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Wolny J, Moussa-Tooks AB, Bailey AJ, MacDonald Iii AW, Mervis JE, Hetrick WP. Measurement invariance of the Revised-Green Paranoid Thought Scale across Black and White Americans. Schizophr Res 2024; 266:227-233. [PMID: 38428120 PMCID: PMC10961092 DOI: 10.1016/j.schres.2024.02.024] [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: 04/27/2023] [Revised: 11/11/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
Given the culturally diverse landscape of mental healthcare and research, ensuring that our psychological constructs are measured equivalently across diverse populations is critical. One construct for which there is significant potential for inequitable assessment is paranoia, a prominent feature in psychotic disorders that can also be driven by culture and racial marginalization. This study examined measurement invariance-an analytic technique to rigorously investigate whether a given construct is being measured similarly across groups-of the Revised-Green Paranoid Thought Scale (R-GPTS; Freeman et al., 2021) across Black and White Americans in the general population. Racial group differences in self-reported paranoia were also examined. The analytic sample consisted of 480 non-Hispanic White and 459 non-Hispanic Black Americans. Analyses demonstrated full invariance (i.e., configural, metric, and scalar invariance) of the R-GPTS across groups, indicating that the R-GPTS appropriately captures self-reported paranoia between Black and White Americans. Accordingly, it is reasonable to compare group endorsement: Black participants endorsed significantly higher scores on both the ideas of reference and ideas of persecution subscales of the R-GPTS (Mean ± SD = 10.91 ± 7.12 versus 8.21 ± 7.17 and Mean ± SD = 10.18 ± 10.03 versus 6.35 ± 8.35, for these subscales respectively). Generalized linear modeling revealed that race remained a large and statistically significant predictor of R-GPTS total score (β = -0.38756, p < 0.001) after controlling for relevant demographic factors (e.g., sex, age). This study addresses a critical gap within the existing literature as it establishes that elevations in paranoia exhibited by Black Americans in the R-GPTS reflect actual differences between groups rather than measurement artifacts.
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Affiliation(s)
- J Wolny
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America.
| | - Alexandra B Moussa-Tooks
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America; Program in Neuroscience, Indiana University Bloomington, IN, United States of America; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, IN, United States of America
| | - Allen J Bailey
- Division of Alcohol, Drugs, and Addiction, McClean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Angus W MacDonald Iii
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States of America; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical Center, Minneapolis, MN, United States of America
| | - Joshua E Mervis
- Department of Psychology, Temple University, Philadelphia, PA, United States of America
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America; Program in Neuroscience, Indiana University Bloomington, IN, United States of America; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
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Mervis JE, Vohs JL, Lysaker PH. An Update on Clinical Insight, Cognitive Insight, and Introspective Accuracy in Schizophrenia-Spectrum Disorders: Symptoms, Cognition, and Treatment. Expert Rev Neurother 2022; 22:245-255. [PMID: 35244496 DOI: 10.1080/14737175.2022.2049757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Poor insight, or unawareness of morbid changes in cognition, emotional states, or behavior, is commonly observed among people with schizophrenia. Poor insight represents a persistent barrier to wellness because it interferes with treatment and self-direction. Paradoxically, good insight may also be a barrier to health when awareness of these changes leads to depression or self-stigma. AREAS COVERED This paper builds upon this previous work by exploring these issues in schizophrenia separately as they have appeared in published research over the last three years in three different kinds of insight: clinical, cognition, and introspective accuracy. Specifically, studies are reviewed that address: the adverse effects of poor insight, the paradoxical effects of good insight, correlates with other forms of cognition, and emerging treatments. EXPERT OPINION The evidence continues to offer a nuanced picture of the complex effects of good insight in schizophrenia. Incremental improvements were also found in the development of novel integrative treatment approaches. This work also highlights the intricacy of the concept of insight, the need for further exploration of the effects of culture, and conceptual work that distinguishes the points of convergence and divergence of these forms of insight.
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Affiliation(s)
- Joshua E Mervis
- University of Minnesota, Department of Psychology, Minneapolis, Minnesota, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Jenifer L Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana, USA.,Eskenzai Health, Sandra Eskenazi Mental Health Center, Prevention and Recovery Center for Early PsychosisE, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana, USA
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Mervis JE, Fischer J, Cooper SE, Deckert AC, Lysaker PH, MacDonald AW, Meyer-Kalos P. Introspective accuracy for substance use across a year of treatment for first episode psychosis. Schizophr Res Cogn 2021; 26:100200. [PMID: 34136362 PMCID: PMC8176356 DOI: 10.1016/j.scog.2021.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
Substance use exacerbates psychosis, mania, depression, and poor functioning in people with first episodes of psychosis (FEP) and is associated with poor treatment outcomes, even when it does not reach the level of a formal disorder. Impaired insight and substance use are common issues that may interfere with treatment outcomes among people experiencing FEP, yet both are treatable. Improvements in these domains are associated with better outcomes. Low insight could increase risk for substance use by impairing the ability to self-appraise and assess consequences. Introspective accuracy (IA) is understudied in this area and is one way of considering self-appraisal. This study is an archival review using data collected from NAVIGATE, a coordinated specialty care program treating people with FEP. IA was operationalized as the difference between clinician and client ratings of substance use. We tested whether IA changed over one year of treatment and whether those changes occurred alongside changes in symptoms and illness self-management. No changes in IA were detected in relation to illness self-management. Changes in IA for substance use occurred midway through treatment—individuals with greater symptom remission had more overconfident IA. Prior research on insight has shown a paradox where greater insight accompanies more symptoms. However, past research has also shown a relationship between IA and functional outcomes, like illness self-management, and that overconfidence in one domain can positively bias clinician ratings in another. Our findings suggest either a positive bias for ratings associated with overconfident IA or an insight paradox type effect. Introspective accuracy is a form of insight that can be applied to early psychosis. Introspective accuracy for substance use paradoxically interacted with symptoms Introspective accuracy for substance use was unrelated to illness self-management.
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Affiliation(s)
- Joshua E Mervis
- University of Minnesota, Department of Psychology, United States of America
| | - Jamie Fischer
- University of Minnesota, School of Social Work, United States of America.,University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Samuel E Cooper
- University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Andrew C Deckert
- University of Minnesota, Department of Psychology, United States of America
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, United States of America.,Indiana University School of Medicine, Department of Psychiatry, United States of America
| | - Angus W MacDonald
- University of Minnesota, Department of Psychology, United States of America.,University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Piper Meyer-Kalos
- University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
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Mervis JE, Bonfils KA, Cooper SE, Wiesepape C, Lysaker PH. Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits. Schizophrenia Bulletin Open 2021; 2:sgab034. [PMID: 34901868 PMCID: PMC8650079 DOI: 10.1093/schizbullopen/sgab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.
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Affiliation(s)
- Joshua E Mervis
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samuel E Cooper
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- To whom correspondence should be addressed; 1481 W 10th St, Indianapolis, IN 46202, USA; tel: (317) 988-2546, e-mail:
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Mervis JE, Fiszdon JM, Lysaker PH, Nienow TM, Mathews L, Wardwell P, Petrik T, Thime W, Choi J. Effects of the Indianapolis Vocational Intervention Program (IVIP) on defeatist beliefs, work motivation, and work outcomes in serious mental illness. Schizophr Res 2017; 182:129-134. [PMID: 27802910 PMCID: PMC5828005 DOI: 10.1016/j.schres.2016.10.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/23/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022]
Abstract
Defeatist beliefs and amotivation are prominent obstacles in vocational rehabilitation for people with serious mental illnesses (SMI). The CBT-based Indianapolis Vocational Intervention Program (IVIP) was specifically designed to reduce defeatist beliefs related to work functioning. In the current study, we examined the impact of IVIP on defeatist beliefs and motivation for work, hypothesizing that IVIP would be associated with a reduction in defeatist beliefs and greater motivation for work. We also examined the effects of IVIP on these variables as well as work outcomes during a 12-month follow-up. Participants with SMI (n=64) enrolled in a four-month work therapy program were randomized to IVIP or a support therapy group (SG). Assessments were conducted at baseline, post-treatment (4months), and follow-up (1year). Compared to those in SG condition, individuals randomized to IVIP condition reported greater reductions in defeatist beliefs and greater motivation for work at follow-up, along with greater supported employment retention rates. Specifically treating and targeting negative expectations for work therapy improves outcomes, even once active supports of the IVIP program and work therapy are withdrawn.
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Affiliation(s)
- Joshua E. Mervis
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN, USA,Corresponding author
| | - Joanna M. Fiszdon
- Psychology Service, VA Connecticut Healthcare System & Yale University School of Medicine, 950 Campbell Ave, West Haven, CT 06516 USA
| | - Paul H. Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tasha M. Nienow
- Minneapolis VA Health Care System, 1 Veterans Dr., Minneapolis, MN 55417 USA
| | - Laura Mathews
- Department of Psychiatric Vocational Services, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Patricia Wardwell
- Department of Psychiatric Vocational Services, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Tammy Petrik
- Department of Psychiatric Vocational Services, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Warren Thime
- Schizophrenia Rehabilitation Program, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Jimmy Choi
- Schizophrenia Rehabilitation Program, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
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Mervis JE, Capizzi RJ, Boroda E, MacDonald AW. Transcranial Direct Current Stimulation over the Dorsolateral Prefrontal Cortex in Schizophrenia: A Quantitative Review of Cognitive Outcomes. Front Hum Neurosci 2017; 11:44. [PMID: 28210217 PMCID: PMC5288642 DOI: 10.3389/fnhum.2017.00044] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Cognitive deficits are a core and disabling feature of psychotic disorders, specifically schizophrenia. Current treatments for impaired cognition in schizophrenia remain insufficient. Recent research suggests transcranial direct current stimulation (tDCS) targeting the dorsolateral prefrontal cortex can potentiate cognitive improvements in healthy individuals and those with psychiatric conditions, such as schizophrenia. However, this burgeoning literature has not been quantitatively evaluated. Through a literature search and quantitative review, we identified 194 papers on tDCS, psychosis, and cognition. Selection criteria included pre/post design and sham control to achieve specific sham-adjusted effect sizes. The 6 retained studies all address schizophrenia populations and include single and repeated stimulation, as well as within and between subject designs. Small positive effects were found for anodal stimulation on behavioral measures of attention and working memory, with tentative findings for cognitive ability and memory. Cathodal stimulation yielded a small positive effect on behaviorally measured cognitive ability. Neurophysiological measures of attention showed a small to medium down-modulation effect for anodal stimulation. Implications of these findings and guidelines for future research are discussed. As revealed by this report, due to the paucity of data available, much remains unknown regarding the clinical efficacy of tDCS in schizophrenia.
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Affiliation(s)
- Joshua E Mervis
- Department of Psychology, University of Minnesota Minneapolis, MN, USA
| | - Riley J Capizzi
- Department of Psychology, University of Minnesota Minneapolis, MN, USA
| | - Elias Boroda
- Department of Neuroscience, University of Minnesota Minneapolis, MN, USA
| | - Angus W MacDonald
- Department of Psychology, University of MinnesotaMinneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical SchoolMinneapolis, MN, USA
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Abstract
BACKGROUND Adults with serious mental illness (SMI) may struggle with expectations of failure in vocational rehabilitation. These expectations can be global and trait-like or performance-specific and related to ability. AIMS To date, it has not been examined whether global or performance-specific defeatist beliefs are related to functional outcomes. METHOD The Indianapolis Vocational Intervention Program (IVIP) is a CBT intervention used to address expectations of failure and improve work performance. We examined the relationships between defeatist beliefs, self-esteem, social functioning, and work behaviors in 54 adults with SMI who completed IVIP within a work therapy program. RESULTS Baseline work-specific defeatist beliefs were related to baseline self-esteem, employment attitude, and work behaviors. Decline in work-specific defeatist beliefs was associated with better social functioning, self-esteem, and work behaviors. Decline in global defeatist beliefs was only associated with improvements in social functioning. CONCLUSIONS Performance-specific expectations about work may be an appropriate therapeutic target to enhance work outcome in SMI.
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Affiliation(s)
- Joshua E. Mervis
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Paul H. Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joanna M. Fiszdon
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT & Yale University School of Medicine, New Haven, CT, USA
| | - Morris D. Bell
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT & Yale University School of Medicine, New Haven, CT, USA
| | - Amanda E. Chue
- Department of Psychology, American University, Washington, DC, USA
| | - Carol Pauls
- Columbia Psychiatry, Columbia University, New York, NY, USA
| | | | - Jimmy Choi
- Institute of Living/Hartford Healthcare Corporation, Hartford, CT, USA
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Bisoglio J, Michaels TI, Mervis JE, Ashinoff BK. Cognitive enhancement through action video game training: great expectations require greater evidence. Front Psychol 2014; 5:136. [PMID: 24600427 PMCID: PMC3928536 DOI: 10.3389/fpsyg.2014.00136] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/01/2014] [Indexed: 11/13/2022] Open
Abstract
Action video game training may hold promise as a cognitive intervention with the potential to enhance daily functioning and remediate impairments, but this must be more thoroughly evaluated through evidence-based practices. We review current research on the effect of action video game training on visual attention and visuospatial processing, executive functions, and learning and memory. Focusing on studies that utilize strict experimental controls and synthesize behavioral and neurophysiological data, we examine whether there is sufficient evidence to support a causal relationship between action video game training and beneficial changes in cognition. Convergent lines of behavioral and neurophysiological evidence tentatively support the efficacy of training, but the magnitude and specificity of these effects remain obscure. Causal inference is thus far limited by a lack of standardized and well-controlled methodology. Considering future directions, we suggest stringent adherence to evidence-based practices and collaboration modeled after clinical trial networks. Finally, we recommend the exploration of more complex causal models, such as indirect causal relationships and interactions that may be masking true effects.
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Affiliation(s)
| | - Timothy I Michaels
- Manhattan Psychiatric Center New York, NY, USA ; Research Foundation for Mental Hygiene, Nathan Kline Institute for Psychiatric Research Orangeburg, NY, USA
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