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Moran EK, Shapiro M, Culbreth AJ, Nepal S, Ben-Zeev D, Campbell A, Barch DM. Loneliness in the Daily Lives of People With Mood and Psychotic Disorders. Schizophr Bull 2024; 50:557-566. [PMID: 38429937 PMCID: PMC11059807 DOI: 10.1093/schbul/sbae022] [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] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND HYPOTHESIS Loneliness, the subjective experience of feeling alone, is associated with physical and psychological impairments. While there is an extensive literature linking loneliness to psychopathology, limited work has examined loneliness in daily life in those with serious mental illness. We hypothesized that trait and momentary loneliness would be transdiagnostic and relate to symptoms and measures of daily functioning. STUDY DESIGN The current study utilized ecological momentary assessment and passive sensing to examine loneliness in those with schizophrenia (N = 59), bipolar disorder (N = 61), unipolar depression (N = 60), remitted unipolar depression (N = 51), and nonclinical comparisons (N = 82) to examine relationships of both trait and momentary loneliness to symptoms and social functioning in daily life. STUDY RESULTS Findings suggest that both trait and momentary loneliness are higher in those with psychopathology (F(4,284) = 28.00, P < .001, ηp2 = 0.27), and that loneliness significantly relates to social functioning beyond negative symptoms and depression (β = -0.44, t = 6.40, P < .001). Furthermore, passive sensing measures showed that greater movement (β = -0.56, t = -3.29, P = .02) and phone calls (β = -0.22, t = 12.79, P = .04), but not text messaging, were specifically related to decreased loneliness in daily life. Individuals higher in trait loneliness show stronger relationships between momentary loneliness and social context and emotions in everyday life. CONCLUSIONS These findings provide further evidence pointing to the importance of loneliness transdiagnostically and its strong relation to social functioning. Furthermore, we show that passive sensing technology can be used to measure behaviors related to loneliness in daily life that may point to potential treatment implications or early detection markers of loneliness.
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Affiliation(s)
- Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Madelyn Shapiro
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Adam J Culbreth
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, Baltimore, MD, USA
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, NH, USA
| | - Dror Ben-Zeev
- Department of Psychiatry, BRiTE Center, University of Washington, Seattle, WA, USA
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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2
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Culbreth AJ, Moran EK, Mahaphanit W, Erickson MA, Boudewyn MA, Frank MJ, Barch DM, MacDonald AW, Ragland JD, Luck SJ, Silverstein SM, Carter CS, Gold JM. A Transdiagnostic Study of Effort-Cost Decision-Making in Psychotic and Mood Disorders. Schizophr Bull 2024; 50:339-348. [PMID: 37901911 PMCID: PMC10919776 DOI: 10.1093/schbul/sbad155] [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] [Indexed: 10/31/2023]
Abstract
BACKGROUND Research suggests that effort-cost decision-making (ECDM), the estimation of work required to obtain reward, may be a relevant framework for understanding motivational impairment in psychotic and mood pathology. Specifically, research has suggested that people with psychotic and mood pathology experience effort as more costly than controls, and thus pursue effortful goals less frequently. This study examined ECDM across psychotic and mood pathology. HYPOTHESIS We hypothesized that patient groups would show reduced willingness to expend effort compared to controls. STUDY DESIGN People with schizophrenia (N = 33), schizoaffective disorder (N = 28), bipolar disorder (N = 39), major depressive disorder (N = 40), and controls (N = 70) completed a physical ECDM task. Participants decided between completing a low-effort or high-effort option for small or larger rewards, respectively. Reward magnitude, reward probability, and effort magnitude varied trial-by-trial. Data were analyzed using standard and hierarchical logistic regression analyses to assess the subject-specific contribution of various factors to choice. Negative symptoms were measured with a clinician-rated interview. STUDY RESULTS There was a significant effect of group, driven by reduced choice of high-effort options in schizophrenia. Hierarchical logistic regression revealed that reduced choice of high-effort options in schizophrenia was driven by weaker contributions of probability information. Use of reward information was inversely associated with motivational impairment in schizophrenia. Surprisingly, individuals with major depressive disorder and bipolar disorder did not differ from controls. CONCLUSIONS Our results provide support for ECDM deficits in schizophrenia. Additionally, differences between groups in ECDM suggest a seemingly similar behavioral phenotype, reduced motivation, could arise from disparate mechanisms.
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Affiliation(s)
- Adam J Culbreth
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, USA
| | - Erin K Moran
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, USA
| | - Wasita Mahaphanit
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, USA
| | - Molly A Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, USA
| | - Megan A Boudewyn
- Department of Psychology, University of California, Santa Cruz, USA
| | - Michael J Frank
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, Providence, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, USA
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, USA
| | | | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, School of Medicine, Davis, USA
| | - Steven J Luck
- Center for Mind and Brain, University of California, Davis, Davis, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, School of Medicine, Davis, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, USA
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Karagoz AB, Moran EK, Barch DM, Kool W, Reagh ZM. Evidence for shallow cognitive maps in schizophrenia. bioRxiv 2024:2024.02.26.582214. [PMID: 38464042 PMCID: PMC10925159 DOI: 10.1101/2024.02.26.582214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Individuals with schizophrenia can have marked deficits in goal-directed decision making. Prominent theories differ in whether schizophrenia (SZ) affects the ability to exert cognitive control, or the motivation to exert control. An alternative explanation is that schizophrenia negatively impacts the formation of cognitive maps, the internal representations of the way the world is structured, necessary for the formation of effective action plans. That is, deficits in decision-making could also arise when goal-directed control and motivation are intact, but used to plan over ill-formed maps. Here, we test the hypothesis that individuals with SZ are impaired in the construction of cognitive maps. We combine a behavioral representational similarity analysis technique with a sequential decision-making task. This enables us to examine how relationships between choice options change when individuals with SZ and healthy age-matched controls build a cognitive map of the task structure. Our results indicate that SZ affects how people represent the structure of the task, focusing more on simpler visual features and less on abstract, higher-order, planning-relevant features. At the same time, we find that SZ were able to display similar performance on this task compared to controls, emphasizing the need for a distinction between cognitive map formation and changes in goal-directed control in understanding cognitive deficits in schizophrenia.
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Affiliation(s)
- Ata B Karagoz
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine
| | - Wouter Kool
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Zachariah M Reagh
- Department of Psychological & Brain Sciences, Washington University in St. Louis
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Merchant JT, Barch DM, Ermel JA, Moran EK, Butler PD. Differential deficits in social versus monetary reinforcement learning in schizophrenia: Associations with facial emotion recognition. J Psychopathol Clin Sci 2024; 133:37-47. [PMID: 38010759 PMCID: PMC10842228 DOI: 10.1037/abn0000869] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Despite evidence that individuals with schizophrenia (SZ) have an intact desire for social relationships, they have small social networks and report high levels of loneliness. Difficulty with reinforcement learning (RL), the ability to update behavior based on feedback, may inhibit the formation and maintenance of social relationships in SZ. However, impaired RL in SZ has largely been demonstrated via monetary tasks. Thus, it remains unclear whether SZ are similarly impaired in social and monetary RL, or whether social-specific factors may further inhibit their ability to learn from social feedback. Thirty-one individuals with SZ and 31 healthy controls (HCs) participated in a RL paradigm to test hypotheses about social versus monetary RL. SZ exhibited impaired RL compared to HCs in both social and monetary tasks. Further, a Group × Task interaction demonstrated that SZ was more impaired when learning from social than monetary reinforcement, F(1, 59) = 5.99, p = .017. This differential deficit to social RL was not accounted for by reported pleasure from social feedback, which did not differ between groups. Instead, SZ had poorer emotion recognition than HCs, t(1, 60) = 4.80, p < .001, particularly for negative emotions, and controlling for this eliminated the differential social RL impairment. These results suggest the possibility that difficulty recognizing social cues, especially those indicating negative feedback, may relate to a reduced ability to learn from others' feedback. Thus, future research could elucidate whether targeting these emotion recognition difficulties in treatment could serve as a potential mechanism for improving social functioning in SZ. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jaisal T Merchant
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Julia A Ermel
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Pamela D Butler
- Department of Clinical Research, Nathan Kline Institute for Psychiatric Research
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Barch DM, Culbreth AJ, Ben Zeev D, Campbell A, Nepal S, Moran EK. Dissociation of Cognitive Effort-Based Decision Making and Its Associations With Symptoms, Cognition, and Everyday Life Function Across Schizophrenia, Bipolar Disorder, and Depression. Biol Psychiatry 2023; 94:501-510. [PMID: 37080416 PMCID: PMC10755814 DOI: 10.1016/j.biopsych.2023.04.007] [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: 01/25/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Anhedonia and amotivation are symptoms of many different mental health disorders that are frequently associated with functional disability, but it is not clear whether the same processes contribute to motivational impairments across disorders. This study focused on one possible factor, the willingness to exert cognitive effort, referred to as cognitive effort-cost decision making. METHODS We examined performance on the deck choice task as a measure of cognitive effort-cost decision making, in which people choose to complete an easy task for a small monetary reward or a harder task for larger rewards, in 5 groups: healthy control (n = 80), schizophrenia/schizoaffective disorder (n = 50), bipolar disorder with psychosis (n = 58), current major depression (n = 60), and past major depression (n = 51). We examined cognitive effort-cost decision making in relation to clinician and self-reported motivation symptoms, working memory and cognitive control performance, and life function measured by ecological momentary assessment and passive sensing. RESULTS We found a significant diagnostic group × reward interaction (F8,588 = 4.37, p < .001, ηp2 = 0.056). Compared with the healthy control group, the schizophrenia/schizoaffective and bipolar disorder groups, but not the current or past major depressive disorder groups, showed a reduced willingness to exert effort at the higher reward values. In the schizophrenia/schizoaffective and bipolar disorder groups, but not the major depressive disorder groups, reduced willingness to exert cognitive effort for higher rewards was associated with greater clinician-rated motivation impairments, worse working memory and cognitive control performance, and less engagement in goal-directed activities measured by ecological momentary assessment. CONCLUSIONS These findings suggest that the mechanisms contributing to motivational impairments differ among individuals with psychosis spectrum disorders versus depression.
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Affiliation(s)
- Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Adam J Culbreth
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore, Maryland
| | - Dror Ben Zeev
- Department of Psychiatry, University of Washington, Seattle, Washington
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
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Dalloul N, Moran EK, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Luck SJ, Barch DM. Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning. Schizophr Bull 2023; 49:1281-1293. [PMID: 37382553 PMCID: PMC10483466 DOI: 10.1093/schbul/sbad095] [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] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND HYPOTHESIS Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships. STUDY DESIGN Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA). RESULTS Two components, working memory/processing speed/episodic memory (βs = 0.18-0.42), and negative/positive reinforcement learning (β = -0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function. CONCLUSIONS These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.
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Affiliation(s)
- Nada Dalloul
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, CA, USA
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, CA, USA
| | | | - Steven J Luck
- Department of Psychology, University of California, Davis, CA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Culbreth AJ, Dershwitz SD, Barch DM, Moran EK. Associations Between Cognitive and Physical Effort-Based Decision Making in People With Schizophrenia and Healthy Control Subjects. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:695-702. [PMID: 36796513 PMCID: PMC10330111 DOI: 10.1016/j.bpsc.2023.02.003] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Effort can take a variety of forms including physical (e.g., button pressing) and cognitive (e.g., working memory tasks). Few studies have examined whether individual differences in willingness to expend effort are similar or different across modalities. METHODS We recruited 30 individuals with schizophrenia and 44 healthy control subjects to complete 2 effort-cost decision-making tasks: the Effort Expenditure for Rewards Task (physical effort) and the cognitive effort discounting task (cognitive effort). RESULTS Willingness to expend cognitive and physical effort was positively associated for both individuals with schizophrenia and control subjects. Further, we found that individual differences in motivation and pleasure dimension of negative symptoms modulated the association between physical and cognitive effort. Specifically, participants with lower motivation and pleasure scores, irrespective of group status, showed stronger associations between task measures of cognitive and physical effort-cost decision making. CONCLUSIONS These results suggest a generalized deficit across effort modalities in individuals with schizophrenia. Further, reductions in motivation and pleasure may impact effort-cost decision making in a domain-general manner.
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Affiliation(s)
- Adam J Culbreth
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland.
| | - Sally D Dershwitz
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Moran EK, Prevost C, Culbreth AJ, Barch DM. Effort-cost decision-making in psychotic and mood disorders. J Psychopathol Clin Sci 2023; 132:490-498. [PMID: 37079841 PMCID: PMC10164124 DOI: 10.1037/abn0000822] [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] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Avolition and anhedonia are core symptoms across psychosis and mood disorders. One important mechanism thought to relate to these symptoms is effort-cost decision-making (ECDM), the valuation and estimation of work required to obtain a given reward. While recent work suggests impairments in ECDM in both mood disorders and psychosis relative to controls, limited work has taken a transdiagnostic approach to examine how these deficits relate to different symptom profiles across disorders. The present study investigated ECDM across schizophrenia/schizoaffective disorder (N = 33), bipolar disorder (N = 47), unipolar depression (N = 61), and healthy controls (N = 58) to examine willingness to expend physical effort. Moreover, we examined the relationship between ECDM and motivation and pleasure symptoms across participants. We found that people with schizophrenia and bipolar disorder showed a reduced willingness to expend physical effort at high reward values relative to controls, while as a group, those with depression showed no differences relative to controls. However, individual differences in self-reported motivation and pleasure predicted reduced ECDM, particularly at high reward values, suggesting that both severity of symptoms and diagnostic categories are important for understanding altered ECDM in psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Erin K. Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130
| | - Caroline Prevost
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130
| | - Adam J. Culbreth
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore, MD, 21201
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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Abstract
BACKGROUND Deficits in goal-directed behavior (i.e. behavior conducted to achieve a specific goal or outcome) are core to schizophrenia, difficult to treat, and associated with poor functional outcomes. Factors such as negative symptoms, effort-cost decision-making, cognition, and functional skills have all been associated with goal-directed behavior in schizophrenia as indexed by clinical interviews or laboratory-based tasks. However, little work has examined whether these factors relate to the real-world pursuit of goal-directed activities in this population. METHODS This study aimed to fill this gap by using Ecological Momentary Assessment (four survey prompts per day for 1 week) to test hypotheses about symptom, effort allocation, cognitive, and functional measures associated with planned and completed goal-directed behavior in the daily lives of 63 individuals with schizophrenia. RESULTS Individuals with schizophrenia completed more goal-directed activities than they planned [t(62) = -4.01, p < 0.001]. Motivation and pleasure (i.e. experiential) negative symptoms, controlling for depressive symptoms, negatively related to planned goal-directed behavior [odds ratio (OR) 0.92, p = 0.005]. Increased effort expenditure for high probability rewards (planned: OR 1.01, p = 0.034, completed: OR 1.01, p = 0.034) along with performance on a daily functional skills task (planned: OR 1.04, p = 0.002, completed: OR 1.03, p = 0.047) negatively related to both planned and completed goal-directed activity. CONCLUSIONS Our results present correlates of real-world goal-directed behavior that largely align with impaired ability to make future estimations in schizophrenia. This insight could help identify targeted treatments for the elusive motivated behavior deficits in this population.
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Affiliation(s)
- Jaisal T Merchant
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael J Strube
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Moran EK, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Luck SJ, Barch DM. Both unmedicated and medicated individuals with schizophrenia show impairments across a wide array of cognitive and reinforcement learning tasks. Psychol Med 2022; 52:1115-1125. [PMID: 32799938 PMCID: PMC8095353 DOI: 10.1017/s003329172000286x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Schizophrenia is a disorder characterized by pervasive deficits in cognitive functioning. However, few well-powered studies have examined the degree to which cognitive performance is impaired even among individuals with schizophrenia not currently on antipsychotic medications using a wide range of cognitive and reinforcement learning measures derived from cognitive neuroscience. Such research is particularly needed in the domain of reinforcement learning, given the central role of dopamine in reinforcement learning, and the potential impact of antipsychotic medications on dopamine function. METHODS The present study sought to fill this gap by examining healthy controls (N = 75), unmedicated (N = 48) and medicated (N = 148) individuals with schizophrenia. Participants were recruited across five sites as part of the CNTRaCS Consortium to complete tasks assessing processing speed, cognitive control, working memory, verbal learning, relational encoding and retrieval, visual integration and reinforcement learning. RESULTS Individuals with schizophrenia who were not taking antipsychotic medications, as well as those taking antipsychotic medications, showed pervasive deficits across cognitive domains including reinforcement learning, processing speed, cognitive control, working memory, verbal learning and relational encoding and retrieval. Further, we found that chlorpromazine equivalency rates were significantly related to processing speed and working memory, while there were no significant relationships between anticholinergic load and performance on other tasks. CONCLUSIONS These findings add to a body of literature suggesting that cognitive deficits are an enduring aspect of schizophrenia, present in those off antipsychotic medications as well as those taking antipsychotic medications.
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Affiliation(s)
- Erin K. Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - James M. Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | - Steven M. Silverstein
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School Hospital, Piscataway, NJ
| | - Steven J. Luck
- Department of Psychology, University of California, Davis, CA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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Merchant JT, Moran EK, Barch DM. Negative and depressive symptoms differentially relate to real-world anticipatory and consummatory pleasure in schizophrenia. Schizophr Res 2022; 241:72-77. [PMID: 35091389 DOI: 10.1016/j.schres.2022.01.012] [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: 03/03/2021] [Revised: 10/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
It has been suggested that schizophrenia is associated with deficits in anticipatory but not consummatory pleasure, though there is mixed support for this hypothesis. As individuals with schizophrenia can experience both negative and depressive symptoms, symptom heterogeneity in this population could contribute to these mixed hedonic findings. Specifically, while some research suggests that negative symptoms of schizophrenia are related to reduced anticipatory but not consummatory pleasure, research on major depressive disorder suggests that depressive symptoms are associated with both decreased anticipatory and consummatory pleasure. Still, it is unclear whether depressive symptoms are associated with experiences of pleasure in schizophrenia as they are in major depressive disorder. Thus, the present study used Ecological Momentary Assessment (four prompts per day over one week) to investigate the unique relationships of negative and depressive symptoms with daily reports of real-world anticipatory and consummatory pleasure in 63 individuals with schizophrenia. Higher negative symptoms related to reduced anticipatory but not consummatory pleasure. On the other hand, higher depressive symptoms related to reductions in both anticipatory and consummatory pleasure. Overall, these results indicate that negative and depressive symptoms are differentially associated with hedonic experience in schizophrenia, and suggest the need to account for the severity of both these symptom types when examining pleasure in this population. Elucidating the nature of these symptom contributions to hedonic impairments could increase causal understanding of these deficits and contribute to the development of more targeted treatments to enhance motivation and pleasure in schizophrenia.
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Affiliation(s)
- Jaisal T Merchant
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, United States of America.
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, United States of America; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, United States of America; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, United States of America; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
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12
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Abstract
Anhedonia has long been considered a cardinal symptom of schizophrenia. This symptom is strongly associated with poor functional outcome, and limited treatment options are available. While originally conceptualized as an inability to experience pleasure, recent work has consistently shown that individuals with schizophrenia have an intact capacity to experience pleasure in-the-moment. Adjacent work in basic affective neuroscience has broadened the conceptualization of anhedonia to include not only the capacity to experience pleasure but highlights important temporal affective dynamics and decision-making processes that go awry in schizophrenia. Here we detail these mechanisms for emotional and motivational impairment in people with schizophrenia including: (1) initial response to reward; (2) reward anticipation; (3) reward learning; (4) effort-cost decision-making; (5) working memory and cognitive control. We will review studies that utilized various types of rewards (e.g., monetary, social), in order to draw conclusions regarding whether findings vary by reward type. We will then discuss how modern assessment methods may best incorporate each of the mechanisms, to provide a more fine-grained understanding of anhedonia in individuals with schizophrenia. We will close by providing a discussion of relevant future directions.
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Affiliation(s)
- Erin K Moran
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Adam J Culbreth
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, College Park, MD, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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13
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Culbreth AJ, Barch DM, Moran EK. An ecological examination of loneliness and social functioning in people with schizophrenia. J Abnorm Psychol 2021; 130:899-908. [PMID: 34553952 DOI: 10.1037/abn0000706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Loneliness is associated with a myriad of detrimental outcomes in mental and physical health. Previous studies have found that people with schizophrenia report greater loneliness than controls, and that loneliness is related to depressive symptoms. However, research has been limited, particularly regarding contributions of loneliness to social and occupational functioning. Further, few studies have examined associations between loneliness and daily experience in schizophrenia. Thus, we recruited 35 individuals with schizophrenia and 37 controls. All participants completed the UCLA loneliness scale, symptom assessments, and measures of social and occupational functioning. Additionally, participants with schizophrenia completed an ecological momentary assessment (EMA) protocol that indexed daily social and emotional experiences, including loneliness. Similar to previous reports, we found that those with schizophrenia reported greater loneliness than controls. Further, loneliness was positively associated with depressive and negative symptoms, and negatively associated with self-reported social functioning. Interestingly, loneliness remained a significant predictor of functioning even when controlling for other symptoms, suggesting that severity of depressive and negative symptoms cannot fully explain the relationship between loneliness and functioning. In our EMA analyses, loneliness did not significantly differ when individuals were alone versus with others, underscoring the notion that being alone is not the same as feeling lonely. However, self-reported engagement during social interactions was negatively associated with loneliness, at a trend-level, suggesting that quality of social interactions is a potentially important consideration. Taken together, these findings suggest that loneliness is an important treatment target and provide understanding for how loneliness may manifest in daily life in schizophrenia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Adam J Culbreth
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine
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14
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Culbreth AJ, Moran EK, Kandala S, Westbrook A, Barch DM. Effort, avolition and motivational experience in schizophrenia: Analysis of behavioral and neuroimaging data with relationships to daily motivational experience. Clin Psychol Sci 2020; 8:555-568. [PMID: 33758684 PMCID: PMC7983405 DOI: 10.1177/2167702620901558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recent research suggests that schizophrenia is associated with reduced effort allocation. We examined willingness to expend effort, neural correlates of effort allocation, and the relationship of effort to daily motivational experience in schizophrenia. We recruited 28 individuals with schizophrenia and 30 controls to perform an effort task during fMRI. Individuals with schizophrenia also completed an ecological momentary assessment (EMA) protocol. Individuals with schizophrenia with high negative symptoms were less willing to expend effort for rewards. Daily EMA assessments of motivation were positively associated with effort allocation at a trend-level. Individuals with schizophrenia and controls displayed similar increases in BOLD activation in frontal, cingulate, parietal, and insular regions during effort-based decision-making. However, negative symptoms were associated with reduced BOLD activation in bilateral ventral striatum. These results replicate previous reports of reduced effort allocation in schizophrenia patients with severe negative symptoms, and provide evidence for the role of ventral striatum in effort impairments.
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Affiliation(s)
- Adam J Culbreth
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Sri Kandala
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Andrew Westbrook
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, Providence, RI 02906
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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15
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Weittenhiller LP, Painter JM, Moran EK, Kring AM. The discrepancy between momentary and remembered pleasure in schizophrenia. Schizophr Res 2020; 216:536-537. [PMID: 31818633 DOI: 10.1016/j.schres.2019.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Erin K Moran
- Department of Psychology, University of California, Berkeley, USA
| | - Ann M Kring
- Department of Psychology, University of California, Berkeley, USA
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16
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Moran EK, Culbreth AJ, Kandala S, Barch DM. From neuroimaging to daily functioning: A multimethod analysis of reward anticipation in people with schizophrenia. J Abnorm Psychol 2019; 128:723-734. [PMID: 31464449 DOI: 10.1037/abn0000461] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Negative symptoms are a core clinical feature of schizophrenia that are only marginally responsive to current treatments. Recent work suggests that deficits in reinforcement learning and anticipatory responses to reward may be two mechanisms that help explain impairments in motivation in those with schizophrenia. The present study utilized a reinforcement-learning paradigm, which allowed us to examine both reward anticipation and reinforcement learning. Twenty-eight people with schizophrenia and 30 healthy controls completed a reinforcement-learning task while undergoing functional MRI. Participants with schizophrenia also completed a weeklong ecological momentary assessment protocol reporting anticipated motivation and pleasure in their daily activities. Unexpectedly, we found no significant group differences in performance or neural response in reinforcement learning. However, we found that poorer reward learning was associated with greater clinician ratings of negative symptoms and daily reports of anticipatory motivation and pleasure negative symptoms. In regards to anticipatory responses, we found that people with schizophrenia showed blunted activation in the anterior cingulate, insula, caudate, and putamen while anticipating reward. Further, blood oxygen level-dependent (BOLD) response in reward related regions during anticipation of reward was significantly related to both clinician-rated motivation and pleasure deficits as well as daily reports of motivation and pleasure. Our results provide further evidence of deficits during reward anticipation in individuals with schizophrenia, particularly for those with severe negative symptoms, and some evidence for worse reward learning among those with greater negative symptoms. Moreover, our findings suggest that these deficits show important relationships with emotional and motivational functioning in everyday life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Yanke AB, Urita A, Shin JJ, Cvetanovich GL, Moran EK, Bach BR, Cole BJ, Inoue N, Verma NN. Topographic Analysis of the Distal Femoral Condyle Articular Cartilage Surface: Adequacy of the Graft from Opposite Condyles of the Same or Different Size for the Osteochondral Allograft Transplantation. Cartilage 2019; 10:205-213. [PMID: 29334769 PMCID: PMC6425537 DOI: 10.1177/1947603517752056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyze the topography of the opposite condyle to treat focal femoral condyle articular defects with an osteochondral allograft (OCA). DESIGN Three groups were created: Group 1, same condyle with same width; Group 2, opposite condyle with same width; Group 3, opposite condyle with different width. Computed tomography (CT) of 22 cadaveric femoral hemi-condyles was used to create 3-dimensional CT models that were exported into point-cloud models. Three zones of the donor condyle (anterior, middle, and posterior) were quantified. Four defect sizes were created (15, 18, 23, 25 mm) at the weight-bearing region. The defect was moved throughout each donor condyle zone and the least distance was calculated, defined as the shortest distance between the defect and the donor condyle. RESULTS The mean least distance increased with larger defect size in all groups, yet there was a less than 0.2 mm difference in the least distance among defect sizes. The 15, 18, and 23 mm defect models in Group 1 exhibited greater least distances at the anterior than middle and posterior zones. The 15 mm defect model exhibited greater least distance at the anterior zone than posterior zone in Group 3. However, there was a less than 0.05 mm difference in the mean least distance between zones. There was no significant difference in the least distance between groups. CONCLUSION OCAs from opposite condyles yield similar topographic matching to OCAs from the same condyles, suggesting that opposite condyles can be utilized. Clinical correlation and outcomes are necessary.
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Affiliation(s)
- Adam B. Yanke
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA,Adam B. Yanke, Department of Orthopaedic Surgery, Cartilage Restoration Center at Rush University Medical Center, Midwest Orthopaedic at Rush, 1611 W Harrison Street, Chicago, IL 60612, USA.
| | - Atsushi Urita
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jason J. Shin
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Greg L. Cvetanovich
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Bernard R. Bach
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J. Cole
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nozomu Inoue
- Orthopaedic Biomechanics Laboratory, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N. Verma
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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18
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Painter JM, Stellar JE, Moran EK, Kring AM. A multicomponent approach toward understanding emotion regulation in schizophrenia. J Clin Psychol 2018; 75:178-189. [PMID: 30291751 DOI: 10.1002/jclp.22698] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/04/2018] [Accepted: 07/25/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Emotion deficits are well documented in people with schizophrenia. Far less is known about their ability to implement emotion regulation strategies. We sought to explore whether people with schizophrenia can modify their emotion responses similar to controls. METHODS People with (n = 25) and without (n = 21) schizophrenia were instructed to amplify positive-emotion expression, reappraise negative emotion experience, and suppress physiological response. Multiple components of emotion response were measured (experience, expression, and physiology). RESULTS Although people with schizophrenia showed increased positive expressivity following amplification and decreased negative emotion experience following reappraisal, overall, they expressed less positive emotion and experienced more negative emotion compared with controls. Neither group was effective at physiological suppression. CONCLUSIONS Together these findings suggest that people with schizophrenia can engage in amplification and reappraisal when explicitly instructed to do so, albeit additional practice may be necessary to modify emotion responses to levels similar to controls.
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Affiliation(s)
- Janelle M Painter
- Department of Psychology, University of California, Berkeley, California.,Outpatient Mental Health, VA Puget Sound Health Care System, Seattle, Washington
| | - Jennifer E Stellar
- Department of Psychology, University of California, Berkeley, California.,Department of Psychology, University of Toronto, Mississauga, Ontario, Canada
| | - Erin K Moran
- Department of Psychology, University of California, Berkeley, California.,Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri
| | - Ann M Kring
- Department of Psychology, University of California, Berkeley, California
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19
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Abstract
Motivational impairment has long been associated with schizophrenia but the underlying mechanisms are not clearly understood. Recently, a small but growing literature has suggested that aberrant effort-based decision-making may be a potential contributory mechanism for motivational impairments in psychosis. Specifically, multiple reports have consistently demonstrated that individuals with schizophrenia are less willing than healthy controls to expend effort to obtain rewards. Further, this effort-based decision-making deficit has been shown to correlate with severity of negative symptoms and level of functioning, in many but not all studies. In the current review, we summarize this literature and discuss several factors that may underlie aberrant effort-based decision-making in schizophrenia.
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Affiliation(s)
- Adam J. Culbreth
- Department of Psychological and Brain Sciences, Washington University in Saint Louis
| | - Erin K. Moran
- Department of Psychiatry, Washington University in Saint Louis
| | - Deanna M. Barch
- Department of Psychological and Brain Sciences, Washington University in Saint Louis
- Department of Psychiatry, Washington University in Saint Louis
- Department of Radiology, Washington University in Saint Louis
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20
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Culbreth AJ, Moran EK, Barch DM. Effort-cost decision-making in psychosis and depression: could a similar behavioral deficit arise from disparate psychological and neural mechanisms? Psychol Med 2018; 48:889-904. [PMID: 28889803 DOI: 10.1017/s0033291717002525] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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] [Indexed: 01/13/2023]
Abstract
Motivational impairment is a common feature of both depression and psychosis; however, the psychological and neural mechanisms that give rise to motivational impairment in these disorders are poorly understood. Recent research has suggested that aberrant effort-cost decision-making (ECDM) may be a potential contributor to motivational impairment in both psychosis and depression. ECDM refers to choices that individuals make regarding the amount of 'work' they are willing to expend to obtain a certain outcome or reward. Recent experimental work has suggested that those with psychosis and depression may be less willing to expend effort to obtain rewards compared with controls, and that this effort deficit is related to motivational impairment in both disorders. In the current review, we aim to summarize the current literature on ECDM in psychosis and depression, providing evidence for transdiagnostic impairment. Next, we discuss evidence for the hypothesis that a seemingly similar behavioral ECDM deficit might arise from disparate psychological and neural mechanisms. Specifically, we argue that effort deficits in psychosis might be largely driven by deficits in cognitive control and the neural correlates of cognitive control processes, while effort deficits in depression might be largely driven by reduced reward responsivity and the associated neural correlates of reward responsivity. Finally, we will provide some discussion regarding future directions, as well as interpretative challenges to consider when examining ECDM transdiagnostically.
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Affiliation(s)
- A J Culbreth
- Department of Psychological and Brain Sciences,Washington University in Saint Louis,St. Louis, MO,USA
| | - E K Moran
- Department of Psychiatry,Washington University in Saint Louis,St. Louis, MO,USA
| | - D M Barch
- Department of Psychological and Brain Sciences,Washington University in Saint Louis,St. Louis, MO,USA
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21
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Abstract
While recent evidence has pointed to disturbances in emotion regulation strategy use in schizophrenia, few studies have examined how these regulation strategies relate to emotionality and social behavior in daily life. Using ecological momentary assessment (EMA), we investigated the relationship between emotion regulation, emotional experience and social interaction in the daily lives of individuals with schizophrenia. Participants (N=30) used mobile phones to complete online questionnaires reporting their daily emotional experience and social interaction. Participants also completed self-report measures of habitual emotion regulation. Hierarchical linear modeling revealed that self-reported use of cognitive reappraisal and savoring of emotional experiences were related to greater positive emotion in daily life. In contrast, self-reported suppression was related to greater negative emotion, reduced positive emotion and reduced social interaction in daily life. These findings suggest that individual differences in habitual emotion regulation strategy usage have important relationships to every day emotional and social experiences in schizophrenia.
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Affiliation(s)
- Erin K. Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110,Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130
| | - Adam J. Culbreth
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110,Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130,Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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22
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Abstract
While people with schizophrenia report experiencing as much emotion in the presence of emotionally evocative stimuli as do people without schizophrenia, evidence suggests that they have deficits in the anticipation of positive emotion. However, little is known about the anticipation of negative emotion in schizophrenia, thus leaving open whether anticipation deficits are more general. We sought to assess anticipation of positive and negative stimuli across multiple methods of measurement. We measured reported experience and emotion modulated startle response in people with (n = 27) and without (n = 27) schizophrenia as they anticipated and subsequently viewed evocative pictures. People with schizophrenia showed an overall dampened response during the anticipation of positive and negative stimuli, suggesting a more general deficit in anticipatory emotional responses. Moreover, anticipatory responses were related to symptoms and functioning in people with schizophrenia. Together, these findings point to important new directions for understanding emotion deficits in schizophrenia.
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Affiliation(s)
- Erin K Moran
- Washington University School of Medicine, Department of Psychiatry
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23
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Moran EK, Culbreth AJ, Barch DM. Ecological momentary assessment of negative symptoms in schizophrenia: Relationships to effort-based decision making and reinforcement learning. J Abnorm Psychol 2016; 126:96-105. [PMID: 27893230 DOI: 10.1037/abn0000240] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Negative symptoms are a core clinical feature of schizophrenia, but conceptual and methodological problems with current instruments can make their assessment challenging. One hypothesis is that current symptom assessments may be influenced by impairments in memory and may not be fully reflective of actual functioning outside of the laboratory. The present study sought to investigate the validity of assessing negative symptoms using ecological momentary assessment (EMA). Participants with schizophrenia (N = 31) completed electronic questionnaires on smartphones 4 times a day for 1 week. Participants also completed effort-based decision making and reinforcement learning (RL) tasks to assess the relationship between EMA and laboratory measures, which tap into negative symptom relevant domains. Hierarchical linear modeling analyses revealed that clinician-rated and self-report measures of negative symptoms were significantly related to negative symptoms assessed via EMA. However, working memory moderated the relationship between EMA and retrospective measures of negative symptoms, such that there was a stronger relationship between EMA and retrospective negative symptom measures among individuals with better working memory. The authors also found that negative symptoms assessed via EMA were related to poor performance on the effort task, whereas clinician-rated symptoms and self-reports were not. Further, they found that negative symptoms were related to poorer performance on learning reward contingencies. The findings suggest that negative symptoms can be assessed through EMA and that working memory impairments frequently seen in schizophrenia may affect recall of symptoms. Moreover, these findings suggest the importance of examining the relationship between laboratory tasks and symptoms assessed during daily life. (PsycINFO Database Record
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Affiliation(s)
- Erin K Moran
- Department of Psychiatry, School of Medicine, Washington University in St. Louis
| | - Adam J Culbreth
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Deanna M Barch
- Department of Psychiatry, School of Medicine, Washington University in St. Louis
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24
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Caponigro JM, Moran EK, Kring AM, Moskowitz JT. Awareness and coping with emotion in schizophrenia: acceptability, feasibility and case illustrations. Clin Psychol Psychother 2014; 21:371-80. [PMID: 23553953 PMCID: PMC4067468 DOI: 10.1002/cpp.1839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 02/14/2013] [Accepted: 02/18/2013] [Indexed: 11/10/2022]
Abstract
UNLABELLED Although current treatments help to alleviate some of the symptoms of schizophrenia, people with schizophrenia often continue to experience residual symptoms. An emotion-focused treatment approach may help to improve well-being in this population by increasing positive experiences and resources. In this article, we discuss the feasibility and acceptability of a skills-based group treatment for people schizophrenia or schizoaffective disorder. As part of the Awareness and Coping with Emotion in Schizophrenia (ACES) intervention, group members learned eight empirically supported cognitive and behavioural skills covering emotional awareness and coping. Group member feedback and three case illustrations illuminate participants' experiences with the group, as well as the potential benefits and challenges of this treatment approach. These data suggest that ACES is a feasible and acceptable group intervention. Future research is needed to examine whether ACES has a selective impact on well-being, but these initial findings point to the promise of this intervention to improve quality of life for individuals with schizophrenia and schizoaffective disorder, thus filling a void in existing treatments options. KEY PRACTITIONER MESSAGE There is a void in existing treatments for schizophrenia with few interventions focusing on increasing well-being in this population. Awareness and Coping with Emotion in Schizophrenia (ACES) is a skills-based group intervention that teaches cognitive and behavioural interventions to promote awareness and coping with emotion. Preliminary evidence demonstrates the feasibility and acceptance of the ACES group intervention in increasing well-being in those with schizophrenia. Future studies should extend this work by systematically evaluating the efficacy of this treatment approach.
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Affiliation(s)
| | - Erin K. Moran
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Ann M. Kring
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Judith T. Moskowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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25
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Abstract
The current studies were designed to investigate if the emotion context insensitivity hypothesis (ECI; Rottenberg & Gotlib, 2004) is applicable across the time course of emotion. Recent affective science research has pointed to the importance of considering anticipation and maintenance of emotion. In the current studies, we assessed emotion responses among college students with depression symptoms in anticipation of, during, and after an emotional picture using the emotion modulated startle paradigm. People with and without depression symptoms did not differ in blink magnitude in anticipation of emotional pictures suggesting that some anticipatory processes may not be impaired by depression symptoms. In contrast, individuals with depression symptoms did not exhibit blink magnitudes that varied by valence, either during viewing or after the pictures were removed from view. These findings suggest that ECI is relevant not only for those diagnosed with major depressive disorder, but also for people with depression symptoms that may not cross the diagnostic threshold. These data also point to the importance of considering the time course of emotion to better understand emotional deficits in individuals with differing levels of depression symptoms. Identifying where emotion goes awry across the time course of emotion can help inform treatment development.
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Affiliation(s)
- Erin K Moran
- Department of Psychology, University of California, Berkeley, CA 94720, USA.
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26
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Rentz DM, Locascio JJ, Becker JA, Moran EK, Eng E, Buckner RL, Sperling RA, Johnson KA. Cognition, reserve, and amyloid deposition in normal aging. Ann Neurol 2010; 67:353-64. [PMID: 20373347 PMCID: PMC3074985 DOI: 10.1002/ana.21904] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 09/29/2009] [Accepted: 10/20/2009] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To determine whether amyloid deposition is associated with impaired neuropsychological (NP) performance and whether cognitive reserve (CR) modifies this association. METHODS In 66 normal elderly controls and 17 patients with Alzheimer disease (AD), we related brain retention of Pittsburgh Compound B (PiB) to NP performance and evaluated the impact of CR using education and American National Adult Reading Test intelligence quotient as proposed proxies. RESULTS We found in the combined sample of subjects that PiB retention in the precuneus was inversely related to NP performance, especially in tests of memory function, but also in tests of working memory, semantic processing, language, and visuospatial perception. CR significantly modified the relationship, such that at progressively higher levels of CR, increased amyloid deposition was less or not at all associated with poorer neuropsychological performance. In a subsample of normal controls, both the main effect of amyloid deposition of worse memory performance and the interaction with CR were replicated using a particularly challenging memory test. INTERPRETATION Amyloid deposition is associated with lower cognitive performance both in AD patients and in the normal elderly, but the association is modified by CR, suggesting that CR may be protective against amyloid-related cognitive impairment.
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Affiliation(s)
- Dorene M Rentz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 33 Fruit Street, Boston, MA 02114, USA
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27
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Abstract
Our understanding of the emotional features of schizophrenia has benefited greatly from the adoption of methods and theory from the field of affective science. This article covers basic concepts and methods from affective science on the psychological and neural mechanisms contributing to emotions and reviews the ways in which this research has advanced our understanding of emotional response deficits in schizophrenia. We review naturalistic studies and elicitation studies that evoke emotion responses among participants, including emotion expression, experience, and autonomic physiology. We also consider how these emotion response measures correspond to schizophrenia symptoms, and we focus particular attention on the issue of sex differences in emotional responding and how this may influence our understanding emotional functioning among individuals with schizophrenia.
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Affiliation(s)
- Ann M. Kring
- Department of Psychology, University of California, Berkeley, CA,To whom correspondence should be addressed; Department of Psychology, 3210 Tolman Hall, University of California, Berkeley, CA 94720-1650; tel: 510-643-1560, fax: 510-642-5293, e-mail:
| | - Erin K. Moran
- Department of Psychology, University of California, Berkeley, CA
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28
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Johnson KA, Gregas M, Becker JA, Kinnecom C, Salat DH, Moran EK, Smith EE, Rosand J, Rentz DM, Klunk WE, Mathis CA, Price JC, Dekosky ST, Fischman AJ, Greenberg SM. Imaging of amyloid burden and distribution in cerebral amyloid angiopathy. Ann Neurol 2007; 62:229-34. [PMID: 17683091 DOI: 10.1002/ana.21164] [Citation(s) in RCA: 376] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cerebrovascular deposition of beta-amyloid (cerebral amyloid angiopathy [CAA]) is a major cause of hemorrhagic stroke and a likely contributor to vascular cognitive impairment. We evaluated positron emission tomographic imaging with the beta-amyloid-binding compound Pittsburgh Compound B (PiB) as a potential noninvasive method for detection of CAA. We hypothesized that amyloid deposition would be observed with PiB in CAA, and based on the occipital predilection of CAA pathology and associated hemorrhages, that specific PiB retention would be disproportionately greater in occipital lobes. METHODS We compared specific cortical PiB retention in 6 nondemented subjects diagnosed with probable CAA with 15 healthy control subjects and 9 patients with probable Alzheimer's disease (AD). RESULTS All CAA and AD subjects were PiB-positive, both by distribution volume ratio measurements and by visual inspection of positron emission tomographic images. Global cortical PiB retention was significantly increased in CAA (distribution volume ratio 1.18 +/- 0.06) relative to healthy control subjects (1.04 +/- 0.10; p = 0.0009), but was lower in CAA than in AD subjects (1.41 +/- 0.17; p = 0.002). The occipital-to-global PiB ratio, however, was significantly greater in CAA than in AD subjects (0.99 +/- 0.07 vs 0.86 +/- 0.05; p = 0.003). INTERPRETATION We conclude that PiB-positron emission tomography can detect cerebrovascular beta-amyloid and may serve as a method for identifying the extent of CAA in living subjects.
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Affiliation(s)
- Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Rentz DM, Huh TJ, Sardinha LM, Moran EK, Becker JA, Daffner KR, Sperling RA, Johnson KA. Intelligence quotient-adjusted memory impairment is associated with abnormal single photon emission computed tomography perfusion. J Int Neuropsychol Soc 2007; 13:821-31. [PMID: 17697413 DOI: 10.1017/s1355617707071056] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 10/02/2006] [Revised: 03/16/2007] [Accepted: 03/16/2007] [Indexed: 11/07/2022]
Abstract
Cognitive reserve among highly intelligent older individuals makes detection of early Alzheimer's disease (AD) difficult. We tested the hypothesis that mild memory impairment determined by IQ-adjusted norms is associated with single photon emission computed tomography (SPECT) perfusion abnormality at baseline and predictive of future decline. Twenty-three subjects with a Clinical Dementia Rating (CDR) score of 0, were reclassified after scores were adjusted for IQ into two groups, 10 as having mild memory impairments for ability (IQ-MI) and 13 as memory-normal (IQ-MN). Subjects underwent cognitive and functional assessments at baseline and annual follow-up for 3 years. Perfusion SPECT was acquired at baseline. At follow-up, the IQ-MI subjects demonstrated decline in memory, visuospatial processing, and phonemic fluency, and 6 of 10 had progressed to a CDR of 0.5, while the IQ-MN subjects did not show decline. The IQ-MI group had significantly lower perfusion than the IQ-MN group in parietal/precuneus, temporal, and opercular frontal regions. In contrast, higher perfusion was observed in IQ-MI compared with IQ-MN in the left medial frontal and rostral anterior cingulate regions. IQ-adjusted memory impairment in individuals with high cognitive reserve is associated with baseline SPECT abnormality in a pattern consistent with prodromal AD and predicts subsequent cognitive and functional decline.
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Affiliation(s)
- Dorene M Rentz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Moran EK, Becker JA, Satlin A, Lyoo IK, Fischman AJ, Johnson KA. Psychosis of Alzheimer's disease: Gender differences in regional perfusion. Neurobiol Aging 2007; 29:1218-25. [PMID: 17408808 DOI: 10.1016/j.neurobiolaging.2007.02.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 02/07/2007] [Accepted: 02/15/2007] [Indexed: 11/19/2022]
Abstract
We sought to determine whether the presence of psychotic symptoms in patients with Alzheimer's disease is associated with abnormal regional cerebral function. Perfusion single photon emission computed tomography images from 51 AD patients with psychotic symptoms were compared to images of 52 AD patients without such symptoms. Group comparisons were made with a voxel-based method, Statistical Parametric Mapping. We found that perfusion was lower in female patients with psychotic symptoms in right infero-lateral prefrontal cortex and in inferior temporal regions compared to female patients without such symptoms. In contrast, perfusion was higher in male patients with psychotic symptoms in the right striatum compared to male patients without such symptoms. Comparison groups did not differ in age or in dementia severity, as estimated by the Mini-Mental State Examination (MMSE). These results support the role of right hemisphere prefrontal and lateral temporal cortex in the psychosis of AD in women but not in men, and raise the possibility that these dysfunctional processes have a gender-specific regional pathophysiology in AD.
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Affiliation(s)
- E K Moran
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Tilton 201, Boston, MA 02114, USA
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Johnson KA, Moran EK, Becker JA, Blacker D, Fischman AJ, Albert MS. Single photon emission computed tomography perfusion differences in mild cognitive impairment. J Neurol Neurosurg Psychiatry 2007; 78:240-7. [PMID: 17056633 PMCID: PMC2117661 DOI: 10.1136/jnnp.2006.096800] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To relate cerebral perfusion abnormalities to subsequent changes in clinical status among patients with mild cognitive impairment (MCI). METHODS Perfusion single photon emission computed tomography (SPECT) images were acquired in 105 elderly patients without dementia with MCI, using 99mTc-HMPAO. Clinical outcome after a 5-year follow-up period was heterogeneous. RESULTS Baseline SPECT data differed in those patients with MCI who were later diagnosed with Alzheimer's disease (the converter group) from those patients with MCI who experienced clinically evident decline but did not progress to a diagnosis of Alzheimer's disease within the follow-up period (the decliner group), from patients with MCI who had no clinical evidence of progression (the stable group), and from a group of 19 normal subjects (the control group). The most consistent decreases in relative perfusion in converters compared with the normal, stable and decliner groups were observed in the caudal anterior cingulate, and in the posterior cingulate. In addition, converters showed increased relative perfusion in the rostral anterior cingulate in comparison to the stable and decliner groups. A group of patients with Alzheimer's disease were also included for purposes of comparison. The group of patients with Alzheimer's disease at baseline differed from each of the other groups, with temporoparietal regions showing the most significant reductions in perfusion. CONCLUSIONS These results suggest that clinical heterogeneity in MCI is reflected in SPECT perfusion differences, and that the pattern of perfusion abnormalities evolves with increasing clinical severity.
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Affiliation(s)
- K A Johnson
- Department of Radiology, Massachusetts General Hospital, Fruit Street, Boston, MA 02114, USA.
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Rentz DM, Sardinha LM, Manning LN, Moran EK, Becker JA, DeKosky ST, Klunk WE, Mathis CA, Sperling RA, Fischman AJ, Johnson KA. IC–103–04: Amyloid burden correlates with cognitive function in normal aging, MCI and AD. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Keith A. Johnson
- Brigham and Women's HospitalBostonMAUSA
- Massachusetts General HospitalBostonMAUSA
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Rentz DM, Sardinha LM, Manning LN, Moran EK, Becker JA, Sperling RA, DeKosky ST, Mathis CA, Klunk WE, Fischman AJ, Johnson KA. P2–329: Amyloid burden correlates with cognitive function in normal aging, MCI and AD. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Keith A. Johnson
- Brigham and Women's HospitalBostonMAUSA
- Massachusetts General HospitalBostonMAUSA
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Greenberg SM, Kinnecom K, Klunk WE, Mathis CA, DeKosky ST, Price JC, Rentz DM, Moran EK, Fischman AJ, Johnson KA. IC–P–016: Imaging of cerebral amyloid angiopathy with Pittsburgh compound B. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Keith A. Johnson
- Massachusetts General HospitalBostonMAUSA
- Brigham and Women's HospitalBostonMAUSA
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Abstract
The role of laughter during psychotherapy is poorly understood. This study examined 10 unique sessions of psychodynamic psychotherapy with digital videotape and simultaneous measures of skin conductivity (SC) from patients and therapists. Independent observers coded laugh episodes using published criteria. Observers identified 167 laugh responses. Of the 119 patient laughs, 91 (76.5%) were patient as speaker, compared with 28 (23.4%) as nonspeaker audience. In contrast, of the 48 therapist laughs, only five (10.4%) were therapist as speaker, whereas 43 (90.3%) were as nonspeaker audience. The difference was highly significant (p < .001). Physiologic data showed that mean SC level increased regardless of role as patient, therapist, speaker, or audience (p < .001). Two-factor analysis of variance indicated that SC change scores were significantly larger when patients and therapists laughed together compared with laughing alone (p < .05). The results support an empirically based approach to the study of laughter and the use of psychophysiology as a measure of process during psychotherapy.
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Affiliation(s)
- Carl D Marci
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston 02114, USA
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Johnson KA, Moran EK, Becker JA, Killiany R, Blacker D, Fischman AL, Albert M. P2-240 Prediction of clinical stability vs. progression in questionable ad using perfusion spect. Neurobiol Aging 2004. [DOI: 10.1016/s0197-4580(04)80986-2] [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: 11/29/2022]
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Johnson KA, Rentz DM, Moran EK, Becker JA, Schlossmacher MG, Sudarsky LR, Fischman AJ. O4-06-06 Combined dopamine transporter and FDG pet in DLB, AD, and PD. Neurobiol Aging 2004. [DOI: 10.1016/s0197-4580(04)80293-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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