Shyness, emotion processing, and objective quality of life among adults with schizophrenia: an ERP study

Purpose: Although individual differences in temperament have been shown to influence Quality of Life (QoL) among individuals with schizophrenia, there exists considerable heterogeneity in such outcomes suggesting moderating factors. Here we used event-related potential (ERP) methodology to examine whether the processing of facial emotions moderated the association between shyness and objective QoL among adults with schizophrenia.Methods: Forty stable outpatients with schizophrenia completed measures of shyness and QoL. Early visual ERP components (P100, N170) were recorded while participants viewed emotional faces.Results: We observed a significant interaction between shyness and P100 and N170 amplitudes in response to fearful faces in predicting Intrapsychic Foundations QoL. Patients with reduced P100 and N170 amplitudes to fearful compared to neutral faces displayed the lowest QoL, but only if they were also high in shyness. We also found a significant interaction between shyness and ERP latency at the P100 and N170 in response to happy faces. Patients who displayed longer P100 and N170 latencies to happy faces compared to neutral faces and with higher shyness levels scored lower on Intrapsychic Foundations and Interpersonal Relations QoL, respectively.Conclusion: These findings suggest that the neural processing of emotional faces and shyness interact to predict aspects of QoL among outpatients with schizophrenia.

Totally All Alone with My Thoughts: Development, Psychometric Properties and Correlates of the Loneliness Automatic Thoughts Questionnaire

Introduction

The current article introduces the Loneliness Automatic Thoughts Questionnaire (LATQ) and describes research evaluating its psychometric properties and correlates.

Methods

Two separate samples of university student participants (Study 1; N = 282, Study 2; N = 289) were administered the LATQ along with a battery of other measures. Whereas Study 1 involved a preliminary investigation of the psychometric properties of the LATQ, Study 2 provided an opportunity to further expand on this aim by assessing the concurrent validity of the measure across studies.

Results

Overall, psychometric analyses confirmed that the LATQ items are measured with an adequate degree of internal consistency and confirmatory factor analyses established that the nine items loaded significantly on one replicable factor. Concurrent validity was established in terms of links with other loneliness measures and a measure of persistent and intrusive negative thoughts. Furthermore, LATQ scores were associated with anti-mattering, social hopelessness, anxiety, depression, and unbearable psychache. Moreover, regression analyses established that the LATQ predicted significant unique variance in depression and psychache beyond the variance attributable to measures of loneliness and adaptability to loneliness.

Discussion

Collectively, results indicate that loneliness-related automatic thoughts represent a unique and important element of the loneliness construct. Future research applications and additional psychometric issues to address in future research are discussed and a need for a greater focus on the cognitive aspects of loneliness is explored.

Too Close for Comfort: Stigma by Association in Family Members Who Live with Relatives with Mental Illness

Stigma by association is described in qualitative research of family members who have relatives diagnosed with mental illness, depicting their sense of public shame for having these relationship ties. However, there have been relatively few empirical studies thus far, in part due to the isolation of family members affecting research recruitment. In order to address this gap, an online survey was administered to 124 family members, comparing those who live in the same home with their ill relative (n = 81) and those who do not (n = 43). A remarkable incidence of one in three family members reported experiencing stigma by association. Those living with an ill relative reported comparatively higher levels of stigma by association using an adapted questionnaire measure. Both groups experienced loneliness (moderate levels), but importantly, the cohabiting relatives perceived themselves as lacking support from friends and other family members. Correlational analyses revealed that those with heightened stigma by association reported heightened anti-mattering: that is, feeling that other people treat them as if they are insignificant and invisible. Anti-mattering was also associated with more loneliness and reduced social support. Our discussion focuses on the theme that family members who actually live with mentally ill relatives experience heightened social isolation that is under-recognized due to public stigma concerns, compounded by feeling their own lives do not matter to others. Public health implications are considered for the stigmatized family members who appear to be particularly marginalized.

Distinct profiles of psychological and neuropsychological functions underlying goal-directed pursuit in schizophrenia

OBJECTIVES

Several components are known to underlie goal-directed pursuit, including executive, motivational and volitional functions. These were explored in schizophrenia spectrum disorders in order to identify subgroups with distinct profiles.

METHODS

Multiple executive, motivational and volitional tests were administered to a sample of outpatients with schizophrenia spectrum diagnoses (n = 59) and controls (n = 63). Research questions included whether distinct profiles exist and whether some functions are impacted disproportionately. These questions were addressed via cluster analysis and profile analysis, respectively.

RESULTS

Some such functions were significantly altered in schizophrenia while others were unaffected. Two distinct profiles emerged, one characterized by energizing deficits, reduced reward sensitivity and few subjective complaints; while another was characterized by markedly increased punishment sensitivity, intact reward sensitivity and substantial subjective reporting of avolitional symptoms and boredom susceptibility.

CONCLUSION

These findings highlight the importance of considering distinct patterns of strengths and deficits in functions governing goal-directed pursuit in schizophrenia that demarcate identifiable subtypes. These distinctions have implications for treatment, assessment and research.

The impact of social media coverage on attitudes towards mental illness and violent offending

The aim of this study is to better understand stigma towards individuals with mental illness who commit violent offences, and examine ways to mitigate the negative impact of social media news stories of schizophrenia and violent offending. Psychology undergraduate students (N = 255) were exposed to Instagram images and captions of recent real news stories of violent offending by individuals with schizophrenia. In the experimental condition, contextual clinical explanatory information was integrated. Pre- and post-measures of stigma were completed. There was a significant increase in negative attitudes towards individuals with mental illness who committed violent offences following the no-context condition, which was clearly mitigated in the experimental condition where context was provided. In both conditions, there were significant increases in intended social-distancing behaviours towards and perceptions of dangerousness of individuals with schizophrenia, and negative beliefs about mental illness more generally. There appears to be utility in incorporating knowledge-based clinical information to mitigate some facets of stigma.

Mistakes in interpersonal perceptions: Social cognition in aggressive forensic psychiatry patients

BACKGROUND

While there is an established link between untreated psychosis and aggression, an enhanced understanding of the role of social cognition is still needed.

AIMS

To examine social cognitive functioning among patients in a specialist forensic mental health service who had been deemed not criminally responsible for acts of violence due to a psychotic disorder. It was hypothesised, first, that such patients would show reduced social cognitive functioning compared with healthy, nonviolent comparison participants and, second, that those who continued to be aggressive while inpatients would demonstrate significant reductions compared to the now nonaggressive group.

METHODS

The study samples were of 10 recently aggressive and 15 not-recently aggressive patients and 20 healthy, nonviolent comparison participants. Each completed the Toronto Empathy Questionnaire (TEQ), the Reading the Mind in the Eyes Test-Revised (RMET) and the Interpersonal Perception Task-15 (IPT-15).

RESULTS

There was no significance between group differences on the RMET and TEQ. The patient group as a whole, however, showed significant interpersonal misperceptions, with specific misperceptions on IPT-15 deception and kinship subscales, while at the same time lacking self-awareness of their errors. Misperceptions on the IPT-15 competition subscale were unique to recently aggressive patients.

CONCLUSIONS

Select aspects of reduced social cognitive functioning were found among not criminally responsible patients with psychosis who had committed violent acts and who continued to act aggressively while forensic inpatients. These findings enhance our understanding of the role of social cognition in predisposing toward violence and the potential importance of incorporating interventions which improve social cognition directly. We suggest also the potential for future research using virtual reality technologies in treatment.

Efficacy of a minimally guided internet treatment for alcohol misuse and emotional problems in young adults: Results of a randomized controlled trial

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Cognitive-behavioural therapy (CBT) and motivational interviewing (MI) can be readily adapted for brief, minimally guided, online interventions.

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Minimally guided online treatment is beneficial for hazardous drinking, mood difficulties, and quality of life in the short-term among young adults.

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Strategies designed to increase treatment engagement will likely mitigate the risk of attrition in future programs.

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Future versions of the Take Care of Me program are still needed to determine long-term effects and differential responses to treatment.

Many young adults struggle with comorbid alcohol misuse and emotional problems (i.e., depression and anxiety). However, there is currently a paucity of evidence-based, integrated, accessible treatment options for individuals with these comorbidities. The main goal of this study was to examine efficacy of a novel online, minimally guided, integrated program for comorbid alcohol misuse and emotional problems in young adults. Method: The study was an open-label two-arm RCT. Participants (N = 222, M_age = 24.6, 67.6% female) were randomized to one of two conditions: the Take Care of Me program (an 8-week, online integrated treatment condition consisting of 12 modules), or an online psychoeducational control condition. Intervention modules incorporated content based on principles of cognitive behavioral therapy and motivational interviewing. Participants completed assessment data at baseline, at the end of treatment (i.e., 8 weeks), and at follow-up (i.e., 24 weeks). Data were analyzed using generalized linear mixed models. Results: We observed that participants in the treatment condition showed larger reductions in depression, hazardous drinking, as well as increases in psychological quality of life and confidence at the end of treatment. We did not find group differences on total alcohol use at follow-up, but participants in the treatment group reduced their hazardous drinking and improved their quality of life at 24-week follow-up. Conclusions: Our study provides promising initial evidence for the first iteration of the comorbid alcohol misuse and emotional problems online program.

The Anti-Mattering Scale: Development, Psychometric Properties and Associations With Well-Being and Distress Measures in Adolescents and Emerging Adults

Previous work has focused on positive feelings of mattering, which pertain to the human need to feel significant. In the current article, we examine a complementary yet distinct construct involving feelings of not mattering that may arise from being marginalized and experiences that heighten a sense of being insignificant to others. We also describe the development, validation, and research applications of the Anti-Mattering Scale. The Anti-Mattering Scale (AMS) is a five-item inventory assessing feelings of not mattering to other people. Psychometric analyses of data from samples of emerging adults and adolescents confirmed that the AMS comprises one factor with high internal consistency and adequate validity. Our findings suggest that individuals who feel like they do not matter to others have a highly negative self-view, insecure attachment, and perceived deficits in meeting key psychological needs. Analyses established that links between elevated AMS scores and levels of depression, social anxiety, and loneliness. Most notably, scores on this new measure predicted unique variance in key outcomes beyond the variance attributable to other predictors. Overall, these results attest to the research utility and clinical potential of the AMS as an instrument examining the tendency of certain people to experience a profound sense of not mattering to others in ways that represent a unique source of risk, social disconnection, and personal vulnerability.

Revisiting Shyness and Sociability in Schizophrenia: A Psychometric Examination of Measurement Invariance and Mean Level Differences

Although there is a long and rich empirical history of demonstrating differences on psychological self-report measures between people with schizophrenia and healthy controls, the question of whether both groups respond to psychological measures in the same way has gone largely unexplored. That is, is there measurement equivalence, or invariance, across the samples? To our knowledge, there have been no published studies on measurement equivalency in personality measures across groups diagnosed with and without schizophrenia. Here we examined the question of measurement invariance on two widely used questionnaires assessing temperament, the Cheek and Buss Shyness and Sociability Scales (CBSHY and CBSOC, respectively) between 147 stable adult outpatients with schizophrenia and 147 healthy age- and sex-matched controls. Results supported measurement invariance of the CBSHY and CBSOC across our clinical and non-clinical groups. These findings suggested that stable adult outpatients with schizophrenia and age- and sex-matched controls respond to the shyness and sociability items in the same way. We found that adults with schizophrenia reported higher levels of shyness and lower levels of sociability than healthy controls, consistent with prior studies. Findings are discussed concerning their relevance more broadly to self-report assessments of personality and psychological traits in clinical populations.

The Double Jeopardy of Feeling Lonely and Unimportant: State and Trait Loneliness and Feelings and Fears of Not Mattering

There have been recent concerns about an "epidemic of loneliness" during the pandemic, given the pervasiveness of loneliness in the population and its harmful effects on health and well-being. Therefore, it is important to establish the correlates of loneliness. The purpose of the current study was to explore how loneliness relates to a construct termed mattering, which is the feeling of being important to other people. Mattering was assessed with multiple measures in the current study (e.g., mattering in general, fears of not mattering, and mattering to peers). A sample of 172 female psychology undergraduate students aged 18-25 years completed self-report measures of general mattering, mattering to peers, anti-mattering, fear of not mattering, and state and trait loneliness. As predicted, lower levels of both general mattering and mattering to peers were associated with higher state loneliness. Higher feelings of anti-mattering (feelings of being invisible and insignificant to others) and fears of not mattering were associated with greater trait loneliness, as well as a reduced sense of mattering to friends. The findings illustrate that feeling as though one does not matter to others (i.e., feeling insignificant and unimportant) is associated with increased state and trait loneliness among young women. Implications are discussed for loneliness theory and how these results can enhance both clinical understanding and practice.

What Celebrity Case Studies Can Teach about Clinical Formulation of Mental Health Conditions

A key challenge in the 'making of the psychologist' is how to teach clinical case formulation, which goes beyond just listing the symptoms that make the 'diagnosis'. One approach which has been both effective and popular among students entails employing case studies of individuals who are celebrities with known mental health conditions and then exploring not only their presenting problems and symptoms, but also a detailed analysis of biopsychosocial predisposing concerns, precipitating events, perpetuating circumstances, and protective factors. Nine cases deemed to be particularly suitable for such psychobiographical instruction are reviewed to illustrate the learning points about case formulation. The cases were chosen because they provide a breadth of presenting symptoms and the individuals under consideration are ones who for the most part have been self-disclosing about their conditions, which makes the clinical material accessible for study; a number have been leaders in the fight against mental illness stigma. The use of celebrity case accounts serves to develop talents in case formulation and appreciation for the complexity of people and the developmental influences in identity formation. Further pedagogic benefits are heightened awareness of mental health stigma issues and the personal and societal barriers individuals face in seeking needed help.

Shyness, hormones, and quality of life among adults with schizophrenia

OBJECTIVE

Although individual differences in personality are known to influence quality of life in individuals with schizophrenia, relatively few studies have attempted to identify putative links underlying this relation.

METHODS

Here, we examined associations among temperamental shyness, hormones (ie baseline salivary cortisol and testosterone), and quality of life (QoL) measured in 42 stable outpatient adults with schizophrenia.

RESULTS

We found that baseline cortisol, but not testosterone, moderated the relation between shyness and QoL (ß = 1.09, p = 0.004). Among individuals with relatively low baseline cortisol, higher shyness was associated with lower Intrapsychic Foundations QoL. Individuals with relatively higher baseline cortisol reported similar QoL scores irrespective of level of shyness.

CONCLUSION

These preliminary results suggest that relatively lower baseline cortisol may be helpful to understanding the relation between temperament and Intrapsychic Foundations QoL in schizophrenia. The present findings are consistent with previous studies implicating relatively lower baseline cortisol levels in nonclinical samples of people who are shy and the negative downstream effects resulting from HPA axis dysregulation, and extends these prior findings to people with schizophrenia who are also shy.

Short, Shorter, Shortest

The accuracy of different subtest combinations in predicting Verbal, Performance, and Full Scale IQ, scores on the revised edition of the Wechsler Adult Intelligence Scale (WAIS-R) was examined. A best subset multiple regression technique with sample sizes ranging from 1,062 to 1,084 individuals was used. All possible subtest combinations were analyzed to determine the ones that showed the three best and the single worst multiple Rs with IQ scores from the complete WAIS-R. All short forms provided accurate estimates of Full Scale scores, and predictive accuracy increased slightly as more subtests were used. The data suggest that statistically searching for a “best” short form is largely futile. Short forms should be selected on the basis of their efficiency to provide the information required.

Boredom proneness predicts quality of life in outpatients diagnosed with schizophrenia-spectrum disorders

BACKGROUND

There is increasing recognition of the clinical significance of boredom associated with functional impairments in schizophrenia. Previous work has highlighted the importance of motivational deficits more broadly, although no study has yet explored the unique effects of boredom on community outcomes.

AIMS

This study aims to measure boredom proneness among outpatients diagnosed with schizophrenia to determine whether it is elevated in this population and to determine its relation to quality-of-life outcomes.

METHODS

A self-report measure of boredom proneness along with standard measures of symptoms and functional status was administered to a community-dwelling sample of schizophrenia outpatients.

RESULTS

Boredom proneness was found to be elevated in this population and was associated with reduced quality of life, specifically with leisure activity dissatisfaction and reduced sense of financial well-being. Negative symptoms were determined to be associated with reduced work and school functioning.

CONCLUSION

This pattern of unique effects on quality of life highlights the clinical relevance of identifying a subjective state of boredom and has theoretical importance in distinguishing boredom proneness specifically from more general avolitional and amotivational conditions that have tended to be the focus of clinical observation and previous research.

An event-related source localization study of response monitoring and social impairments in autism spectrum disorder

A number of studies suggest anterior cingulate cortex (ACC) abnormalities in autism spectrum disorder (ASD), which might underlie response monitoring and social impairments exhibited by children and adolescents with ASD. The goal of the present study was to extend this work by examining error and correct response monitoring using event-related potentials (ERN, Pe, CRN) and LORETA source localization in high functioning adults with ASD and controls. Adults with ASD showed reduced ERN and Pe amplitudes and reduced rostral ACC activation compared with controls. Adults with ASD also showed less differentiation between error and correct ERP components. Social impairments and higher overall autism symptoms were related to reduced rostral ACC activity at the time of the ERN, particularly in adults with ASD. These findings suggest that reduced ACC activity may reflect a putative brain mechanism involved in the origins and maintenance of social impairments and raise the possibility of the presence of stable brain-behavior relation impairment across development in some individuals with ASD.

When Ideals Get in the Way of Self-Care

In the current study, we investigated whether adolescents high in perfectionism are prone to experiencing self-stigma for seeking psychological help. This work is based on the premise that the need to seek help for psychological difficulties is not consistent with idealistic personal goals of perfectionistic young people and their desire to retain an idealistic self-image. A sample of 85 high school students completed the Child and Adolescent Perfectionism Scale, the Self-Stigma of Seeking Help Scale, and a measure of contact with individuals with mental illness. Results indicated that perfectionism was associated with self-stigma among those students with little to no experience with people with a history of mental illness. These findings suggest that certain perfectionistic students have a propensity toward low self-acceptance and judge themselves negatively for needing help. Implications are discussed for prevention and intervention programs that emphasize contact and experiential opportunities with individuals who have mental illness.

Temperament and its relation to social functioning in schizophrenia

BACKGROUND

We previously noted increased shyness in stable community outpatients with schizophrenia compared to healthy controls and that shyness may be a risk factor for social functioning impairment in this population (Goldberg & Schmidt, 2001).

AIMS

We attempted to replicate and extend these findings by comparing the use of a brief trait measure of shyness and sociability (SS; Cheek, 1983; Cheek & Buss, 1981) with the longer Temperament and Character Inventory (TCI; Cloninger, Przybeck, Svrakic, & Wetzel, 1994) used traditionally in work to measure personality dimensions in this population.

METHODS

A group of stable outpatients with schizophrenia (n = 41) and healthy controls (n = 41) matched on age and gender were compared on the SS and TCI measures. Patients were assessed on clinical symptoms using the Positive and Negative Symptom Scale (PANSS) and on social functioning measures using a Quality of Life Scale (QLS).

RESULTS

Patients reported significantly higher shyness, retrospective inhibition and harm avoidance, and lower novelty seeking, self-directedness and cooperativeness than healthy adults, replicating previous findings. Shyness and sociability were related to conceptually linked dimensional sub-scales of the TCI and were predictive of social functioning in the patient group. Importantly, scores on these measures were unrelated to symptom profiles and explained additional variance in social functioning beyond clinical symptoms.

CONCLUSIONS

These findings suggest that individual differences in trait shyness and sociability may influence social functioning in stable outpatients with schizophrenia. The results also support the use of the brief trait measures of shyness and sociability in this population.

The Canadian Objective Assessment of Life Skills (COALS): a new measure of functional competence in schizophrenia

This study examined the reliability and validity of a new performance-based measure of functional competence for individuals with serious mental illness, the Canadian Objective Assessment of Life Skills (COALS). The COALS assesses both routinized procedural knowledge routines (PKR) and executive operations (EXO) in order to capture functional outcome variance. The COALS was administered to 101 outpatients with schizophrenia and schizoaffective disorder and 80 non-psychiatric controls. One month later, 95 patients and 63 controls completed a follow-up assessment. Measures of psychopathology, neurocognition, functionality and community adjustment were also administered. Results indicated that the COALS summary scores had good test-retest reliability for patient data. Further, the COALS correlated with other measures of functionality and with negative symptoms, but was independent of positive symptoms, demonstrating concurrent and discriminant validity. The overall COALS summary score added incremental validity to the prediction of community independence over and above the contribution of symptoms, intellectual ability and neurocognitive performance. Inclusion of EXO scores provided incremental validity not available with PKR scores alone. The COALS increases the number of functional competence instruments and offers the advantage of specific validity while incorporating important distinctions in cognitive performance.

WAIS-IV Profile of Cognition in Schizophrenia

The Wechsler Adult Intelligence Scale (WAIS) has been used extensively to study impairment across a range of cognitive domains in schizophrenia. However, cognitive performance among those with the illness has yet to be examined using the newest edition of this measure. Hence, the current study aims first, to provide WAIS-IV normative data for Canadian individuals with schizophrenia of low average intelligence; second, to examine schizophrenia performance on all WAIS-IV subtest, index and general intelligence scores relative to healthy comparison subjects; and third, to revalidate the pattern of impairment identified in this clinical group using the WAIS-III, where processing speed (PS) was most affected, followed by working memory (WM), perceptual reasoning (PR) and verbal comprehension (VC). The WAIS-IV was administered to outpatients with schizophrenia and their performance compared with age, gender, and education matched controls. WAIS-IV schizophrenia performance data are provided. Analyses revealed significant impairment on several tasks, including the new Cancellation subtest and the VC supplemental subtest, Comprehension. At the index score level, group differences in PS were significantly larger than those observed in all other cognitive domains. Impairments were also observed in WM amid relatively preserved performance in VC, thereby confirming the pattern of impairment identified using the WAIS-III.

Self-Stigma of Mental Illness in High School Youth

Despite the prevalence of mental health problems, society continues to stigmatize and discriminate against people with mental illness and in particular, schizophrenia. Among the negative consequences of stigma, is that some individuals with mental illness internalize negative stereotypes about themselves, referred to as self-stigma, which is associated with a reluctance to seek needed treatment. The challenge to overcome mental illness stigma has led to the development of global anti-stigma initiatives, which effectively engage young people in school-based programs. The present study examines the effectiveness of a single-session anti-stigma intervention with high school youth ( n = 254). The findings replicate and extend previous work demonstrating that a brief anti-stigma initiative can produce significant improvements in knowledge, social distance, and self-stigma. Self-stigma was found to be associated with low self-esteem and factors affecting self-disclosure were identified. Implications for school curricula, mental health policy, and future research are discussed.

Autonomic regulation predicts performance on Wisconsin Card Sorting Test (WCST) in adults with schizophrenia

Although executive functions have been associated with autonomic regulatory capacity in healthy adults, there appear to be no reports of these relations in adults with schizophrenia to date. We tested whether baseline autonomic regulation was associated with performance on the Wisconsin Card Sorting Test (WCST) in a group of 42 stable community outpatients with schizophrenia. Patients exhibited faster resting heart rates and lower respiratory sinus arrhythmia (RSA) than age-matched controls, consistent with previous research. Patients also completed relatively few WCST categories and made many perseverative errors, replicating prior studies. Within the patient group, relatively better WCST performance was associated with slower resting heart rate and higher RSA, suggesting that inefficient executive and autonomic functioning in schizophrenia may be linked. WCST performance and autonomic regulatory capacity were further reduced in a subset of patients receiving clozapine, but relations between WCST performance and autonomic regulatory parameters did not differ from those of other patients. Findings extend the neurovisceral integration model of autonomic regulation to adults with schizophrenia and attest to the reliability of the model.

Successful change in tobacco use in schizophrenia

The high rates of tobacco use among individuals with schizophrenia are well documented, but there has been less attention paid to identifying what are the special needs for this population. In fact, there have even been suggestions from early work that standard interventions and approaches might be adequate. In contrast, based on more than a decade of experience supporting change smoking behavior among people with schizophrenia, three key factors were identified as unique considerations that are associated with success. The first factor involves readiness to change; smokers with schizophrenia are rarely given opportunities to even try to quit unlike their counterparts in the general population and therefore have not benefited from the self-efficacy aspects of attempt experiences. The second factor is medication and symptom monitoring; there are special needs for nurses and medical staff to monitor symptoms (including schizophrenia symptoms and mood symptoms), medication dosage and side-effects, during the period when individuals with schizophrenia are changing (reducing) their tobacco use, particularly when nicotine replacement therapy is being implemented. Finally, the third factor is peer and caregiver support; the use of peer assistants in group-based programs and the teaching of nurses and other professional casegivers as well as family members about their role as supports can make an important difference in tipping the balance toward successful change and toward maintenance of change over time.

Cognitive, clinical, and functional characteristics of verbally superior schizophrenia patients

The existence of small numbers of schizophrenia patients with superior ability in specific cognitive domains is implied by meta-analytic evidence as well as by occasional empirical reports. The authors identified 25 patients with superior (i.e., > or =90th percentile) ability on the Vocabulary subtest of the Wechsler Adult Intelligence Scale 3rd edition (Wechsler, 1997). These cognitively advantaged patients were compared with 22 healthy participants performing at the superior level and with 126 schizophrenia patients and 50 healthy participants scoring below the superior range. Verbally superior schizophrenia patients and verbally superior healthy participants had similar cognitive profiles and life skills performance, but diverged markedly in terms of independent "real-world" functioning. Verbally superior patients significantly outperformed more typical patients in other aspects of cognitive performance, life skills, and support requirements. However, severity of positive and negative symptoms was equivalent in the patient groups. Detailed biobehavioral study of cognitively exceptional patients may offer new insights into mechanisms mediating psychotic disorders.

Predictors of medication competence in schizophrenia patients

Competence in self-administration of a drug regimen is related to both treatment adherence and functional outcome. Previous research with middle-aged and older schizophrenia patients suggests a central role for cognitive performance in predicting this competence. We examined the relative and joint contributions of demographic, clinical and cognitive predictors of medication management ability in an age-representative group of patients. The study participants comprised 147 patients with schizophrenia or schizoaffective disorder ranging from 21 to 65 years of age. Measures included demographic variables, current symptoms, subjective treatment response and a battery of cognitive tests. Competence in medication management was indexed with the Medication Management Ability Assessment (MMAA). Multiple regression analyses revealed that cognitive variables accounted for a significant proportion of the variance in MMAA scores over and above the contribution of all other variables. Measures of word recognition and pronunciation, auditory working memory and verbal learning yielded unique contributions to prediction. Positive and negative symptoms and subject treatment evaluations did not independently predict medication competency. This study documents a considerable range in MMAA scores across a demographically broad schizophrenia sample and supports the unique contribution of specific cognitive factors in predicting medication competence.

Psychotic disorders, eating habits, and physical activity: who is ready for lifestyle changes?

OBJECTIVES

Significant weight gain is a serious side effect of many antipsychotic medications, yet successful strategies for significant weight loss are lacking. The transtheoretical model for weight management can be used to identify people who are ready to change (contemplation-preparation group) their eating habits and physical activity. This study compared characteristics of patients in Canada who had a psychotic disorder and were ready to make lifestyle changes with characteristics of patients who were not considering lifestyle changes.

METHODS

Participants were surveyed to determine their stages of change for eating habits and physical activity, and various characteristics were measured, including body mass index, body image, nutritional intake, and level of physical activity.

RESULTS

A total of 101 participants (64 men) (mean+/-SD age 35+/-11 years) were taking antipsychotic medications. Seventy-one percent had schizophrenia spectrum disorders, and 15% had affective psychosis. The prevalence of patients identified as being ready for change was higher than expected: 68% for eating habits and 54% for physical activity. Participants who were ready to change eating habits were also ready to change physical activity habits (p<.04). Stages of change for eating habits were associated with body mass index (p<.004), whereas stages of change for physical activity were associated with self-reported vigorous (p<.001) and moderate (p<.005) physical activity but not mild physical activity.

CONCLUSIONS

Clinicians may help patients develop healthier eating and physical activity habits by using the transtheoretical model, because it identifies patients who are ready to change to healthier lifestyle strategies and may help patients with antipsychotic-induced weight gain.

Impaired distractor inhibition in patients with schizophrenia on a negative priming task

BACKGROUND

Numerous studies have suggested, via the interpretation of negative priming effects, that subjects with schizophrenia are less able than controls to inhibit irrelevant distracting information. Further issues concerning impairment in inhibitory processes are investigated here. First, recent research has revealed that negative priming (NP) effects can be caused by different processes, distractor inhibition or perceptual review. Therefore, conclusions concerning reduced inhibition in patients with schizophrenia are not possible from previous NP research. Secondly, previous NP studies have required subjects to identify some feature of the target. This is the first study to examine NP that uses a spatial task in patients with schizophrenia.

METHOD

Twenty-eight subjects with schizophrenia and 28 age and sex matched non-psychiatric control subjects completed a computerized NP task that eliminated the possible contribution of perceptual review.

RESULTS

Subjects with schizophrenia had reduced levels of NP compared to control subjects on this spatial NP task (t = 2.46, P < 0.02). Current age, positive, negative or total PANNS scores did not correlate with negative priming scores, but post hoc analyses revealed that clozapine-treated patients had significantly greater levels of negative priming than patients receiving typical antipsychotic medications.

CONCLUSIONS

The present experiment eliminated the contribution of perceptual review to negative priming and demonstrated that when a pure measure of inhibition is taken on a localization task, patients with schizophrenia were less able to inhibit irrelevant distracting stimuli. The fact that NP was reduced in a spatial task suggested a more diffuse reduction in inhibition than previous studies that examined only identification-based responses.

Benefits of switching from typical to atypical antipsychotic medications: a longitudinal study in a community-based setting

OBJECTIVE

This study examines the clinical and resource utilization effects of switching stable outpatients with schizophrenia from a typical to an atypical antipsychotic medication.

METHOD

We monitored 43 schizophrenia patients from a community mental health program who tolerated switching from typical to atypical antipsychotic medications. We used the Positive and Negative Syndrome Scale (PANSS), Lehman Quality of Life Interview (QOL), and service utilization data for 2 years before and 2 years after the switch.

RESULTS

The switch to atypical antipsychotics was associated with significant improvements in positive symptoms, in general psychopathology, and in quality of life. Resource requirements, including case-management and crisis services and hospitalization days, were significantly reduced. We observed no changes in the sample's already low levels of negative symptoms.

CONCLUSIONS

In stable outpatients with schizophrenia in a real-world setting, switching to an atypical antipsychotic can result in sustained, significant improvement in clinical response and quality of life, as well as in reduced need for hospitalization and community support.

Shyness, sociability, and social dysfunction in schizophrenia

Recent bio-developmental models of shyness traits (Schmidt, L.A., Fox, N.A., 1998. The development and outcomes of childhood shyness. Annals of Child Development 13, 1--20; Schmidt, L.A. Fox, N.A., 1999. Conceptual, biological, and behavioural distinctions among different types of shy children. In: Schmidt, L.A., Schulkin, J. (Eds.), Extreme Fear, Shyness, and Social Phobia: Origins, Biological Mechanisms, and Clinical Outcomes. Oxford University Press, New York, pp. 47--66) have proposed that childhood shyness and early sociability troubles may be a precursor to pervasive social dysfunction in adulthood. An important question in testing the vulnerability model is to determine the severity of shyness among adults who have a serious social dysfunction, such as individuals diagnosed with schizophrenia. The Cheek and Buss Shyness and Sociability Scales (Cheek, J.M., Buss, A.H., 1981. Shyness and sociability. Journal of Personality and Social Psychology 41, 330--339) and the Reznick Retrospective Self-report of Inhibition (Reznick, J.S., Hegeman, I.N., Kaufman, E.R., Woods, S.W., Jacobs, M., 1992. Retrospective and concurrent self-report of behavioural inhibition and their relation to adult mental health. Development and Psychopathology 4, 301--321) were administered to 23 schizophrenia outpatients and 23 control subjects matched for age and sex. The results indicated that individuals with schizophrenia showed significantly more shyness (P<0.004), lower sociability (P<0.02) and more recollections of childhood social troubles (P<0.007) compared with the control group. Within the schizophrenia group, both shyness traits (P<0.04) and limited sociability (P<0.01) were clearly associated with interpersonal dysfunction, while significant correlations were also found between troubled sociability and negative symptoms (P<0.05). The findings of shyness traits, impaired sociability and more recollections of childhood social difficulties among stable outpatients diagnosed with schizophrenia are consistent with predictions based on a bio-developmental shyness vulnerability model.

Natural cognitive coping strategies in schizophrenia

Recent attention has focused on cognitive-behavioural treatment (CBT) for psychotic thinking. These interventions may be especially appropriate for drug-resistant patients or as an adjunct to pharmacotherapy. However, CBT for schizophrenia was developed in the absence of any systematic investigation of personal self-statements that psychotic individuals develop on their own. The current investigation explored the natural cognitive strategies of 10 community-based persons with schizophrenia. An exploratory interview was employed as the method of inquiry. A data bank of 344 statements was obtained from which 55 pertained to coping strategies. The results were interpreted using the grounded theory method (GTM) of qualitative analysis. Systematic analysis of the meaning units yielded a major category called coping self-talk which pertained to cognitive strategies (the focus of this research report). This category was composed of nine lower-level categories; that is, nine types of self-talk that persons with schizophrenia use actively in their own efforts toward managing psychotic symptoms were identified. These naturalistic coping strategies could provide useful guides for directing cognitive interventions.

What's in a name? The MMPI-2 PTSD scales

The MMPI-2 post-traumatic stress disorder scales (PK and PS) were examined with a sample of 96 outpatient anxiety disorder and 97 outpatient traffic accident subjects. PK and PS correlated .96 and showed highly similar correlations with MMPI-2 validity, clinical, content and supplementary scales for both groups, which indicated that these scales are indices of MMPI first-factor variance. This was supported by separate principal components analyses for each group, in which PK and PS contributed the most variance to the first component. Although the groups showed different MMPI-2 mean profiles, neither PK nor PS contributed to discriminant function classification of group members. It is suggested that PK and PS are indices of general emotional distress and maladjustment; implications for their use in diagnosing post-traumatic stress disorder were discussed.

MCMI-II item weights: their lack of effectiveness

Millon Clinical Multiaxial Inventory II (MCMI-II; Millon, 1987) results from 134 patients were scored twice; with and without the item weights. The results showed that the correlations between the weighted and unweighted versions of the same scales were extremely high, exceeding .90 in all cases. Furthermore, weighting did not significantly reduce the correlations among the scales, either within each of the four syndrome/pattern categories of the MCMI-II, or between categories. It is concluded that item weighting reduces the access of the MCMI-II by clinicians, without increasing its psychometric properties.

The effects of the modifier and correction indices on MCMI-II profiles

Five modifier and correction indices are used in the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987) to improve the sensitivity and specificity of its scales; however, profile analyses indicated that they had little effect on the profiles of 141 psychiatric inpatients. The profiles generated within each MCMI-II section with and without the indices had the same shape and generally showed no significant differences on the various scales. A simple procedure applied to the initial, uncorrected scores provided a good estimate of the final base rate (BR) scores that are obtained when the correction and modifier indices are applied. Examination of individual profiles indicated that the 3-point codetypes were usually the same regardless of whether or not the correction indices were applied. When there were changes, these usually involved changes in rank order; new scales were rarely introduced in a code type. Although the utility of the indices for assessing test-taking attitude remains to be determined, these results argue against their use for modifying BR scores.