PsyCog: A computerised mini battery for assessing cognition in psychosis

Despite the functional impact of cognitive deficit in people with psychosis, objective cognitive assessment is not typically part of routine clinical care. This is partly due to the length of traditional assessments and the need for a highly trained administrator. Brief, automated computerised assessments could help to address this issue. We present data from an evaluation of PsyCog, a computerised, non-verbal, mini battery of cognitive tests. Healthy Control (HC) (N = 135), Clinical High Risk (CHR) (N = 233), and First Episode Psychosis (FEP) (N = 301) participants from a multi-centre prospective study were assessed at baseline, 6 months, and 12 months. PsyCog was used to assess cognitive performance at baseline and at up to two follow-up timepoints. Mean total testing time was 35.95 min (SD = 2.87). Relative to HCs, effect sizes of performance impairments were medium to large in FEP patients (composite score G = 1.21, subtest range = 0.52-0.88) and small to medium in CHR patients (composite score G = 0.59, subtest range = 0.18-0.49). Site effects were minimal, and test-retest reliability of the PsyCog composite was good (ICC = 0.82-0.89), though some practice effects and differences in data completion between groups were found. The present implementation of PsyCog shows it to be a useful tool for assessing cognitive function in people with psychosis. Computerised cognitive assessments have the potential to facilitate the evaluation of cognition in psychosis in both research and in clinical care, though caution should still be taken in terms of implementation and study design.

Placebo versus no treatment for people with schizophrenia

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To compare the effects of placebo versus no treatment in people with schizophrenia.

Acceptability of cannabidiol in patients with psychosis

Background

Cannabidiol (CBD) is a promising novel candidate treatment for psychosis. It has a more benign side effect profile than antipsychotic medications, and being treated with CBD is not perceived as being stigmatising. These observations suggest that patients with psychosis would find CBD to be a relatively acceptable treatment.

Objective

This study tested the above hypothesis by assessing the views of a sample of patients.

Methods

Patients with a psychotic disorder were invited to complete a survey exploring their expectations about the efficacy and side effects of CBD.

Results

Seventy patients completed the survey. The majority (86%) were willing to try CBD as a treatment. Most patients believed that CBD would improve their psychotic symptoms (69%) and that it would have fewer side effects than their current medication (64%; mainly antipsychotics). A minority of patients (10%) were concerned that CBD might exacerbate their psychotic symptoms. This, however, appeared to reflect confusion between the effects of CBD and those of cannabis.

Conclusion

Most patients with psychosis regard CBD as an acceptable treatment. Although CBD has not yet been approved as a treatment for psychosis, many patients are aware of it through the presence of CBD in cannabis and in health supplements. When added to the emerging evidence of its efficacy and the low risk of side effects, the high acceptability of CBD underlines its therapeutic potential.

Steady-state visual evoked potential responses predict visual discomfort judgements

It has been suggested that aesthetically pleasing stimuli are processed efficiently by the visual system, whereas uncomfortable stimuli are processed inefficiently. This study consists of a series of three experiments investigating this idea using a range of images of abstract artworks, photographs of natural scenes, and computer-generated stimuli previously shown to be uncomfortable. Subjective judgements and neural correlates were measured using electroencephalogram (EEG) (steady-state visual evoked potentials, SSVEPs). In addition, global image statistics (contrast, Fourier amplitude spectral slope and fractal dimension) were taken into account. When effects of physical image contrast were controlled, fractal dimension predicted discomfort judgements, suggesting the SSVEP response is more likely to be influenced by distribution of edges than the spectral slope. Importantly, when effects of physical contrast and fractal dimension were accounted for using linear mixed effects modelling, SSVEP responses predicted subjective judgements of images. Specifically, when stimuli were not matched for perceived contrast, there was a positive relationship between SSVEP responses and how pleasing a stimulus was judged to be, and conversely a negative relationship between discomfort and SSVEP response. This is significant as it shows that the neural responses in early visual areas contribute to the subjective (un)pleasantness of images, although the results of this study do not provide clear support for the theory of efficient coding as the cause of perceived pleasantness or discomfort of images, and so other explanations need to be considered.

Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer

OBJECTIVE

To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer.

DESIGN

Two-phase retrospective cohort study.

SETTING

West London Gynaecological Cancer Centre, UK.

POPULATION

Women with stage 3 or 4, ovarian, fallopian or primary peritoneal cancer undergoing cytoreductive surgery.

METHODS

Preoperative CT images were reviewed by experienced radiologists to assess the presence or absence of disease at predetermined sites. Multivariable stepwise logistic regression models determined sites of disease which were significantly associated with surgical outcomes in the test (n = 111) and validation (n = 70) sets.

MAIN OUTCOME MEASURES

Sensitivity and specificity of CT in predicting surgical outcome.

RESULTS

Stepwise logistic regression identified that the presence of lung metastasis, pleural effusion, deposits on the large-bowel mesentery and small-bowel mesentery, and infrarenal para-aortic nodes were associated with debulking status. Logistic regression determined a surgical predictive score which was able to significantly predict suboptimal debulking (n = 94, P = 0.0001) with an area under the curve (AUC) of 0.749 (95% confidence interval [95% CI]: 0.652, 0.846) and a sensitivity of 69.2%, specificity of 71.4%, positive predictive value of 75.0% and negative predictive value of 65.2%. These results remained significant in a recent validation set. There was a significant difference in residual disease volume in the test and validation sets (P < 0.001) in keeping with improved optimal debulking rates.

CONCLUSIONS

The presence of disease at some sites on preoperative CT scan is significantly associated with suboptimal debulking and may be an indication for a change in surgical planning.

The achromatic locus: effect of navigation direction in color space

An achromatic stimulus is defined as a patch of light that is devoid of any hue. This is usually achieved by asking observers to adjust the stimulus such that it looks neither red nor green and at the same time neither yellow nor blue. Despite the theoretical and practical importance of the achromatic locus, little is known about the variability in these settings. The main purpose of the current study was to evaluate whether achromatic settings were dependent on the task of the observers, namely the navigation direction in color space. Observers could either adjust the test patch along the two chromatic axes in the CIE u*v* diagram or, alternatively, navigate along the unique-hue lines. Our main result is that the navigation method affects the reliability of these achromatic settings. Observers are able to make more reliable achromatic settings when adjusting the test patch along the directions defined by the four unique hues as opposed to navigating along the main axes in the commonly used CIE u*v* chromaticity plane. This result holds across different ambient viewing conditions (Dark, Daylight, Cool White Fluorescent) and different test luminance levels (5, 20, and 50 cd/m(2)). The reduced variability in the achromatic settings is consistent with the idea that internal color representations are more aligned with the unique-hue lines than the u* and v* axes.

Blue-green color categorization in Mandarin-English speakers

Observers are faster to detect a target among a set of distracters if the targets and distracters come from different color categories. This cross-boundary advantage seems to be limited to the right visual field, which is consistent with the dominance of the left hemisphere for language processing [Gilbert et al., Proc. Natl. Acad. Sci. USA 103, 489 (2006)]. Here we study whether a similar visual field advantage is found in the color identification task in speakers of Mandarin, a language that uses a logographic system. Forty late Mandarin-English bilinguals performed a blue-green color categorization task, in a blocked design, in their first language (L1: Mandarin) or second language (L2: English). Eleven color singletons ranging from blue to green were presented for 160 ms, randomly in the left visual field (LVF) or right visual field (RVF). Color boundary and reaction times (RTs) at the color boundary were estimated in L1 and L2, for both visual fields. We found that the color boundary did not differ between the languages; RTs at the color boundary, however, were on average more than 100 ms shorter in the English compared to the Mandarin sessions, but only when the stimuli were presented in the RVF. The finding may be explained by the script nature of the two languages: Mandarin logographic characters are analyzed visuospatially in the right hemisphere, which conceivably facilitates identification of color presented to the LVF.