, 08007 Barcelona, Spain
| | - Juana Gómez-Benito
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, 08007 Barcelona, Spain; (G.G.); (J.G.-B.); (M.B.)
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, 08007 Barcelona, Spain
| | - Maite Barrios
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, 08007 Barcelona, Spain; (G.G.); (J.G.-B.); (M.B.)
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, 08007 Barcelona, Spain
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Haddad C, Salameh P, Hallit S, Sacre H, Clément JP, Calvet B. Self-assessment of social cognition in a sample of Lebanese in-patients with schizophrenia. Schizophr Res Cogn 2021; 26:100207. [PMID: 34522626 PMCID: PMC8427464 DOI: 10.1016/j.scog.2021.100207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022]
Abstract
Objective The primary objective was to evaluate social cognitive complaints in a sample of chronic in-patients with schizophrenia and compare it to healthy controls. The secondary objective was to explore factors related to social cognitive complaints in these patients, such as neurocognition, clinical symptoms, depression, and insight. Methods A cross-sectional study conducted between July 2019 and March 2020 at the Psychiatric Hospital of the Cross (HPC)-Lebanon enrolled 120 chronic in-patients diagnosed with schizophrenia and schizoaffective disorders and 60 healthy controls. The Self-Assessment of Social Cognition Impairments (ACSo) scale was used to assess social cognitive complaints. Results A significant difference was found between schizophrenia patients and healthy controls in all social cognitive complaints: theory of mind complaint, attributional biases complaint, emotional processes complaint, and social perception and knowledge complaint (p < 0.001 for all). All objective cognitive disorders were significantly associated with social cognitive complaints except for attention and speed of information processing. Higher verbal memory and verbal fluency were significantly associated with lower emotional processes complaint scores. The results of the multivariate analysis showed that a higher cognition (Beta = −0.08, p = 0.001) was significantly associated with a lower social cognitive complaint, contrary a higher depression (Beta = 0.38, p = 0.04) was significantly associated with a higher social cognitive complaint, in particular attributional biases complaints. Conclusion This study showed that patients with schizophrenia have complaints about their social cognition. It could also demonstrate that subjective social cognitive complaints are correlated with depressive symptoms and objective cognitive deficits among these patients. Individuals with schizophrenia often have impairments in social cognition Despite low insight, patients report difficulties in their social cognitive skills. A correlation exists between neurocognition and subjective social cognition in schizophrenia Clinical symptoms (positive and negative symptoms) were not associated with social cognitive complaints Social cognitive complaints might help in cognitive remediation and therapy
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Key Words
- AB, attributional bias
- ACSo, Self-Assessment of Social Cognition Impairments
- ADS, Anticholinergic Drug Scale
- BACS, Brief Assessment of Cognition in Schizophrenia
- CDSS, Calgary Depression Scale for Schizophrenia
- Cognitive complaint
- DSM, Diagnostic and Statistical Manual of Mental Disorders
- EP, emotional processing
- HPC, Psychiatric Hospital of the Cross
- MANCOVA, multivariate analysis of covariance
- Neurocognition
- PANSS, Positive and Negative Syndrome Scale
- SASCCS, Self-Assessment Scale of Cognitive Complaints in Schizophrenia
- SP, social perception and knowledge
- SPSS, Statistical Package for Social Sciences
- Schizophrenia
- Social cognition
- TOM, theory of mind
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Affiliation(s)
- Chadia Haddad
- INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Pôle Universitaire de Psychiatrie de l'Adulte, de l'Agée et d'Addictologie, centre hospitalier Esquirol, 87025 Limoges, France.,INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.,University of Nicosia Medical School, Nicosia, Cyprus
| | - Souheil Hallit
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Jean-Pierre Clément
- INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Pôle Universitaire de Psychiatrie de l'Adulte, de l'Agée et d'Addictologie, centre hospitalier Esquirol, 87025 Limoges, France
| | - Benjamin Calvet
- INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Pôle Universitaire de Psychiatrie de l'Adulte, de l'Agée et d'Addictologie, centre hospitalier Esquirol, 87025 Limoges, France.,Unité Recherche et Innovations, Centre Hospitalier Esquirol, 87025 Limoges, France
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20
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Wright AC, McGurk SR, Shaya Y, Feldman K, Mueser KT. Does comprehensive cognitive remediation improve emotion perception? Cogn Neuropsychiatry 2021; 26:343-356. [PMID: 34180363 DOI: 10.1080/13546805.2021.1946386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Social cognition, including emotion perception, is impaired in people with serious mental illnesses (SMI), and is associated with cognitive and community functioning. Cognitive remediation can improve neurocognition, but the impact on emotion perception has been less well studied. The current study aimed to evaluate the efficacy of a cognitive remediation programme in improving emotion perception.Methods: Thirty-seven people with SMI and a history of difficulties obtaining employment were randomised to either vocational rehabilitation only, or vocational rehabilitation combined with cognitive remediation. Participants were assessed at baseline and post-treatment on a neurocognitive battery, work history, and emotion perception.Results: The cognitive remediation group did not improve more than the vocational rehabilitation only group on either measure of emotion perception, despite significantly greater gains in cognitive functioning. Baseline emotion identification, but not discrimination, was significantly associated with cognition and work history.Conclusions: Despite associations between social and neurocognition, there was no evident transfer of cognitive gains to performance on measures of emotion perception. The findings, though limited by a small sample size, are important in expanding the research indicating that the effects of cognitive remediation tend to be limited to the specific cognitive domains targeted in the program.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial & Systemic Research, Department of Psychiatry, Massachusetts General Hospital. Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan R McGurk
- Departments of Occupational Therapy, Psychological and Brain Sciences, The Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Yaniv Shaya
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | | | - Kim T Mueser
- Departments of Occupational Therapy, Psychological and Brain Sciences, The Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
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21
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Baez S, Fittipaldi S, de la Fuente LA, Carballo M, Ferrando R, García-Cordero I, Gonzalez Campo C, Garcia AM, Sedeño L, Ibáñez A. Empathy deficits and their behavioral, neuroanatomical, and functional connectivity correlates in smoked cocaine users. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110328. [PMID: 33865925 DOI: 10.1016/j.pnpbp.2021.110328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
Reduced empathic abilities are frequently observed in drug abusers. These deficits may compromise interpersonal interactions and contribute to diminished social functioning. However, previous evidence regarding empathy and addiction is behaviorally unspecific and virtually null in terms of their brain structural or functional correlates. Moreover, no previous study has investigated how empathy is affected by drugs whose consumption is particularly characterized by counter-empathic behaviors. Here, we conducted the first assessment of neurocognitive correlates of empathy for pain in dependent users (predominantly men) of smoked cocaine (SC, coca paste, n = 37). We compared their performance in the empathy task with that of two groups matched in relevant demographic variables: 24 dependent users of insufflated cocaine hydrochloride (CC) and 21 healthy controls. In addition, we explored the structural anatomy and functional connectivity (FC) correlates of empathic impairments across groups. Our results showed that, compared to CC and controls, SC users exhibited a selective reduction of empathic concern for intentional harms. These impairments were associated with lower gray matter volumes in regions subserving social cognition (i.e., right inferior parietal lobule, supramarginal and angular gyri). Furthermore, reduced empathic concern correlated with FC within affective empathy and social cognition networks, which are also linked to cognitive changes reported in addiction (i.e., inferior frontal and orbital gyri, posterior insula, supplementary motor area, cingulate cortex). Our findings suggest that chronic consumption of SC may involve reduced empathic concern and relevant neuroanatomical and FC abnormalities, which, in turn, may result in social interaction dysfunction. These results can inform theoretical and applied developments in neuropsychopharmacology.
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22
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Montemagni C, Del Favero E, Riccardi C, Canta L, Toye M, Zanalda E, Rocca P. Effects of Cognitive Remediation on Cognition, Metacognition, and Social Cognition in Patients With Schizophrenia. Front Psychiatry 2021; 12:649737. [PMID: 34305668 PMCID: PMC8299002 DOI: 10.3389/fpsyt.2021.649737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
We aimed to evaluate in a sample of outpatients with schizophrenia (SCZ) the effectiveness of a cognitive remediation (CR) program (through the use of the Cogpack software) [computer-assisted CR (CACR)] in addition to standard therapy on cognitive outcomes as compared with that in a control active group (CAG) and to highlight a possible effect on social cognition (SC), metacognition, symptomatology, and real-world functioning. Of the 66 subjects enrolled, 33 were allocated to CACR and 33 to the CAG. Twenty-three patients in the CACR group and 25 subjects in the CAG completed at least 80% of the 48 prescribed CACR sessions, performed twice a week, for a total of 24 weeks of treatment. A significant time × group interaction was evident, suggesting that patients undergoing CACR intervention improved in specific metacognitive sub-functions (understanding others' mind and mastery), some cognitive domains (verbal learning processing speed, visual learning, reasoning, and problem solving) (h2 = 0.126), depressive symptoms, SC, awareness of symptoms, and real-world functioning domains (community activities and interpersonal relationships) more significantly than did patients undergoing CAG. The most noticeable differential improvement between the two groups was detected in two metacognitive sub-functions (understanding others' mind and mastery), in verbal learning, in interpersonal relationship, and in depressive symptomatology, achieving large effect sizes. These are encouraging findings in support of the possible integration of CACR in rehabilitation practice in the Italian mental health services.
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Affiliation(s)
- Cristiana Montemagni
- Department of Neuroscience "Rita Levi Montalcini", Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Elisa Del Favero
- Department of Neuroscience "Rita Levi Montalcini", Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Cecilia Riccardi
- Department of Neuroscience "Rita Levi Montalcini", Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Laura Canta
- Department of Mental Health, Azianda Sanitaria Locale (ASL) TO3 & Azienda Ospedaliera Universitaria (AOU) San Luigi Gonzaga, Orbassano, Italy
| | - Mario Toye
- Department of Mental Health, Azianda Sanitaria Locale (ASL) TO3 & Azienda Ospedaliera Universitaria (AOU) San Luigi Gonzaga, Orbassano, Italy
| | - Enrico Zanalda
- Department of Mental Health, Azianda Sanitaria Locale (ASL) TO3 & Azienda Ospedaliera Universitaria (AOU) San Luigi Gonzaga, Orbassano, Italy
| | - Paola Rocca
- Department of Neuroscience "Rita Levi Montalcini", Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, University of Turin, Turin, Italy
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23
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Harris AWF, Kightley M, Williams J, Ma C, Dodds C. Does Adding Social Cognitive Remediation Therapy to Neurocognitive Remediation Therapy Improve Outcomes in Young People With a Severe Mental Illness?-The Advantage Trial. Front Psychiatry 2021; 12:789628. [PMID: 35368729 PMCID: PMC8964396 DOI: 10.3389/fpsyt.2021.789628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cognitive impairments are a common and significant issue for young people with a severe mental illness. Young people with schizophrenia, bipolar disorder and major depression all experience significant cognitive problems that impede their ability to return to work or study. These neurocognitive problems are frequently exacerbated by social cognitive deficits that interfere with their ability to integrate into the community and understand the social and emotional nuances about them. This study aimed to assess if the addition of a social cognitive remediation treatment to a neurocognitive remediation therapy improved functional outcome. METHODS Five youth mental health services were trained in both the Neuropsychological Educational Approach to Remediation (NEAR) and the Social Cognition and Interaction Training (SCIT) treatments. Participants were randomised between receiving either NEAR + SCIT or NEAR + treatment as usual (TAU) over a 20-week period, with all participants receiving the NEAR treatment first. Symptoms, neurocognition, social cognition and functioning were examined at baseline, end of treatment and at 3 months follow-up and compared between the two arms of the study. The primary outcome was function. RESULTS Thirty-nine participants were randomised to treatment (Schizophrenia spectrum = 28, Bipolar disorder = 7, Major Depression = 2). The trial was curtailed by Covid-related service restrictions. There was an overall significant improvement in function over time with a trend towards a greater improvement in the NEAR + SCIT arm. No changes in symptoms, neurocognitive or social cognitive measures were seen. While 74% completed treatment only 49% agreed to follow up at 3 months affecting our ability to interpret the findings. Attrition did not differ by arm. CONCLUSIONS In a pragmatic, service-based research project, treatment aimed at improving cognition enhanced functional outcome in young people with a range of severe mental illnesses. There was a trend towards improved function in young people who had a combined NEAR + SCIT approach. CLINICAL TRIAL REGISTRATION Identifier: ACTRN12622000192785.
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Affiliation(s)
- Anthony W F Harris
- Specialty of Psychiatry, University of Sydney School of Medicine, The University of Sydney, Sydney, NSW, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Child and Youth Mental Health Service, Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Michelle Kightley
- Child and Youth Mental Health Service, Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Joanna Williams
- Child and Youth Mental Health Service, Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Cassandra Ma
- Child and Youth Mental Health Service, Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Carlie Dodds
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
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24
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Valaparla VL, Nehra R, Mehta UM, Grover S. Social cognitive deficits in schizophrenia and their neurocognitive correlates across the different phases of illness. Asian J Psychiatr 2021; 55:102501. [PMID: 33296864 DOI: 10.1016/j.ajp.2020.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/01/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022]
Abstract
AIM This study aimed to assess the relationship between neurocognition (NC) and social cognition (SC) in patients with schizophrenia during the symptomatic phase and the phase of clinical remission. METHODOLOGY Thirty-two patients were assessed on Color trail test (CTT), Hopkins verbal learning test (HVLT), Controlled oral word association (COWA) test, Wisconsin card sorting test (WCST), Ravens standard progressive matrices (SPM) and Social cognition rating tool in Indian setting (SOCRATIS) during symptomatic and remission phases of illness at least 3 months apart. RESULTS Compared to baseline assessment, even after controlling for PANSS scores except for social perception index all other domains of SC showed significant improvement at the time of remission. Although there was significant improvement in a few subtests of verbal learning, IQ and number of correct responses of COWA, colour trail test, no significant difference was seen in performance on WCST. Although second order theory of mind task had some association with IQ at the baseline assessment, no association was seen between SC and NC in the remission phase. CONCLUSIONS To conclude, present study suggests that impairments in all the domains of SC (except for social perception index) and NC (except for WCST) improve in the remission phase.
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Affiliation(s)
| | - Ritu Nehra
- Department of Psychiatry, PGIMER, Chandigarh, 160012, India
| | | | - Sandeep Grover
- Department of Psychiatry, PGIMER, Chandigarh, 160012, India.
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25
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Affiliation(s)
- Anthony O Ahmed
- Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
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26
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Abstract
Deficits in social cognition are common in people with psychotic disorders and negatively impact functioning. Social Cognition Training (SCT) has been found to improve social cognition and functioning, but it is unknown which interventions are most effective, how characteristics of treatments and participants moderate efficacy, and whether improvements are durable. This meta-analysis included 46 randomized studies. SCTs were categorized according to their focus (targeted/broad-based) and inclusion of cognitive remediation therapy (CRT). Network meta-analysis was conducted, using both direct (original) and indirect (inferred from the network of comparisons) evidence. All SCT types were compared to treatment as usual (TAU; the chosen reference group). Moderators of outcome were investigated with meta-regression and long-term efficacy with multivariate meta-analysis. Compared to TAU, emotion perception was improved by targeted SCT without CRT (d = 0.68) and broad-based SCT without CRT (d = 0.46). Individual treatments worked better for emotion perception. All treatments significantly improved social perception (active control, d = 0.98, targeted SCT with and without CRT, d = 1.38 and d = 1.36, broad-based SCT with and without CRT, d = 1.45 and d = 1.35). Only broad-based SCT (d = 0.42) improved ToM. Broad-based SCT (d = 0.82 without and d = 0.41 with CRT) improved functioning; group treatments worked significantly better. Male gender was negatively related to effects on social functioning and psychiatric symptoms. At follow-up, a moderate effect on social functioning (d = 0.66) was found. No effect was found on attribution, social cognition (miscellaneous), and psychiatric symptoms. While targeted SCT is the most effective for emotion perception and social perception, broad-based SCT produces the best overall outcomes. CRT did not enhance SCT effects.
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Affiliation(s)
- Saskia A Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth C D van der Stouwe
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
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27
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Jung M, Baik SY, Kim Y, Kim S, Min D, Kim JY, Won S, Lee SH. Empathy and Social Attribution Skills Moderate the Relationship between Temporal Lobe Volume and Facial Expression Recognition Ability in Schizophrenia. Clin Psychopharmacol Neurosci 2020; 18:362-374. [PMID: 32702215 PMCID: PMC7383013 DOI: 10.9758/cpn.2020.18.3.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Objective While impaired facial expression recognition has been closely associated with reduced temporal lobe volume in patients with schizophrenia, this study aimed at examining whether empathy and social attribution affect such a relationship. Methods A total of 43 patients with schizophrenia and 43 healthy controls underwent a facial expression recognition task (FERT) and magnetic resonance imaging. Basic empathy scale and the social attribution task-multiple choice were used to measure empathy and social attribution. Results Patients with schizophrenia showed significant positive correlations between the total temporal lobe volume and the FERT-accuracy (FERT-ACC). Diminished temporal lobe volume predicted the impaired facial emotion recognition ability. Both empathy and social attribution played roles as moderators of the path from the left amygdala volume, left fusiform gyrus volume, both sides of the superior temporal gyrus volume, and left middle temporal gyrus volume to the FERT-ACC. In contrast, empathy alone functioned as a moderator between the right fusiform gyrus volume, right middle temporal gyrus volume, and FERT-ACC. No significant interaction was found for healthy controls. Conclusion Our results suggest that social cognition remediation training on empathy and social attribution, could buffer the negative effects of small temporal lobe volume on interpersonal emotional communication in patients with schizophrenia.
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Affiliation(s)
- Minjee Jung
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seung Yeon Baik
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Yourim Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Sungkean Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Dongil Min
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Jeong-Youn Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seunghee Won
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea.,Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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28
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García-Fernández L, Cabot-Ivorra N, Romero-Ferreiro V, Pérez-Martín J, Rodriguez-Jimenez R. Differences in theory of mind between early and chronic stages in schizophrenia. J Psychiatr Res 2020; 127:35-41. [PMID: 32460156 DOI: 10.1016/j.jpsychires.2020.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 01/01/2023]
Abstract
The evolution of social cognition throughout the course of schizophrenia is unclear not being possible to state whether it remains stable from early stages to chronicity, or it changes as the disease develops. For this purpose, 90 patients with schizophrenia and 139 healthy controls have been compared establishing 4 different groups paired by age and gender: first episode of psychosis patients (FEP), young healthy controls (YHC), chronic patients with schizophrenia (CS) and adult healthy controls (AHC). Performance in Theory of Mind (ToM) has been assessed using The Hinting Task and The Reading the Mind in the Eyes Test (RMET). In the Hinting Task, when comparing patients with their respective control group, differences found between CS patients and their corresponding controls (p < .001) are much bigger (almost twice) than differences between FEP patients and young controls (p = .001). In fact, young and adult healthy controls did not significantly differ in their scores, while the CS group showed significant worse performance than the FEP group. In the Reading the Mind in the Eyes test (RMET), patients globally performed worse than controls (p < .001). However, the Cohort × Diagnosis interaction was not significant (p = .27). In this task, there were no differences between CS and FEP scores. In conclusion, data suggest poor performance in all phases of the disease with a probable worsening related to chronicity especially in the aspects of social cognition measured by the Hinting Task.
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Affiliation(s)
- Lorena García-Fernández
- Department of Clinical Medicine, Universidad Miguel Hernández, Edificio Muhammad Al-Shafra, Campus de San Juan, Ctra. de Valencia, Km 87, 03550, San Juan, Alicante, Spain; Department of Psychiatry, Hospital Universitario de San Juan, Alicante. Ctra. Nacional. 332, S/n, 03550, San Juan, Alicante, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain.
| | - Nuria Cabot-Ivorra
- Doctoral School, Universidad Católica de Valencia San Vicente Mártir, C/ Guillem de Castro, 65 bajo, 46008, Valencia, Spain.
| | - Verónica Romero-Ferreiro
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Brain Mapping Unit, Instituto Pluridisciplinar, Complutense University of Madrid, Paseo Juan XXIII, 1, 28040, Madrid, Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas 12), Av. Córdoba S/n, 28041, Madrid, Spain.
| | - Jorge Pérez-Martín
- Department of Psychiatry, Hospital Universitario de San Juan, Alicante. Ctra. Nacional. 332, S/n, 03550, San Juan, Alicante, Spain.
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas 12), Av. Córdoba S/n, 28041, Madrid, Spain; CogPsy-Group. Universidad Complutense (UCM), Madrid, Spain.
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29
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Aşık E, Ünsal G. An evaluation of a psychoeducation programme for emotion identification and expression in individuals diagnosed with schizophrenia. Int J Ment Health Nurs 2020; 29:693-702. [PMID: 32061042 DOI: 10.1111/inm.12703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
The inability of individuals diagnosed with schizophrenia to recognize facial expressions is an important issue that has an impact on social functioning. This study was conducted to determine the effects of a psychoeducation programme for emotion identification and expression in those diagnosed with schizophrenia on their ability to identify and discriminate between emotions and social functionality. This quasi-experimental study (pretest-post-test, with control group) comprised an intervention (21) and a control (21) group conducted with individuals diagnosed with schizophrenia. A 10-week psychoeducation programme was offered to the intervention group. Measuring instruments were administered to the groups before the intervention, after the intervention, and 3 months after that. The measuring instruments consisted of a personal information form, the Facial Emotion Identification Test, Facial Emotion Discrimination Test, and Personal and Social Performance Scale. The data were analysed using the 'two-way repeated measures analysis of variance'. The TREND method was used for reporting. In the first measurements taken after the psychoeducation programme, a significant difference was found between the two groups in terms of their 'Facial Emotion Identification Test' and 'Personal and Social Performance Scale' mean scores. In the measurements taken 3 months after the psychoeducation programme, this difference had disappeared. The psychoeducation programme is an effective programme that makes recognition of facially expressed emotions possible and increases the social functioning of patients.
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Affiliation(s)
- Elif Aşık
- Department of Nursing, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - Gül Ünsal
- Department of Psychiatric Nursing, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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30
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Bitter N, Roeg D, van Nieuwenhuizen C, van Weeghel J. Recovery in Supported Accommodations: A Scoping Review and Synthesis of Interventions for People with Severe Mental Illness. Community Ment Health J 2020; 56:1053-1076. [PMID: 32016620 PMCID: PMC7289772 DOI: 10.1007/s10597-020-00561-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
Research on the recovery domains beside clinical recovery of people with severe mental illness in need of supported accommodations is limited. The aim of this study was (1) to investigate which recovery interventions exist for this group of people and (2) to explore the scientific evidence. We conducted a scoping review, including studies with different designs, evaluating the effectiveness the recovery interventions available. The search resulted in 53 eligible articles of which 22 focused on societal recovery, six on personal recovery, five on functional recovery, 13 on lifestyle-interventions, and seven on creative and spiritual interventions. About a quarter of these interventions showed added value and half of them initial promising results. The research in this area is still limited, but a number of recovery promoting interventions on other areas than clinical recovery have been developed and evaluated. Further innovation and research to strengthen and repeat the evidence are needed.
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, PO Box 909, 5600, AX, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900, AH, Castricum, The Netherlands
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Frajo-Apor B, Kemmler G, Pardeller S, Huber M, Macina C, Welte AS, Hoertnagl C, Hofer A. Emotional intelligence in bipolar-I-disorder: A comparison between patients, unaffected siblings, and control subjects. Eur Psychiatry 2020; 63:e69. [PMID: 32594936 PMCID: PMC7443786 DOI: 10.1192/j.eurpsy.2020.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Impairments in social and nonsocial cognition have been demonstrated in both patients suffering from bipolar disorder (BD) and their unaffected relatives and might therefore represent a heritable marker of risk. This study investigated the relevance of emotional intelligence (EI) as part of the emotion processing domain of social cognition in this regard. METHODS A total of 54 outpatients suffering from BD, 54 unaffected siblings, and 80 control subjects were investigated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the Brief Assessment of Cognition in Schizophrenia (BACS). Analyses of covariance (ANCOVAs) were performed with adjustment for the BACS composite score. The three groups were compared by one-way analysis of variance or chi-square test, depending on the variable type. As the three groups differed significantly in their level of education, additional ANCOVAs with adjustment for education were performed. RESULTS Patients achieved significantly lower levels of overall EI and overall nonsocial cognitive functioning compared to unaffected siblings and controls, whereas performance of the latter two groups was comparable in both domains. CONCLUSIONS Due to comparable levels of EI in unaffected siblings of patients suffering from BD and control subjects, EI assessed by means of the MSCEIT does not represent an endophenotype for BD.
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Affiliation(s)
- Beatrice Frajo-Apor
- Department of Psychiatry, Psychotherapy and Psychosomatics: Division of Psychiatry I, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics: Division of Psychiatry I, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Silvia Pardeller
- Department of Psychiatry, Psychotherapy and Psychosomatics: Division of Psychiatry I, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Markus Huber
- Department of Psychiatry, General Hospital Brunico, 39031 Brunico, Italy
| | - Christian Macina
- Department of Psychiatry, General Hospital Brunico, 39031 Brunico, Italy
| | - Anna-Sophia Welte
- Department of Psychiatry, Psychotherapy and Psychosomatics: Division of Psychiatry I, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Christine Hoertnagl
- Department of Psychiatry, Psychotherapy and Psychosomatics: Division of Psychiatry I, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics: Division of Psychiatry I, Medical University Innsbruck, 6020 Innsbruck, Austria
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Abstract
Aggressive and violent behavior, including both verbal and physical aggression, have considerable adverse consequences for people with schizophrenia. There are several potential causes of violent behavior on the part of people with severe mental illness, which include intellectual impairments, cognitive and social-cognitive deficits, skills deficits, substance abuse, antisocial features, and specific psychotic features. This review explores the interventions that have been tested to this date. Computerized Cognitive Training (CCT) or Computerized Social-Cognitive Training (CSCT) have been associated with reductions in violence. Combined CCT and CSCT have been found to improve social cognition and neurocognition, as well as everyday functioning when combined with rehabilitation interventions. These interventions have been shown to reduce violence in schizophrenia patients across multiple environments, including forensic settings. The reductions in violence and aggression have manifested in various ways, including reduced violent thinking and behavior, reduced physical and violent assaults, and reduced disruptive and aggressive behaviors. Effects of cognitive training may be associated with improvements in problem-solving and the increased ability to deploy alternative strategies. The effect of social cognition training on violence reduction appears to be direct, with improvements in violence related to the extent of improvement in social cognition. There are still remaining issues to be addressed in the use of CCT and CSCT, and the benefits should not be overstated; however, the results of these interventions are very promising.
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Abstract
We report on the ongoing R21 project “Social Reward Learning in Schizophrenia”. Impairments in social cognition are a hallmark of schizophrenia. However, little work has been done on social reward learning deficits in schizophrenia. The overall goal of the project is to assess social reward learning in schizophrenia. A probabilistic reward learning (PRL) task is being used in the MRI scanner to evaluate reward learning to negative and positive social feedback. Monetary reward learning is used as a comparison to assess specificity. Behavioral outcomes and brain areas, included those involved in reward, are assessed in patients with schizophrenia or schizoaffective disorder and controls. It is also critical to determine whether decreased expected value (EV) of social stimuli and/or reward prediction error (RPE) learning underlie social reward learning deficits to inform potential treatment pathways. Our central hypothesis is that the pattern of social learning deficits is an extension of a more general reward learning impairment in schizophrenia and that social reward learning deficits critically contribute to deficits in social motivation and pleasure. We hypothesize that people with schizophrenia will show impaired behavioral social reward learning compared to controls, as well as decreased ventromedial prefrontal cortex (vmPFC) EV signaling at time of choice and decreased striatal RPE signaling at time of outcome, with potentially greater impairment to positive than negative feedback. The grant is in its second year. It is hoped that this innovative approach may lead to novel and more targeted treatment approaches for social cognitive impairments, using cognitive remediation and/or brain stimulation.
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Obeid S, Hallit S, Sacre H, Kazour GR. Effectiveness of integrated psychological therapy on cognitive function among Lebanese patients with schizophrenia: a pilot study. Int J Psychiatry Clin Pract 2020; 24:43-52. [PMID: 31661346 DOI: 10.1080/13651501.2019.1682615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: The integrated term emphasises the need for cognitive therapy to always be embedded into an extended treatment concept adapted to cognitive resources and deficits and to patient rehabilitation. One of the first approaches is integrated psychological therapy (IPT).Aim: To assess the effect of the IPT Programme compared to the Treatment as Usual (TaU) in terms of cognitive performance and social skills among a group of schizophrenic patients.Methods: This randomised controlled study enrolled 20 patients in each group. Patients attended 60-min sessions, 3 days/week.Results: When considering the TaU group, the bivariate results showed that significantly higher means of attention scores, lower means in social dysfunction and aggression, social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be weak. When considering the IPT group, significantly higher means attention score, lower means cognitive disorders, social dysfunction, aggression and social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be high.Conclusion: The therapeutic combination of the IPT programme with medical treatment has shown additional beneficial effects on the schizophrenic patients' treatment, enabling them, as far as possible, to reintegrate into the community.KEY POINTSIn cases, a significantly higher GZ-F and KL scores and a lower SDAS-9 and SDAS-6 scores were found post-IPT respectively.In controls, a significant increase in the GZ-F and KL subscales and a decrease in all other scales was found post-IPT respectively.This therapeutic combination of the integrative programme with medical treatment has shown additive beneficial effects in patients with schizophreniaThe treatment approach would allow them, as far as possible, to reintegrate within the community.
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Affiliation(s)
- Sahar Obeid
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Science, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Hala Sacre
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Gisèle Rouphaël Kazour
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Human Sciences, Lebanese University, Beirut, Lebanon
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Fernández-Modamio M, Gil-Sanz D, Arrieta-Rodríguez M, Santacoloma-Cabero I, Bengochea-Seco R, González-Fraile E, Muñiz J. Neurocognition functioning as a prerequisite to intact social cognition in schizophrenia. Cogn Neuropsychiatry 2020; 25:14-27. [PMID: 31621495 DOI: 10.1080/13546805.2019.1680355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: There are mixed findings regarding the relationships between neurocognition and social cognition in schizophrenia. This study aims to provide new empirical evidence to help determine the relationships between these constructs in schizophrenia.Methods: 299 stabilised patients with schizophrenia aged 18-65 years old were recruited. After having into account exclusion criteria, final sample was contained 284 patients. The Emotion Recognition Assessment Test (ERAT) was used to assess six basic emotions. To assess the theory of mind (ToM), the Hinting Task and the Faux-Pas Test were used, and the Screen for Cognitive Impairment in Psychiatry (SCIP) was administered to assess cognitive functioning. Bivariate and multivariate analyses (partial correlations, canonical correlation, regression analysis, and confirmatory and exploratory factor analysis) were conducted.Results: Statistically significant relationships were found between the subtests of the SCIP and social cognitive measures. The redundancy coefficient in the canonical analysis was 0.13. The CFA analysis showed that the best model has a two-factor structure, in which neurocognition and social cognition are correlated factors. Less than 10% of patients with impaired cognitive functioning have a performance within normal range on social cognition tests.Conclusions: The findings show that neurocognition and social cognition are independent but related constructs.
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Affiliation(s)
| | - David Gil-Sanz
- Centro Hospitalario Padre Menni, Santander, Spain.,Universidad Europea del Atlántico, Santander, Spain
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- Centro Hospitalario Padre Menni, Santander, Spain
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Biagianti B, Merchant J, Brambilla P, Lewandowski KE. The effects of cognitive remediation in patients with affective psychosis: A systematic review: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2019; 255:S0165-0327(18)32460-1. [PMID: 30878159 PMCID: PMC6591034 DOI: 10.1016/j.jad.2019.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Schizophrenia, schizoaffective disorder, and related illnesses are associated with significant impairment in cognitive functioning which is among the strongest predictors of disability and poor quality of life. Cognitive remediation (CR) was developed as a set of behavioral interventions directly targeting cognitive symptoms. Studies have shown that CR produces cognitive improvements in patients with schizophrenia and bipolar disorder that may be associated with improvements in functioning. However, the relative efficacy of CR across diagnoses has not been established. Indirect evidence suggests that CR is effective in patients with affective illness as well as patients with schizophrenia (SZ); however, the one study to evaluate the effects of diagnosis on outcomes directly in patients with SZ versus schizoaffective disorder (SZA) found no differences by diagnosis. METHODS In this systematic review, we evaluated cognitive and functional outcomes after CR in studies including patients with SZA, and examined specificity of training content to outcomes. RESULTS Sixteen studies met inclusion criteria: 10 studies that compared CR to a control condition (n = 779) and 6 comparative effectiveness studies. None of the studies explicitly compared patients by diagnosis. Studies included a mixture of patients with SZA or SZ. Of the CR versus control studies, effect sizes for cognitive outcomes were moderate-large (d = .36-.94). Studies comparing CR paradigms targeting different cognitive domains showed specificity of training focus to outcomes. Five of studies reported significant functional improvement after CR as secondary outcomes. CONCLUSIONS In this review, we found support for the use of CR paradigms in patients with affective psychosis, with evidence that reported treatment effects in mixed affective and non-affective samples are at or above the levels previously reported in SZ. However, lack of availability of data directly comparing patients by diagnosis or examining moderator or mediator effects of diagnosis or diagnosis-related patient characteristics limits our understanding of the relative efficacy of CR across patient group.
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Affiliation(s)
- Bruno Biagianti
- Posit Science Inc.,160 Pine Street Suite 200, 94111 San Francisco, CA, USA.
| | - Jaisal Merchant
- Schizophrenia and Bipolar Disorder Program, McLean
Hospital, Belmont, MA, USA
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation,
University of Milan, Milan, Italy,Department of Psychiatry, IRCCS Fondazione Ca’
Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;,Department of Psychiatry and Behavioral Sciences, The
University of Texas Health Science Center at Houston, McGovern Medical School,
Houston, TX, USA
| | - Kathryn E Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean
Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston,
MA, USA
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Kuo SS, Wojtalik JA, Mesholam-Gately RI, Keshavan MS, Eack SM. Establishing a standard emotion processing battery for treatment evaluation in adults with autism spectrum disorder: Evidence supporting the Mayer-Salovey-Caruso Emotion Intelligence Test (MSCEIT). Psychiatry Res 2019; 278:116-124. [PMID: 31163301 PMCID: PMC9671709 DOI: 10.1016/j.psychres.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorder (ASD) and schizophrenia are neurodevelopmental disorders which show markedly similar deficits in emotion processing, yet treatment evaluation in ASD and treatment comparisons across ASD and schizophrenia are constrained by a lack of empirical work validating a standard emotion processing battery across ASD and schizophrenia. Encouragingly, the Mayer-Salovey-Caruso Emotion Intelligence Test, version 2.0 (MSCEIT (Mayer et al., 2003) spans the range of emotion processing deficits in schizophrenia and ASD. This study therefore aimed to establish MSCEIT's factorial, measurement, and structural invariance in community-residing adults with schizophrenia (N = 103) and ASD (N = 113) using multigroup confirmatory factor analysis. Consistent with prior studies in normative populations, a two-factor structure comprised of emotional experiencing and emotional reasoning was supported in ASD and schizophrenia. Both groups operationalize MSCEIT measures similarly, with all measures except for Facilitation and Management showing comparability across groups. To our knowledge, this study is not only the first to establish the measurement and structural invariance of a standard emotion perception battery in adults with ASD, it is also the first to establish its comparability across ASD and schizophrenia. Ultimately, these findings underscore MSCEIT's utility for standardizing treatment evaluation of social cognitive outcomes across the autism-schizophrenia spectrum.
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Affiliation(s)
- Susan S Kuo
- Department of Psychology, University of Pittsburgh, 4209 Sennott Square, 210 S Bouquet St., Pittsburgh, PA 15213, United States.
| | - Jessica A Wojtalik
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA 15260, United States.
| | - Raquelle I Mesholam-Gately
- Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, United States.
| | - Matcheri S Keshavan
- Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, United States.
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA 15260, United States; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
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Abstract
Neurocognitive and social cognitive deficits are a hallmark of schizophrenia. The purpose of the present study was to investigate long-term changes in theory of mind (ToM), executive functions, lexical retrieval, and speed of information processing/attention in schizophrenia. We followed-up 31 outpatients with schizophrenia and 31 healthy control subjects for 15 years. ToM was assessed with the Reading the Mind from the Eyes Test (RMET), whereas neurocognitive functions were measured with the verbal fluency (VF) task (executive functions and lexical retrieval) and with the Digit-Symbol Substitution Test (DSST) (speed of information processing/attention). Clinical symptoms and general functioning were rated with the Positive and Negative Syndrome Scale (PANSS) and with the Global Assessment of Functioning (GAF) scale, respectively. At baseline assessment, patients with schizophrenia exhibited significant and generalized impairments on all measures. At follow-up, relative to the baseline, we observed marked improvements in ToM (RMET), stability in executive functions and lexical retrieval (VF), and a significant decline in psychomotor speed/attention (DSST) in schizophrenia. Clinical symptoms and psychosocial functions did not differ at baseline and at follow-up examinations (mild-to-moderate symptoms on the PANSS and moderate difficulty in social and occupational functions on the GAF). These results indicate that patients with schizophrenia with mild-to-moderate symptoms and functional deficits are characterized by improved ToM during over a decade.
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Mahncke HW, Kim SJ, Rose A, Stasio C, Buckley P, Caroff S, Duncan E, Yasmin S, Jarskog LF, Lamberti JS, Nuechterlein K, Strassnig M, Velligan D, Ventura J, Walker T, Stroup TS, Keefe RSE. Evaluation of a plasticity-based cognitive training program in schizophrenia: Results from the eCaesar trial. Schizophr Res 2019; 208:182-189. [PMID: 30930034 PMCID: PMC6544484 DOI: 10.1016/j.schres.2019.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cognitive impairment in schizophrenia is a core feature of the disorder. Computerized cognitive training has shown promise in pilot studies. A 26-week randomized blinded placebo-controlled trial was conducted to investigate the effect of a novel computerized cognitive training program on cognitive and functional capacity outcomes. METHOD The study followed MATRICS guidelines for the evaluation of interventions designed to improve cognitive function in schizophrenia. Participants (N = 150) were randomized to experimental (computerized cognitive training in a game-like format) or active control (computer games) groups. Training was conducted in-clinic, with an intended training schedule of 5 days per week, 1 h per day, for 26 weeks. Co-primary outcome measures were the MATRICS Consensus Cognitive Battery (MCCB) composite score and the UCSD Performance-Based Skills Assessment (UPSA-2) total score, secondary outcome measures included the Cognitive Assessment Interview (CAI) and the Short-Form-12 Mental Composite Score (SF-12 MCS). Target engagement was assessed with task-learning based assessment. RESULTS At baseline, the groups were well matched. No significant effect of the experimental treatment was seen on the primary or secondary outcome measures compared to the active control. Review of the task learning/target engagement data suggested inadequate target engagement. CONCLUSIONS Results do not support a cognitive or functional capacity benefit from this implementation of a computerized cognitive training program in people with schizophrenia. In future trials, careful consideration is merited of the assessment of task learning/target engagement, the effects of making the cognitive training game-like on motivation, and the implicit effects of trial requirements on participant selection.
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Affiliation(s)
| | | | | | | | - Peter Buckley
- Virginia Commonwealth University, United States of America
| | - Stanley Caroff
- Corporal Michael J. Crescenz VA Medical Center, The Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Erica Duncan
- Atlanta Veterans Affairs Medical Center, Emory University, United States of America
| | - Sarah Yasmin
- Palo Alto Veterans Affairs Medical Center, United States of America
| | - L Fredrik Jarskog
- University of North Carolina at Chapel Hill, United States of America
| | | | | | | | - Dawn Velligan
- University of Texas Health Science Center in Austin, United States of America
| | - Joseph Ventura
- University of California, Los Angeles, United States of America
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Harvey PD, Balzer AM, Kotwicki RJ. Training engagement, baseline cognitive functioning, and cognitive gains with computerized cognitive training: A cross-diagnostic study. Schizophr Res Cogn 2019; 19:100150. [PMID: 31832340 PMCID: PMC6889599 DOI: 10.1016/j.scog.2019.100150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022]
Abstract
Computerized cognitive training (CCT) interventions are increasing in their use in outpatient mental health settings. These interventions have demonstrated efficacy for improving functional outcomes when combined with rehabilitation interventions. It has recently been suggested that patients with more cognitive impairment have a greater therapeutic response and that reduced engagement in training can identify cases who manifest low levels of benefit from treatment. Participants were psychiatric rehabilitation clients, with diagnoses of major depression, bipolar disorder and schizophrenia. Newly admitted cases received CCT, delivered via Brain HQ, with cognitive functioning divided into groups on the basis of a BACS t-score of 40 or less vs. more. Training engagement was indexed by the number of training levels achieved per day trained. Forty-nine cases trained on average for 17 days and completed a mean of 150 levels. Overall, patients improved by an average of 4.4 points (0.44 SD) in BACS t-scores (p < .001). Improvements were positively correlated with training engagement (r = 0.30, p < .05), but not with days trained (r = 0.09) or levels earned (r = 0.03) alone. Patients with higher levels of baseline cognitive performance had reduced cognitive gains (p < .003), but did not have less training engagement (p = .97). Diagnoses did not predict cognitive gains (p = .93) or target engagement (p = .74). Poorer performance at baseline and higher levels of training engagement accounted for >10% in independent variance in cognitive gains. The mean level of cognitive improvement far exceeded practice effects. The index of engagement, levels achieved per training day, is easily extracted from the training records of patients, which would allow for early and continuous monitoring of treatment engagement in CCT activities and therapist intervention as needed to improve engagement.
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Harvey PD, Deckler E, Jarskog LF, Penn DL, Pinkham A. Predictors of social functioning in patients with higher and lower levels of reduced emotional experience: Social cognition, social competence, and symptom severity. Schizophr Res 2019; 206:271-276. [PMID: 30446271 PMCID: PMC6513726 DOI: 10.1016/j.schres.2018.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/01/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Deficits in social functioning in schizophrenia are primarily predicted by negative symptoms, social cognition deficits, and social skills deficits. Here we examine those predictive variables across variations in the severity of reduced emotional experience. We hypothesized that in patients with high symptom severity, factors such as social cognition would have reduced importance for predicting social outcomes. METHODS Participants with schizophrenia (n = 312) were tested using five different measures of social cognition. Performance-based assessments and clinical ratings of reduced emotion experience were used to assess social competence. High contact informants rated interpersonal functioning and social acceptability of behavior, while unaware of other patient data. Patients were divided into higher and lower reduced emotional experience using previously validated criteria. RESULTS 33% of the patients had at least moderate symptoms of reduced emotional experience. Patients with greater severity had more social functioning impairment, but not poorer social competence and social cognition. In the patients with lower severity, social cognition accounted for 9% of the variance in interpersonal functioning, while in patients with higher severity, social cognition did not predict any variance. In the patients with lower severity, social cognition accounted for 4% of the variance in social acceptability of behavior, while in patients with higher severity, social cognition also did not predict any variance. IMPLICATIONS The influence of social cognition on social outcomes appears greater in patients with less severe symptoms of reduced emotional experience. As there are treatments for both these symptoms and social cognition with demonstrated efficacy, these data suggest differential application of these interventions based on symptom severity.
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Affiliation(s)
- Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL,Research Service, Miami VA Healthcare System
| | - Elizabeth Deckler
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC,School of Psychology, Australian Catholic University, Melbourne, VIC
| | - Amy Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX
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Jahshan C, Vinogradov S, Wynn JK, Hellemann G, Green MF. A randomized controlled trial comparing a "bottom-up" and "top-down" approach to cognitive training in schizophrenia. J Psychiatr Res 2019; 109:118-125. [PMID: 30529836 PMCID: PMC9199200 DOI: 10.1016/j.jpsychires.2018.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022]
Abstract
The development of effective cognitive training (CT) interventions is critical for improving the daily lives of people with schizophrenia. At this point, it is unclear whether a so-called "bottom-up" or "top-down" CT approach is more beneficial for inducing cognitive gains and generalization in this population. The aims of this randomized controlled trial were to: 1) Compare the effects of these two types of training approaches on performance-based (MATRICS Consensus Cognitive Battery, MCCB) and neurophysiological (mismatch negativity, MMN) measures of cognition, and 2) Evaluate MMN as a potential predictor of treatment response. Ninety-nine patients with persistent schizophrenia (mean age of 51 and illness duration of 30 years) were randomly assigned in a 2:2:1 ratio to a "bottom-up" intervention that selectively targets basic auditory processing and verbal learning (Brain Fitness), a "top-down" intervention that targets a broad range of higher-order cognitive functions (COGPACK), or a control condition consisting of commercial computer games (Sporcle). Participants completed on average 30 h of training over 12 weeks. Despite demonstrated improvement on training tasks, we found no significant treatment effects on measures of neurocognition (MCCB), MMN, or functional capacity from either intervention. Interestingly, there was an association between an enhanced MMN response at 6 weeks and improved reasoning/problem solving at 12 weeks in the COGPACK group. Although this study had several methodological strengths, the results were mainly negative. It suggests that CT trials in schizophrenia should try to better understand mediators and moderators of treatment response to develop more personalized interventions.
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Affiliation(s)
- Carol Jahshan
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Sophia Vinogradov
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | - Jonathan K. Wynn
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Gerhard Hellemann
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA,Department of Biostatistics, University of California, Los Angeles, CA
| | - Michael F. Green
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
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Baez S, Santamaría-García H, Ibáñez A. Disarming Ex-Combatants' Minds: Toward Situated Reintegration Process in Post-conflict Colombia. Front Psychol 2019; 10:73. [PMID: 30761041 PMCID: PMC6361777 DOI: 10.3389/fpsyg.2019.00073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/10/2019] [Indexed: 01/23/2023] Open
Abstract
Collective violence in the context of armed conflict impacts the economy, health systems, and social stability of affected countries. This is considered a complex phenomenon with interwoven biological, psychological, social, cultural, and political factors. However, most of the research on this topic still lacks suitable established integrative approaches to assess multilevel perspectives. Social, cognitive and affective mental processes (SCAMP) are critical factors that should be considered in multilevel approaches. In this article, we critically discuss some of the classically isolated approaches used in violence research, the absence of successful interventions for ex-combatants reintegration, and the specific neglect of SCAMP in these interventions. We present the case of post-conflict Colombia as a unique opportunity to study the different roots of collective violence, and we call for a more robust and situated approach to understanding of and intervention in this multifaceted phenomenon. In addition, we suggest a two-stage approach for addressing ex-combatants’ reintegration programs, which considers the situated nature of post-conflict scenarios and the urgent need for evidence-based interventions. This approach focuses on the comprehensive scientific assessment of specific factors involved in violence exposure and the subsequent design of successful interventions. The implementation of this approach will contribute to the effective reintegration of individuals who have been exposed to extreme violence for more than 50 years.
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Affiliation(s)
- Sandra Baez
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Hernando Santamaría-García
- Centro de Memoria y Cognición, Intellectus-Hospital Universitario San Ignacio, Bogotá, Colombia.,Physiology and Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience, Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council, Buenos Aires, Argentina.,Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Harvey PD. Combining training leads to better results: Implications for clinical delivery of computerized cognitive and social cognitive training. Schizophr Res 2018; 202:48-9. [PMID: 30029832 DOI: 10.1016/j.schres.2018.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/21/2022]
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Adery LH, Ichinose M, Torregrossa LJ, Wade J, Nichols H, Bekele E, Bian D, Gizdic A, Granholm E, Sarkar N, Park S. The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings. Psychiatry Res 2018; 270:496-502. [PMID: 30326433 PMCID: PMC6314809 DOI: 10.1016/j.psychres.2018.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/16/2018] [Accepted: 10/07/2018] [Indexed: 11/25/2022]
Abstract
Social impairment is a core feature of schizophrenia that presents a major barrier toward recovery. Some of the psychotic symptoms are partly ameliorated by medication but the route to recovery is hampered by social impairments. Since existing social skills interventions tend to suffer from lack of availability, high-burden and low adherence, there is a dire need for an effective, alternative strategy. The present study examined the feasibility and acceptability of Multimodal Adaptive Social Intervention in Virtual Reality (MASI-VR) for improving social functioning and clinical outcomes in schizophrenia. Out of eighteen patients with schizophrenia who enrolled, seventeen participants completed the pre-treatment assessment and 10 sessions of MASI-VR, but one patient did not complete the post-treatment assessments. Therefore, the complete training plus pre- and post-treatment assessment data are available from sixteen participants. Clinical ratings of symptom severity were obtained at pre- and post-training. Retention rates were very high and training was rated as extremely satisfactory for the majority of participants. Participants exhibited a significant reduction in overall clinical symptoms, especially negative symptoms following 10 sessions of MASI-VR. These preliminary results support the feasibility and acceptability of a novel virtual reality social skills training program for individuals with schizophrenia.
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Affiliation(s)
- Laura H Adery
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Megan Ichinose
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Joshua Wade
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Heathman Nichols
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Esube Bekele
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Dayi Bian
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Alena Gizdic
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nilanjan Sarkar
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN, USA; Global Academy for Future Civilizations, Kyung Hee University, Seoul, Korea.
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Caponnetto P, Maglia M, Auditore R, Bocchieri M, Caruso A, DiPiazza J, Polosa R. Improving neurocognitive functioning in schizophrenia by addition of cognitive remediation therapy to a standard treatment of metacognitive training. Ment Illn 2018; 10:7812. [PMID: 30746055 PMCID: PMC6342025 DOI: 10.4081/mi.2018.7812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Cognitive dysfunctions are a common clinical feature of schizophrenia and represent important indicators of outcome among patients who are affected. Therefore, a randomized, controlled, monocentric, singleblind trial was carried out to compare two different rehabilitation strategies adopted for the restoration and recovery of cognitive functioning of residential patients with schizophrenia. A sample of 110 residential patients were selected and, during the experimental period, a group of 55 patients was treated with sets of domain-specific exercises (SRT+CRT), whereas an equal control group was treated with sets of nondomain- specific exercises (SRT+PBO) belonging to the Cogpack® software. The effects on the scores (between T0 and T1) of the variables treatment and time and of the interaction time X treatment were analyzed: for the total BACS, the main effect of the between-factors variable treatment is statistically significant (F=201.562 P=0.000), as well as the effect of the within-factors variable “time” (F=496.68 P=0.000).The interaction of these two factors is also statistically significant (F=299.594 P=0.000). The addition of cognitive remediation therapy (CRT) to a standard treatment of metacognitive training (MCT) resulted in a significant improvement in global neurocognitive functioning and has reported positive effects with regard to the strengthening of verbal and working memory, selective and sustained attention at T1. A relevant result is the statistically significance of “time X treatment” for all the tests administered: we can assume that the domain-specific cognitive training amplifies the effects of SRT, as the primary and secondary goals of the present study were achieved.
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Affiliation(s)
- Pasquale Caponnetto
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Marilena Maglia
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Roberta Auditore
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Marta Bocchieri
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Antonio Caruso
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Jennifer DiPiazza
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Riccardo Polosa
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
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Lindenmayer JP, Khan A, McGurk SR, Kulsa MKC, Ljuri I, Ozog V, Fregenti S, Capodilupo G, Buccellato K, Thanju A, Goldring A, Parak M, Parker B. Does social cognition training augment response to computer-assisted cognitive remediation for schizophrenia? Schizophr Res 2018; 201:180-186. [PMID: 29910120 DOI: 10.1016/j.schres.2018.06.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cognitive remediation therapy (CRT) has shown significant improvement in cognition in schizophrenia. However, effect sizes of CRT have been reported to be modest raising the issue how to augment the effects of CRT on neurocognition and social cognition. Our aim was to examine whether the addition of computerized social cognition training would enhance the effects on neurocognition and social cognition as compared to CRT alone. METHODS This is a 12-week, parallel group trial of 131 in- and out-patients with schizophrenia randomized to CRT (COGPACK or Brain Fitness) with computerized social cognition training (MRIGE), or CRT alone for 36 sessions. Participants were assessed at baseline and after 12 weeks of treatment. Assessments included neurocognition, social cognition, psychopathology, and functioning. RESULTS The combined intervention, CRT + MRIGE, showed greater improvements in the MCCB indices of Visual Learning, Working Memory, Reasoning and Problem-Solving, and the neurocognitive composite score compared to CRT alone (Bonferroni adjusted p = 0.004, p = 0.005, p = 0.01, respectively), as did social cognition measures (Bonferroni adjusted p = 0.006, p = 0.005, respectively). CONCLUSIONS Supplementing CRT with computerized social cognition training produced greater benefits in neurocognition, including visual learning, memory, executive functions, and social cognition relative to cognitive training alone. These findings favoring the combined training may be contributed to both the greater overall amount of cognitive practice, as well as the specific cognitive functions engaged by the social cognition training.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; New York University School of Medicine, 550 1st Avenue, New York, NY 10016, United States.
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; NeuroCog Trials, 3211 Shannon Road #300, Durham, NC 27707, United States.
| | - Susan R McGurk
- Boston University, 1 Silber Way, Boston, MA 02215, United States.
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Teachers College Columbia University, 525 West 120th Street, New York, NY 10027, United States.
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States.
| | - Veronica Ozog
- Adelphi University, 1 South Avenue, Garden City, NY 11530, United States.
| | - Samantha Fregenti
- Mental Health Service Corps, 425 East 25th Street, New York, NY 10010, United States.
| | - Gianna Capodilupo
- MedAvante-ProPhase, 3 Park Avenue, New York, NY 10016, United States
| | - Kiara Buccellato
- Henry Jackson Foundation at The Walter Reed National Military Medical Center, 901 Rockville Pike, Bethesda, MD 20889, United States
| | - Amod Thanju
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Abraham Goldring
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Mohan Parak
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Benedicto Parker
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States.
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Nuño L, Barrios M, Rojo E, Gómez-Benito J, Guilera G. Validation of the ICF Core Sets for schizophrenia from the perspective of psychiatrists: An international Delphi study. J Psychiatr Res 2018; 103:134-41. [PMID: 29852420 DOI: 10.1016/j.jpsychires.2018.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/26/2018] [Accepted: 05/12/2018] [Indexed: 11/23/2022]
Abstract
Schizophrenia is a chronic mental illness associated with several functional impairments. The International Classification of Functioning, Disability and Health (ICF) Core Sets for schizophrenia are shortlists of ICF categories that are relevant for describing the functioning and disability of people suffering from schizophrenia. The aims of this study were to explore the content validity of these Core Sets from the perspective of psychiatrists and to identify - from this perspective and using the ICF framework - the most common problems of patients with schizophrenia. In a three-round survey using the Delphi technique, psychiatrists experienced in schizophrenia treatment were asked about the problems they commonly encounter in these patients. A total of 352 psychiatrists from 63 countries representing all six WHO regions responded to the first-round questionnaire, and 303 completed all three rounds (86% response rate). From the first-round responses, 7133 concepts were extracted and linked to 387 ICF categories and 35 personal factors. Of these, consensus (≥75% agreement) was reached for 91 ICF categories and 31 personal factors. Eighty-seven of the 97 ICF categories that form the Comprehensive ICF Core Set for schizophrenia were represented in this list. Only four of the categories for which consensus was reached do not feature in the Comprehensive Core Set. From the perspective of psychiatrists the content validity of the ICF Core Sets for schizophrenia was largely supported. This suggests that these Core Sets offer an effective framework for describing functioning and disability in individuals with schizophrenia.
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50
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Harvey PD, McGurk SR, Mahncke H, Wykes T. Controversies in Computerized Cognitive Training. Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 3:907-915. [PMID: 30197048 DOI: 10.1016/j.bpsc.2018.06.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
Computerized cognitive training (CCT) to improve cognitive functioning is of enormous interest and has been applied in a broad range of populations with goals of improving both cognition and community functioning. Recent reviews presenting negative conclusions about CCT efficacy have inconsistent definitions of the treatment targets and cognitive improvement. They do not present an accurate representation of the typical process of CCT and cognitive remediation (CR), especially as delivered in major mental illnesses such as schizophrenia. This review provides guidance on the definitions of CCT and CR, the uses of CCT and CR, and the definitions and measurements of cognitive and functional gains. The review focuses on schizophrenia and healthy aging, with each population receiving unique CCT or CR approaches and substantial extant literature with which to elucidate fundamental CCT and CR concepts and research findings. It is our conclusion that CCT has been shown in most studies to improve cognitive performance on untrained tests in healthy older people and in people with schizophrenia. Functional gains in schizophrenia appear to be limited to CR studies. Clearly defining CCT, CR, and levels of treatment-related gains will be critical for understanding the benefits of these widely used treatment programs.
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Affiliation(s)
- Philip D Harvey
- University of Miami Miller School of Medicine, Miami VA Medical Center, Miami, Florida.
| | - Susan R McGurk
- Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
| | - Henry Mahncke
- Posit Science Corporation, San Francisco, California
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, and South London, London, United Kingdom; Maudsley NHS Foundation Trust, London, United Kingdom
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