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Miley K, Bronstein MV, Ma S, Lee H, Green MF, Ventura J, Hooker CI, Nahum M, Vinogradov S. Trajectories and predictors of response to social cognition training in people with schizophrenia: A proof-of-concept machine learning study. Schizophr Res 2024; 266:92-99. [PMID: 38387253 PMCID: PMC11005939 DOI: 10.1016/j.schres.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/15/2023] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Social cognition training (SCT) can improve social cognition deficits in schizophrenia. However, little is known about patterns of response to SCT or individual characteristics that predict response. METHODS 76 adults with schizophrenia randomized to receive 8-12 weeks of remotely-delivered SCT were included in this analysis. Social cognition was measured with a composite of six assessments. Latent class growth analyses identified trajectories of social cognitive response to SCT. Random forest and logistic regression models were trained to predict membership in the trajectory group that showed improvement from baseline measures including symptoms, functioning, motivation, and cognition. RESULTS Five trajectory groups were identified: Group 1 (29 %) began with slightly above average social cognition, and this ability significantly improved with SCT. Group 2 (9 %) had baseline social cognition approximately one standard deviation above the sample mean and did not improve with training. Groups 3 (18 %) and 4 (36 %) began with average to slightly below-average social cognition and showed non-significant trends toward improvement. Group 5 (8 %) began with social cognition approximately one standard deviation below the sample mean, and experienced significant deterioration in social cognition. The random forest model had the best performance, predicting Group 1 membership with an area under the curve of 0.73 (SD 0.24; 95 % CI [0.51-0.87]). CONCLUSIONS Findings suggest that there are distinct patterns of response to SCT in schizophrenia and that those with slightly above average social cognition at baseline may be most likely to experience gains. Results may inform future research seeking to individualize SCT treatment for schizophrenia.
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Affiliation(s)
- Kathleen Miley
- HealthPartners Institute, Minneapolis, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, MN, USA.
| | - Michael V Bronstein
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, MN, USA
| | - Sisi Ma
- Institute for Health Informatics, University of Minnesota, MN, USA
| | - Hyunkyu Lee
- Department of Research and Development, Posit Science Inc., San Francisco, CA, USA
| | - Michael F Green
- VA Greater Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Christine I Hooker
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mor Nahum
- School of Occupational Therapy, Hebrew University of Jerusalem, Israel
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, MN, USA
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2
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Le TP, Ventura J, Subotnik KL, Nuechterlein KH. Intrinsic motivation predicts cognitive and functional gains during coordinated specialty care for first-episode schizophrenia. Schizophr Res 2024; 266:249-255. [PMID: 38442522 DOI: 10.1016/j.schres.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/01/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
Coordinated Specialty Care (CSC) and embedded group therapeutic interventions have been effective in improving outcomes for individuals experiencing recent first-episode schizophrenia, including cognitive performance and functioning. Treatment response varies substantially, with some patients experiencing limited or no improvement. Motivation has emerged as a key determinant of treatment engagement and efficacy. However, the impact of intrinsic and extrinsic aspects of motivation has not been directly examined with treatment outcomes in first-episode schizophrenia. This study investigated whether baseline levels of intrinsic and extrinsic motivation predicted cognitive and functional gains over 6 and 12 months in CSC. Forty participants with first-episode schizophrenia completed a 12-month CSC treatment period. Baseline measures of intrinsic and extrinsic motivation were obtained for group therapeutic interventions and work/school, as well as measures of cognition and functioning (role and social) at baseline, 6 months, and 12 months. Results revealed that higher baseline scores of intrinsic motivation for group therapeutic interventions were significantly predictive of greater cognitive gains at 12 months, and a similar tendency was observed at 6 months. Additionally, baseline scores of intrinsic motivation for work/school predicted role gains at 6 months, with a similar tendency observed at 12 months. Extrinsic motivation did not consistently impact treatment outcomes, except for work/school-related extrinsic motivation, which was linked to greater social functioning gains at 12 months. These findings provide insight into the factors influencing treatment outcomes for individuals with first-episode schizophrenia and highlight the importance of intrinsic motivation as a modifiable personal variable that can enhance response to CSC.
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Affiliation(s)
- Thanh P Le
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Department of Psychology, University of California, Los Angeles, CA, USA
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3
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Ruiz-Yu B, Le TP, Ventura J, Arevian A, Hellemann GS, Nuechterlein KH. Exercise behaviours and motivation after a first psychotic episode: A digital intervention. Early Interv Psychiatry 2024. [PMID: 38356325 DOI: 10.1111/eip.13518] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/15/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
AIM Research has demonstrated that participation in aerobic exercise can have significant beneficial effects across both physical and mental health domains for individuals who are in the early phase of schizophrenia. Despite these notable benefits of exercise, deficits in motivation and a lack of methods to increase engagement are significant barriers for exercise participation, limiting these potentially positive effects. Fortunately, digital health tools have the potential to improve adherence to an exercise program. The present study examined the role of motivation for exercise and the effects of an automated digital text messaging program on participation in an aerobic exercise program. METHODS A total of 46 first-episode psychosis participants from an ongoing 12-month randomized clinical trial (Enhancing Cognitive Training through Exercise Following a First Schizophrenia Episode (CT&E-RCT)) were included in an analysis to examine the efficacy of motivational text messaging. Personalized motivational text message reminders were sent to participants with the aim of increasing engagement in the exercise program. RESULTS We found that participants with higher levels of intrinsic motivation to participate in a text messaging program and in an exercise intervention completed a higher proportion of individual, at-home exercise sessions. In a between groups analysis, participants who received motivational text messages, compared to those who did not, completed a higher proportion of at-home exercise sessions. CONCLUSION These results indicate the importance of considering a person's level of motivation for exercise and the potential utility of using individualized and interactive mobile text messaging reminders to increase engagement in aerobic exercise in the early phase of psychosis. We emphasize the need for understanding how individualized patient preferences and needs interplay between intrinsic motivation and digital health interventions for young adults.
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Affiliation(s)
- Bernalyn Ruiz-Yu
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Thanh P Le
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Armen Arevian
- Chorus Innovations, Inc., Long Beach, California, USA
| | - Gerhard S Hellemann
- Department of Public Health, Biostatistics, University of Alabama, Tuscaloosa, Alabama, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
- Department of Psychology, University of California, Los Angeles, California, USA
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4
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Hajdúk M, Abplanalp SJ, Jimenez AM, Fisher M, Haut KM, Hooker CI, Lee H, Ventura J, Nahum M, Green MF. Linking social motivation, general motivation, and social cognition to interpersonal functioning in schizophrenia: insights from exploratory graph analysis. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01733-4. [PMID: 38110742 DOI: 10.1007/s00406-023-01733-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023]
Abstract
Motivation in general, and social motivation in particular are important for interpersonal functioning in individuals with schizophrenia. Still, their roles after accounting for social cognition, are not well understood. The sample consisted of 147 patients with schizophrenia. General motivation was measured using the Behavioral inhibition/activation scale (BIS/BAS). Social motivation was measured by Passive social withdrawal and Active social avoidance items from PANSS. Interpersonal functioning was evaluated with Birchwood's Social Functioning Scale (SFS). We used Exploratory Graph Analysis for network estimation and community detection. Active social avoidance, passive social withdrawal, and social withdrawal/engagement (from SFS) were the most important nodes. In addition, three distinct communities were identified: Social cognition, Social motivation, and Interpersonal functioning. Notably, the BIS and BAS measures of general motivation were not part of any community. BAS showed stronger links to functioning than BIS. Passive social withdrawal was more strongly linked to interpersonal functioning than social cognitive abilities. Results suggest that social motivation, especially social approach, is more closely related to interpersonal functioning in schizophrenia than general motivation. In contrast, we found that general motivation was largely unrelated to social motivation. This pattern highlights the importance of type of motivation for understanding variability in interpersonal difficulties in schizophrenia.
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Affiliation(s)
- Michal Hajdúk
- Department of Psychology, Faculty of Arts, Comenius University in Bratislava, Gondova 2, Bratislava, 811 02, Slovakia.
- The Centre for Psychiatric Disorders Research, Science Park, Comenius University in Bratislava, Bratislava, Slovakia.
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.
| | - Samuel J Abplanalp
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, USA
| | - Amy M Jimenez
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, USA
| | - Melissa Fisher
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Kristen M Haut
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Christine I Hooker
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Hyunkyu Lee
- Department of Research and Development, Posit Science Inc, San Francisco, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, USA
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael F Green
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, USA
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Kuo SS, Ventura J, Forsyth JK, Subotnik KL, Turner LR, Nuechterlein KH. Developmental trajectories of premorbid functioning predict cognitive remediation treatment response in first-episode schizophrenia. Psychol Med 2023; 53:6132-6141. [PMID: 36349373 PMCID: PMC10166766 DOI: 10.1017/s0033291722003312] [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: 01/06/2023]
Abstract
BACKGROUND Cognitive development after schizophrenia onset can be shaped by interventions such as cognitive remediation, yet no study to date has investigated whether patterns of early behavioral development may predict later cognitive changes following intervention. We therefore investigated the extent to which premorbid adjustment trajectories predict cognitive remediation gains in schizophrenia. METHODS In a total sample of 215 participants (170 first-episode schizophrenia participants and 45 controls), we classified premorbid functioning trajectories from childhood through late adolescence using the Cannon-Spoor Premorbid Adjustment Scale. For the 62 schizophrenia participants who underwent 6 months of computer-assisted, bottom-up cognitive remediation interventions, we identified MATRICS Consensus Cognitive Battery scores for which participants demonstrated mean changes after intervention, then evaluated whether developmental trajectories predicted these changes. RESULTS Growth mixture models supported three premorbid functioning trajectories: stable-good, deteriorating, and stable-poor adjustment. Schizophrenia participants demonstrated significant cognitive remediation gains in processing speed, verbal learning, and overall cognition. Notably, participants with stable-poor trajectories demonstrated significantly greater improvements in processing speed compared to participants with deteriorating trajectories. CONCLUSIONS This is the first study to our knowledge to characterize the associations between premorbid functioning trajectories and cognitive remediation gains after schizophrenia onset, indicating that 6 months of bottom-up cognitive remediation appears to be sufficient to yield a full standard deviation gain in processing speed for individuals with early, enduring functioning difficulties. Our findings highlight the connection between trajectories of premorbid and postmorbid functioning in schizophrenia and emphasize the utility of considering the lifespan developmental course in personalizing therapeutic interventions.
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Affiliation(s)
- Susan S. Kuo
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | | | | | - Luana R. Turner
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
- Department of Psychology, UCLA, Los Angeles, USA
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Ventura J, Subotnik KL, Han S, Hellemann GS, Green MF, Nuechterlein KH. The relationship between sex and functional outcome in first-episode schizophrenia: the role of premorbid adjustment and insight. Psychol Med 2023; 53:6878-6887. [PMID: 38314778 PMCID: PMC10600815 DOI: 10.1017/s0033291723000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Studies that examined sex differences in first-episode patients consistently show that males compared to females have poor premorbid adjustment, earlier age of onset, worse clinical characteristics, and poorer outcomes. However, little is known about potential mediators that could explain these sex differences. METHODS Our sample consisted of 137 individuals with first episode schizophrenia (males, n = 105; 77%) with a mean age of 22.1(s.d. = 4.1) years and mean education of 12.5(s.d. = 1.7) years. At entry, patients were within 2 years of their first psychotic episode onset. Baseline assessments were conducted for premorbid adjustment, symptoms, cognitive functioning, insight, and at 6-months for role and social functioning. RESULTS Males as compared to females had poorer premorbid adjustment across several key developmental periods (p < 0.01), an earlier age of onset [M = 20.3(3.3) v. 22.8(5.6), p = 0.002], more negative symptoms (p = 0.044), poorer insight (p = 0.031), and poorer baseline and 6-month role (p = 0.002) and social functioning (p = 0.034). Several of these variables in which males showed impairment were significant predictors of 6-month role and social functioning. Premorbid adjustment and insight mediated the relationship between sex and role and social functioning at 6-months, but not negative symptoms. DISCUSSION Males compared to females were at lower levels across several key premorbid and clinical domains which are strongly associated with functional outcome supporting the hypothesis that males might have a more disabling form of schizophrenia. The relationship between sex with role and social functioning was mediated through premorbid adjustment and insight suggesting pathways for understanding why females might have a less disabling form of schizophrenia.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
| | - Kenneth L. Subotnik
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
| | - Sam Han
- Graduate School of Education and Psychology, Pepperdine University, Malibu, California, USA
| | - Gerhard S. Hellemann
- School of Public Health, Biostatistics Department, University of Alabama, Tuscaloosa, Alabama, USA
| | - Michael F. Green
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Keith H. Nuechterlein
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
- UCLA Department of Psychology, University of California, Los Angeles, California, USA
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7
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Nuechterlein KH, McEwen SC, Ventura J, Subotnik KL, Turner LR, Boucher M, Casaus LR, Distler MG, Hayata JN. Aerobic exercise enhances cognitive training effects in first-episode schizophrenia: randomized clinical trial demonstrates cognitive and functional gains. Psychol Med 2023; 53:4751-4761. [PMID: 36047035 PMCID: PMC10388302 DOI: 10.1017/s0033291722001696] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/17/2021] [Revised: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive training (CT) and aerobic exercise both show promising moderate impact on cognition and everyday functioning in schizophrenia. Aerobic exercise is hypothesized to increase brain-derived neurotrophic factor (BDNF) and thereby synaptic plasticity, leading to increased learning capacity. Systematic CT should take advantage of increased learning capacity and be more effective when combined with aerobic exercise. METHODS We examined the impact of a 6-month program of cognitive training & exercise (CT&E) compared to cognitive training alone (CT) in 47 first-episode schizophrenia outpatients. All participants were provided the same Posit Science computerized CT, 4 h/week, using BrainHQ and SocialVille programs. The CT&E group also participated in total body circuit training exercises to enhance aerobic conditioning. Clinic and home-based exercise were combined for a target of 150 min per week. RESULTS The MATRICS Consensus Cognitive Battery Overall Composite improved significantly more with CT&E than with CT alone (p = 0.04), particularly in the first 3 months (6.5 v. 2.2 T-score points, p < 0.02). Work/school functioning improved substantially more with CT&E than with CT alone by 6 months (p < 0.001). BDNF gain tended to predict the amount of cognitive gain but did not reach significance. The cognitive gain by 3 months predicted the amount of work/school functioning improvement at 6 months. The amount of exercise completed was strongly associated with the degree of cognitive and work/school functioning improvement. CONCLUSIONS Aerobic exercise significantly enhances the impact of CT on cognition and functional outcome in first-episode schizophrenia, apparently driven by the amount of exercise completed.
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Affiliation(s)
- Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
- Department of Psychology, University of California, Los Angeles, USA
| | - Sarah C. McEwen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Luana R. Turner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Michael Boucher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Laurie R. Casaus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Margaret G. Distler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Jacqueline N. Hayata
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
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Subotnik KL, McEwen SC, Ventura J, Turner LR, Sturdevant Y, Niess TL, Casaus LR, Distler MG, Zito MF, Hellemann GS, Nguyen CD, Nuechterlein KH. Exercise Predicts a Good Night's Sleep: Preliminary Findings from a UCLA Study of First-Episode Schizophrenia. Behav Sci (Basel) 2023; 13:88. [PMID: 36829317 PMCID: PMC9952381 DOI: 10.3390/bs13020088] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Physical exercise can improve sleep quality in the general population. Understanding the negative impact of poor sleep quality on multiple domains of functioning among persons with schizophrenia is a new frontier of exploration. It is also imperative to investigate non-pharmacologic methods to improve sleep quality as these approaches may not carry the side effect burdens associated with medication. OBJECTIVE We examined the relationship between regular physical exercise and sleep quality among participants in an intervention consisting of both cognitive training and exercise. METHODS Participants (N = 48) were schizophrenia patients who had a first psychotic episode within two years of study entry. Participants received 4 h/week of internet-based cognitive training and an aerobic exercise program over a 6-month period. Sleep was assessed with the Pittsburgh Sleep Quality Index at baseline and six months later. RESULTS During the 3 months prior to the 6-month follow-up sleep assessment, participants completed an average of 12.6 group exercise sessions and an average of 12.9 individual at-home exercise sessions. A significant relationship between the number of exercise sessions and global sleep quality was seen at month six, r = -0.44, df = 39, p < 0.01. Group exercise frequency was also associated with improvement in global sleep quality over the six-month intervention, t(34) = -2.84, p = 0.008. CONCLUSION We demonstrated that a group of young adults with schizophrenia can be engaged in a regular exercise program, even during the tumultuous early course of the disorder. The number of exercise sessions in which they participated was associated with better sleep quality at six months and pre-postintervention improvement in sleep quality. KEY MESSAGE Improved sleep quality appears to be a benefit of regular exercise among individuals with serious mental illness.
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Affiliation(s)
- Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Sarah C. McEwen
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- atai Life Sciences, San Diego, CA 92130, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Luana Rene Turner
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Yurika Sturdevant
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Trudy L. Niess
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Laurie R. Casaus
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Margaret G. Distler
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Michael F. Zito
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Clara D. Nguyen
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- Department of Psychology, UCLA, Los Angeles, CA 90095, USA
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9
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McEwen SC, Jarrahi B, Ventura J, Subotnik KL, Nguyen J, Woo SM, Nuechterlein KH. A combined exercise and cognitive training intervention induces fronto-cingulate cortical plasticity in first-episode psychosis patients. Schizophr Res 2023; 251:12-21. [PMID: 36527955 DOI: 10.1016/j.schres.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/02/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Schizophrenia (SZ) is characterized by neurobiological and associated cognitive and functional deficits, including pronounced cortical thinning, that lead to acute and long-term functional impairment. Research with older adults supports the role of non-pharmacological interventions, such as exercise (E) and cognitive training (CT), for cognitive impairments. This literature influenced the development of combined CT&E treatments for individuals with SZ. However, the impact of longer combined treatment duration (6 months) on neuroanatomy has yet to be explored in patients in the early course of the illness. The impact of adding exercise to cognitive training for key brain regions associated with higher-order cognition was examined here using magnetic resonance imaging (MRI) in first-episode psychosis (FEP) patients. METHODS UCLA Aftercare Research Program patients with a recent first episode of schizophrenia were randomly assigned to either combined cognitive and exercise training (CT&E) (N = 20) or cognitive training alone (CT) (N = 17) intervention. Cortical thickness was measured longitudinally and analyzed for two regions of interest using FreeSurfer. RESULTS Compared to patients in the CT group, those in the CT&E group demonstrated an increase in cortical thickness within the left anterior cingulate cortex over the six-month treatment period (ACC: F(1, 35) = 4.666, P < .04). Directional tendencies were similar in the left dorsolateral prefrontal cortex (DLPFC: F(1,35) = 4.132, P < .05). CONCLUSIONS These findings suggest that exercise and cognitive training may synergistically increase fronto-cingulate cortical thickness to mitigate progressive neural atrophy in the early course of SZ. This combined intervention appears to be a valuable adjunct to standard pharmacologic treatment in FEP patients.
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Affiliation(s)
- S C McEwen
- Pacific Brain Health Center, Pacific Neuroscience Institute, Santa Monica, CA, 90404, United States of America; atai Life Sciences, San Diego, CA, 92130, United States of America; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - B Jarrahi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America; Department of Anesthesia, Stanford University School of Medicine, Palo Alto, CA 94304, United States of America
| | - J Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - K L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - J Nguyen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - S M Woo
- Graduate School of Education & Psychology, Pepperdine University, Los Angeles, CA 90045, United States of America
| | - K H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America; Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States of America.
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10
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Le TP, Ventura J, Ruiz-Yu B, McEwen SC, Subotnik KL, Nuechterlein KH. Treatment engagement in first-episode schizophrenia: Associations between intrinsic motivation and attendance during cognitive training and an aerobic exercise program. Schizophr Res 2023; 251:59-65. [PMID: 36577235 PMCID: PMC10163954 DOI: 10.1016/j.schres.2022.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/21/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
Systematic cognitive training and aerobic exercise programs have emerged as promising interventions to improve cognitive deficits in first-episode schizophrenia, with successful outcomes closely linked with greater treatment engagement (e.g., higher attendance and homework completion rates). Unfortunately, treatment disengagement from these services remains a persistent issue. Intrinsic motivation, or the willingness to exert effort because a task is inherently interesting or meaningful, has emerged as a promising malleable personal factor to enhance treatment engagement. This study investigated whether early task-specific intrinsic motivation and its domains (e.g., interest, perceived competence, and value) predicted treatment engagement within the context of intensive cognitive training and aerobic exercise interventions over a 6-month period. Thirty-nine participants with first-episode schizophrenia were administered baseline measures of task-specific intrinsic motivation inventories, one for cognitive training and one for exercise, and completed a 6-month randomized clinical trial comparing a neuroplasticity-based cognitive training plus aerobic exercise program against the same cognitive training alone. Results indicated that higher baseline scores of intrinsic motivation for cognitive training, specifically early perceptions of task interest and value, were predictive of greater cognitive training and exercise group attendance. Scores for exercise-specific intrinsic motivation were generally unrelated to indices of exercise participation, with the exception that the gain over time in perceived choice for exercise was linked with greater exercise homework completion and a similar directional tendency for greater in-clinic exercise attendance. This study provides support for monitoring and enhancing motivation early during service delivery to maximize engagement and the likelihood of successful treatment outcomes.
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Affiliation(s)
- Thanh P Le
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Bernalyn Ruiz-Yu
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Department of Psychology, University of California, Los Angeles, CA, USA
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11
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Affiliation(s)
- Joseph Ventura
- Department of Psychiatry and Biobehavioral SciencesSemel Institute for Neuroscience and Human Behavior, University of CaliforniaLos Angeles, Los AngelesCAUSA
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12
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Nuechterlein KH, Ventura J, Subotnik KL, Gretchen-Doorly D, Turner LR, Casaus LR, Luo J, Boucher ML, Hayata JN, Bell MD, Medalia A. A randomized controlled trial of cognitive remediation and long-acting injectable risperidone after a first episode of schizophrenia: improving cognition and work/school functioning. Psychol Med 2022; 52:1517-1526. [PMID: 32981534 DOI: 10.1017/s0033291720003335] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive deficits at the first episode of schizophrenia are predictive of functional outcome. Interventions that improve cognitive functioning early in schizophrenia are critical if we hope to prevent or limit long-term disability in this disorder. METHODS We completed a 12-month randomized controlled trial of cognitive remediation and of long-acting injectable (LAI) risperidone with 60 patients with a recent first episode of schizophrenia. Cognitive remediation involved programs focused on basic cognitive processes as well as more complex, life-like situations. Healthy behavior training of equal treatment time was the comparison group for cognitive remediation, while oral risperidone was the comparator for LAI risperidone in a 2 × 2 design. All patients were provided supported employment/education to encourage return to work or school. RESULTS Both antipsychotic medication adherence and cognitive remediation contributed to cognitive improvement. Cognitive remediation was superior to healthy behavior training in the LAI medication condition but not the oral medication condition. Cognitive remediation was also superior when medication adherence and protocol completion were covaried. Both LAI antipsychotic medication and cognitive remediation led to significantly greater improvement in work/school functioning. Effect sizes were larger than in most prior studies of first-episode patients. In addition, cognitive improvement was significantly correlated with work/school functional improvement. CONCLUSIONS These results indicate that consistent antipsychotic medication adherence and cognitive remediation can significantly improve core cognitive deficits in the initial period of schizophrenia. When combined with supported employment/education, cognitive remediation and LAI antipsychotic medication show separate significant impact on improving work/school functioning.
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Affiliation(s)
- Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
- Department of Psychology, University of California, Los Angeles, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Denise Gretchen-Doorly
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Luana R Turner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Laurie R Casaus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - John Luo
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Michael L Boucher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Jacqueline N Hayata
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Morris D Bell
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Alice Medalia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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13
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Giordano GM, Palumbo D, Mucci A, Ventura J, Giuliani L, Perrottelli A, Bucci P, Rocca P, Rossi A, Bertolino A, Rucci P, Galderisi S, Maj M. The Cognitive Assessment Interview (CAI): Association with neuropsychological scores and real-life functioning in a large sample of Italian subjects with schizophrenia. Schizophr Res 2022; 241:161-170. [PMID: 35124435 DOI: 10.1016/j.schres.2022.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The Cognitive Assessment Interview (CAI) is an interview-based scale developed to measure cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). Previous studies demonstrated good psychometric properties of the CAI. However, only relatively small samples of SCZ were investigated. This study aimed to determine in a large sample of SCZ (N = 580) the relationships of the Italian Version of the CAI with measures of cognitive performance and functional capacity and real-life functioning, using state-of-the-art instruments. METHODS Intraclass correlation coefficients (ICCs) and Cronbach's alpha were calculated to examine the CAI's inter-rater reliability and internal consistency. Pearson's correlation coefficients were used to evaluate relationships between CAI global and domain composite scores with neurocognition, social cognition, functional capacity, and functioning. RESULTS The inter-rater reliability and internal consistency were good to excellent. The CAI global composite score showed a strong correlation with the MATRICS Consensus Cognitive Battery (MCCB) composite score (r = -0.50) and moderate/strong associations with measures of functional capacity (-0.46 < r < -0.52) and real-life functioning (-0.30 < r < -0.51). Finally, CAI composite social cognition score correlated moderately with the Facial Emotion Identification Test (r = -0.31) and two subscales of the Awareness of Social Inference Test (-0.32 < r < -0.34). CONCLUSIONS The study suggests that CAI is a valid co-primary measure for clinical trials and a suitable instrument to screen impairment in neurocognitive and social cognitive domains and its impact on functioning in SCZ in everyday clinical practice.
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Affiliation(s)
- Giulia M Giordano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Davide Palumbo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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14
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Ventura J, Jouini L, Aissa A, Larnaout A, Nefzi R, Ghazzai M, Jelili S, Fekih-Romdhane F, Ouali U, Nacef F. Establishing a clinical high-risk program in Tunisia, North Africa: A pilot study in early detection and identification. Early Interv Psychiatry 2021; 15:1777-1783. [PMID: 33477201 DOI: 10.1111/eip.13119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Early identification and prevention research has provided huge advances in our understanding of early screening and identification of young people at clinical high-risk (CHR). Most of these procedures were developed in high-income countries, yet middle-income countries in North Africa such as Tunisia can benefit from these empirically-based assessment approaches. METHODS Using established procedures, nine Tunisian psychiatric raters were trained on structured assessments: the CAARMS, BPRS, and SCID to high standards of interrater reliability. These raters developed a clinical high-risk program (CHiRP) in Tunisia and recruited 10 patients who were exhibiting possible signs of CHR. These patients were evaluated to determine if they met criteria for a CHR group, such as Attenuated Psychosis. RESULTS Trained raters met the following interrater reliability criteria for the CAARMS and BPRS (ICC = .80 or greater) and the SCID (Kappa = .75 or greater). Of 10 pilot patients, six were classified as CHR and belonging to the Attenuated Psychosis Group. One of the six patients converted to psychosis 3 months after study entry for a conversion rate of 17% which is comparable with currently published rates globally. DISCUSSION The first CHR program has been established in Tunisia, a middle-income country using methods developed in high income countries. Efforts aimed at assembling a group of prevention-oriented psychiatrists, obtaining administrative support, and training raters to high levels of interrater reliability were successful. The feasibility was demonstrated for screening, assessing, treating, and following-up of 10 CHR patients suggesting that conversion rates are comparable to those of Western and European countries.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Lamia Jouini
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Amina Aissa
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Amine Larnaout
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Rahma Nefzi
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Malek Ghazzai
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Sélima Jelili
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Child and Adolescent Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Feten Fekih-Romdhane
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Uta Ouali
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
| | - Fethi Nacef
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Psychiatry, Razi Hospital, Tunis, Tunisia
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15
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Druss BG, Cohen AN, Brister T, Cotes RO, Hendry P, Rolin D, Torous J, Ventura J, Gorrindo T. Supporting the Mental Health Workforce During and After COVID-19. Psychiatr Serv 2021; 72:1222-1224. [PMID: 33882690 DOI: 10.1176/appi.ps.202000509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.
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Affiliation(s)
- Benjamin G Druss
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Amy N Cohen
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Teri Brister
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Robert O Cotes
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Patrick Hendry
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Donna Rolin
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - John Torous
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Joseph Ventura
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Tristan Gorrindo
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
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16
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Zito MF, Subotnik KL, Ventura J, Kern RS, Green MF, Nuechterlein KH. Awareness of illness is associated with better social and nonsocial cognition in recent-onset schizophrenia. Schizophr Res 2021; 231:51-53. [PMID: 33770625 PMCID: PMC10758255 DOI: 10.1016/j.schres.2021.02.020] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Michael F Zito
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Semel Institute for Neuroscience and Human Behavior at UCLA, United States of America.
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Semel Institute for Neuroscience and Human Behavior at UCLA, United States of America
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Semel Institute for Neuroscience and Human Behavior at UCLA, United States of America
| | - Robert S Kern
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America; Semel Institute for Neuroscience and Human Behavior at UCLA, United States of America
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America; Semel Institute for Neuroscience and Human Behavior at UCLA, United States of America
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America; Semel Institute for Neuroscience and Human Behavior at UCLA, United States of America
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17
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Wang C, Oughourlian T, Tishler TA, Anwar F, Raymond C, Pham AD, Perschon A, Villablanca JP, Ventura J, Subotnik KL, Nuechterlein KH, Ellingson BM. Cortical morphometric correlational networks associated with cognitive deficits in first episode schizophrenia. Schizophr Res 2021; 231:179-188. [PMID: 33872855 DOI: 10.1016/j.schres.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/09/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022]
Abstract
Schizophrenia (SCZ) is a chronic cognitive and behavioral disorder associated with abnormal cortical activity during information processing. Several brain structures associated with the seven performance domains evaluated using the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery (MCCB) have shown cortical volume loss in first episode schizophrenia (FES) patients. However, the relationship between morphological organization and MCCB performance remains unclear. Therefore, in the current observational study, high-resolution structural MRI scans were collected from 50 FES patients, and the morphometric correlation network (MCN) using cortical volume was established to characterize the cortical pattern associated with poorer MCCB performance. We also investigated topological properties, such as the modularity, the degree and the betweenness centrality. Our findings show structural volume was directly and strongly associated with the cognitive deficits of FES patients in the precuneus, anterior cingulate, and fusiform gyrus, as well as the prefrontal, parietal, and sensorimotor cortices. The medial orbitofrontal, fusiform, and superior frontal gyri were not only identified as the predominant nodes with high degree and betweenness centrality in the MCN, but they were also found to be critical in performance in several of the MCCB domains. Together, these results suggest a widespread cortical network is altered in FES patients and that performance on the MCCB domains is associated with the core pathophysiology of SCZ.
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Affiliation(s)
- Chencai Wang
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Talia Oughourlian
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Todd A Tishler
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Faizan Anwar
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Catalina Raymond
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Alex D Pham
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Abby Perschon
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - J Pablo Villablanca
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Joseph Ventura
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Kenneth L Subotnik
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Keith H Nuechterlein
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Benjamin M Ellingson
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
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18
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Humensky JL, Turner LR, Dixon LB, Drake RE, Becker DR, Subotnik KL, Ventura J, Nuechterlein KH. Personnel time required for supported employment and education services for individuals in a recent-onset psychosis treatment program. Early Interv Psychiatry 2021; 15:402-405. [PMID: 32351048 PMCID: PMC7606755 DOI: 10.1111/eip.12971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
AIM Individual Placement and Support (IPS) improves vocational outcomes in first-episode psychosis patients, but policy makers need information on costs (and personnel time required) to conduct effective IPS. METHODS Using chart records of 42 clients in a first-episode psychosis study, we examined service time for specific activities over 18 months. RESULTS The IPS specialist averaged 92 (SD = 62) minutes per client per week: 39% of time was spent in direct client contact, 9% in meetings without the client, 14% in meetings with the treatment team, 14% in supervision and 24% on travel time. Time required was significantly higher when participants were seeking work/school placements, decreased over duration of enrolment and was similar for those using work vs school support. CONCLUSIONS IPS service time covers numerous activities, is reduced when not seeking work/school placements and required less time over enrolment duration. Financing structures should support the full range of IPS services.
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Affiliation(s)
- Jennifer L Humensky
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - Luana R Turner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Lisa B Dixon
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | | | | | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA.,Department of Psychology, University of California, Los Angeles, California, USA
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Tan EJ, Rossell SL, Subotnik KL, Ventura J, Nuechterlein KH. Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment. Psychol Med 2021; 52:1-10. [PMID: 33706841 DOI: 10.1017/s0033291721000738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with schizophrenia spectrum disorders have been increasingly recognised to form cognitive subgroups with differential levels of impairment. Using cluster analytical techniques, this study sought to identify cognitive clusters in a sample of first-episode psychosis (FEP) patients and examine clinical and developmental differences across the resultant groups. METHODS In total, 105 FEP patients in the University of California Los Angeles Aftercare Research Program were assessed for cognition, symptoms and premorbid developmental adjustment. Hierarchical cluster analysis with Ward's method and squared Euclidean distance was conducted, confirmed by discriminant function analysis and optimised with k-means clustering. The stability of the solution was evaluated through split-sample (random, 80 and 70% samples) and alternate method (average linkage method) replication via Cohen's κ analysis. Controlling for multiple comparisons, one-way analysis of variances examined group differences in symptom severity and premorbid adjustment. RESULTS Three groups were identified: severely impaired (n = 27), moderately impaired (n = 41) and relatively intact (n = 37). There were no significant differences in symptom severity across the groups. Significant differences were observed for scholastic performance at three different developmental stages: childhood, early adolescence and late adolescence, with the relatively intact group demonstrating significantly better scholastic performance at all three stages than both the moderately impaired and severely impaired groups (who did not significantly differ from each other). CONCLUSIONS The findings add to growing evidence that cognitive clusters in FEP mirror that of later-stage schizophrenia. They also suggest that premorbid scholastic performance may not just be a risk factor for developing schizophrenia, but is also related to cognitive impairment severity and potentially to prognosis.
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Affiliation(s)
- Eric J Tan
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- UCLA Department of Psychology, Los Angeles, CA, USA
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Eilam-Stock T, Best P, Sherman K, Shaw MT, Ventura J, Krupp LB, Charvet LE. An Interview-Based Assessment of the Experience of Cognitive Impairment in Multiple Sclerosis: The Cognitive Assessment Interview (CAI). Front Neurol 2021; 12:637895. [PMID: 33643211 PMCID: PMC7905222 DOI: 10.3389/fneur.2021.637895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Cognitive impairment is a common feature of multiple sclerosis (MS). A semi-structured interview, including informant input, can characterize the experience of individuals living with MS and cognitive involvement. Objective: We administered the Cognitive Assessment Interview (CAI), a patient- and informant-based semi-structured interview, to characterize the experience of cognitive impairments in those living with MS. Methods: Trained raters administered the CAI to a sample of MS participants and their informants enrolled for a trial of cognitive remediation. Cognitive impairments on the CAI were characterized and compared to those captured by neuropsychological and self-report measures. Results: A total of n = 109 MS participants (mean age = 50.3 ± 12.2) and their available informants (n = 71) were interviewed. Participants reported experiencing processing speed (90/106, 85%), working memory (87/109, 80%), and learning and memory (79/109, 72%) problems most commonly. CAI-based ratings were moderately correlated with a self-report measure (Multiple Sclerosis Neuropsychological Screening Questionnaire, rs = 0.52, p < 0.001) and only mildly correlated with objective neuropsychological measures specific to executive functions (rs = 0.21, p = 0.029). For those with informant interviews, ratings were overall consistent, suggesting that the CAI is valid even in cases in which an informant is unavailable and the interview is conducted with the patient alone (as is often the case in clinical and research settings). Conclusions: The CAI provides a semi-structured interview to characterize the experience of cognitive impairment in MS, with findings representing real-world functioning, adding valuable information to both self-report measures and neuropsychological assessment.
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Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Pamela Best
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Kathleen Sherman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael T Shaw
- Department of Psychology, Binghamton University, Binghamton, NY, United States
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lauren B Krupp
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Leigh E Charvet
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
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21
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Sarma MK, Pal A, Keller MA, Welikson T, Ventura J, Michalik DE, Nielsen-Saines K, Deville J, Kovacs A, Operskalski E, Church JA, Macey PM, Biswal B, Thomas MA. White matter of perinatally HIV infected older youths shows low frequency fluctuations that may reflect glial cycling. Sci Rep 2021; 11:3086. [PMID: 33542389 PMCID: PMC7862588 DOI: 10.1038/s41598-021-82587-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
In perinatally HIV-infected (PHIV) children, neurodevelopment occurs in the presence of HIV-infection, and even with combination antiretroviral therapy (cART) the brain can be a reservoir for latent HIV. Consequently, patients often demonstrate long-term cognitive deficits and developmental delay, which may be reflected in altered functional brain activity. Our objective was to examine brain function in PHIV on cART by quantifying the amplitude of low frequency fluctuations (ALFF) and regional homogeneity (ReHo). Further, we studied ALFF and ReHo changes with neuropsychological performance and measures of immune health including CD4 count and viral loads in the HIV-infected youths. We found higher ALFF and ReHo in cerebral white matter in the medial orbital lobe for PHIV (N = 11, age mean ± sd = 22.5 ± 2.9 years) compared to controls (N = 16, age = 22.5 ± 3.0 years), with age and gender as co-variates. Bilateral cerebral white matter showed increased spontaneous regional activity in PHIV compared to healthy controls. No brain regions showed lower ALFF or ReHo in PHIV compared to controls. Higher log10 viral load was associated with higher ALFF and ReHo in PHIV in bilateral cerebral white matter and right cerebral white matter respectively after masking the outcomes intrinsic to the brain regions that showed significantly higher ALFF and ReHo in the PHIV compared to the control. Reductions in social cognition and abstract thinking in PHIV were correlated with higher ALFF at the left cerebral white matter in the left medial orbital gyrus and higher ReHo at the right cerebral white matter in the PHIV patients. Although neuroinflammation and associated neuro repair were not directly measured, the findings support their potential role in PHIV impacting neurodevelopment and cognition.
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Affiliation(s)
- Manoj K Sarma
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA
| | - Amrita Pal
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Margaret A Keller
- Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tamara Welikson
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Ventura
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David E Michalik
- Infectious Diseases-Pediatrics, Miller Children's Hospital of Long Beach, Long Beach, CA, USA
| | | | - Jaime Deville
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrea Kovacs
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.,Los Angeles+USC Medical Center, Los Angeles, CA, USA
| | - Eva Operskalski
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.,Los Angeles+USC Medical Center, Los Angeles, CA, USA
| | - Joseph A Church
- Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bharat Biswal
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - M Albert Thomas
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA.
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22
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Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, Guloksuz S, Harvey PD, Jones PB, Malaspina D, McGorry P, Miettunen J, Murray RM, Nuechterlein KH, Peralta V, Thornicroft G, van Winkel R, Ventura J. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry 2021; 20:4-33. [PMID: 33432763 PMCID: PMC7801854 DOI: 10.1002/wps.20809] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
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Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, LVR-Klinikum Düsseldorf, and WHO Collaborating Center on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Dolores Malaspina
- Department of Psychiatry and Neuroscience, Ichan Medical School at Mount Sinai, New York, NY, USA
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jouko Miettunen
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Keith H Nuechterlein
- Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine, and Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ruud van Winkel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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23
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Ventura J, McEwen S, Subotnik KL, Hellemann GS, Ghadiali M, Rahimdel A, Seo MJ, Irwin MR, Nuechterlein KH. Changes in inflammation are related to depression and amount of aerobic exercise in first episode schizophrenia. Early Interv Psychiatry 2021; 15:213-216. [PMID: 32056388 PMCID: PMC7423726 DOI: 10.1111/eip.12946] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/17/2020] [Accepted: 01/26/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Elevated levels of pro-inflammatory cytokines have been reported in meta-analyses of multi-episode schizophrenia patients when compared to controls. However, little is known about whether these same relationships are present in the early course of schizophrenia. OBJECTIVE To assess first episode schizophrenia patients for depression and to assay blood samples collected at baseline and at 6 months for interleukin-6 (IL-6). MATERIALS AND METHODS Trained raters used the Brief Psychiatric Rating Scale to assess depressive symptoms and a standard lab assay kit to assess for IL-6 levels in plasma. CONCLUSIONS Decreases in pro-inflammatory IL-6 levels were significantly related to decreases in depressive symptoms. Within a subset of patients in a 6-month aerobic exercise protocol, the number of exercise sessions completed was significantly correlated with the amount of decrease in IL-6. The reductions observed in IL-6 with aerobic exercise suggest exercise is a promising intervention to reduce brain inflammation effects in schizophrenia patients.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Sarah McEwen
- Pacific Neuroscience Institute, Santa Monica, California
| | - Kenneth L Subotnik
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Gerhard S Hellemann
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Manali Ghadiali
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Amir Rahimdel
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Min Jee Seo
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Michael R Irwin
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Keith H Nuechterlein
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California.,UCLA Department of Psychology, Los Angeles, California
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van Dijk L, Wahid K, Ahmed S, Elgohari B, McCoy L, Sharafi S, Ventura J, Placide J, Jones E, Dearmas A, Rock S, Winkleman A, Drummey R, Cooksey L, Fahim J, Griffin J, Perez-Martinez I, Mohamed A, Fuller C. Big Data Statistical Learning Improves Survival Prediction For Head And Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Rodríguez J, Ventura J. Human resource management systems and organizational performance: an analysis of the Spanish manufacturing industry. The International Journal of Human Resource Management 2020. [DOI: 10.1080/0958519032000114273] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J.M. Rodríguez
- J.M. Rodríguez, Universidad de Oviedo, Departamento de Administración, de Empresas and Contabilidad, Avda de Cristo s/n, 33071 Oviedo, Spain (e-mail: )
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26
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Firth J, Malchow B, Ventura J. Imaging the effects of exercise on the brain. Schizophr Res 2020; 223:71-72. [PMID: 32646804 DOI: 10.1016/j.schres.2020.06.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 06/28/2020] [Accepted: 06/28/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; NICM Health Research Institute, Western Sydney University, Westmead, Australia.
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States of America
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27
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McCleery A, Wynn JK, Lee J, Reavis EA, Ventura J, Subotnik KL, Green MF, Nuechterlein KH. Early Visual Processing Is Associated With Social Cognitive Performance in Recent-Onset Schizophrenia. Front Psychiatry 2020; 11:823. [PMID: 33192628 PMCID: PMC7478198 DOI: 10.3389/fpsyt.2020.00823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Early-stage visual processing deficits are evident in chronic schizophrenia. Consistent with a cascade model of information processing, whereby early perceptual processes have downstream effects on higher-order cognition, impaired visual processing is associated with deficits in social cognition in this clinical population. However, the nature of this relationship in the early phase of illness is unknown. Here, we present data from a study of early visual processing and social cognitive performance in recent-onset schizophrenia (ROSz). METHOD Thirty-two people with ROSz and 20 healthy controls (HC) completed a visual backward masking task using stimuli of real world objects (Object Masking) to assess early-stage (i.e., 0-125 ms post-stimulus onset) visual processing. Subjects also completed two tasks of social cognition, one assessing relatively low-level processes of emotion identification (Emotion Biological Motion, EmoBio), and another assessing more complex, higher-order theory of mind abilities (The Awareness of Social Inference Test, TASIT). Group differences were tested with repeated measures ANOVAs and t-tests. Bivariate correlations and linear regressions tested the strength of associations between early-stage visual processing and social cognitive performance in ROSz. RESULTS For Object Masking, the mask interfered with object identification over a longer interval for ROSz than for HC [F (3.19, 159.35) = 8.51, p < 0.001]. ROSz were less accurate on the EmoBio task [t (50) = -3.36, p = 0.001] and on the TASIT compared to HC [F (1, 50) = 38.37, p < 0.001]. For the TASIT ROSz were disproportionately impaired on items assessing sarcasm detection [F (1, 50) = 4.30, p = 0.04]. In ROSz, better Object Masking performance was associated with better social cognitive performance [r EmoBio = 0.45, p < 0.01; r TASIT = 0.41, p < 0.02]. Regression analyses did not provide significant support for low-level social cognition mediating the relationship between visual processing and high-level social cognition. CONCLUSION Early-stage visual processing, low-level social cognition, and high-level social cognition were all significantly impaired in ROSz. Early-stage visual processing was associated with performance on the social cognitive tasks in ROSz, consistent with a cascade model of information processing. However, significant cascading effects within social cognition were not supported. These data suggest that interventions directed at early visual processing may yield downstream effects on social cognitive processes.
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Affiliation(s)
- Amanda McCleery
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California–Los Angeles, Los Angeles, CA, United States
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Jonathan K. Wynn
- Semel Institute for Neuroscience and Human Behavior, University of California–Los Angeles, Los Angeles, CA, United States
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eric A. Reavis
- Semel Institute for Neuroscience and Human Behavior, University of California–Los Angeles, Los Angeles, CA, United States
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Joseph Ventura
- Semel Institute for Neuroscience and Human Behavior, University of California–Los Angeles, Los Angeles, CA, United States
| | - Kenneth L. Subotnik
- Semel Institute for Neuroscience and Human Behavior, University of California–Los Angeles, Los Angeles, CA, United States
| | - Michael F. Green
- Semel Institute for Neuroscience and Human Behavior, University of California–Los Angeles, Los Angeles, CA, United States
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Keith H. Nuechterlein
- Semel Institute for Neuroscience and Human Behavior, University of California–Los Angeles, Los Angeles, CA, United States
- Department of Psychology, University of California–Los Angeles, Los Angeles, CA, United States
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28
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Chwa WJ, Tishler TA, Raymond C, Tran C, Anwar F, Villablanca JP, Ventura J, Subotnik KL, Nuechterlein KH, Ellingson BM. Association between cortical volume and gray-white matter contrast with second generation antipsychotic medication exposure in first episode male schizophrenia patients. Schizophr Res 2020; 222:397-410. [PMID: 32487466 PMCID: PMC7572538 DOI: 10.1016/j.schres.2020.03.073] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/06/2020] [Accepted: 03/31/2020] [Indexed: 01/19/2023]
Abstract
This cross-sectional study examines the differences in cortical volume and gray-to-white matter contrast (GWC) in first episode schizophrenia patients (SCZ) compared to healthy control participants (HC) and in SCZ patients as a function of exposure to second generation antipsychotic medication. We hypothesize 1) SCZ exhibit regionally lower cortical volumes relative to HCs, 2) cortical volume will be greater with longer exposure to second generation antipsychotics prior to the MRI scan, and 3) lower GWC with longer exposure to second generation antipsychotics prior to the MRI scan, suggesting more blurring from greater intracortical myelin. To accomplish this, MRI scans from 71 male SCZ patients treated with second generation oral risperidone and 42 male HCs were examined. 3D T1-weighted MPRAGE images collected at 1.5T were used to estimate cortical volume and GWC by sampling signal intensity at 30% within the cortical ribbon. Average cortical volume and GWC were calculated and compared between SCZ and HC. Cortical volume and GWC in SCZ patients were correlated with duration of medication exposure for the time period prior to the scan. First-episode SCZ patients had significantly lower cortical volume compared to HCs in bilateral temporal, superior and rostral frontal, postcentral gyral, and parahippocampal regions. In SCZ patients, greater cortical volume was associated with (log-transformed) duration of second-generation antipsychotic medication exposure in bilateral precuneus, right lingual, and right superior parietal regions. Lower GWC was correlated with longer duration of medication exposure bilaterally in the superior frontal lobes. In summary, second generation antipsychotics may increase cortical volume and decrease GWC in first episode SCZ patients.
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Affiliation(s)
- Won Jong Chwa
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Todd A. Tishler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Catalina Raymond
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Cathy Tran
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Faizan Anwar
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - J. Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Nahum M, Lee H, Fisher M, Green MF, Hooker CI, Ventura J, Jordan JT, Rose A, Kim SJ, Haut KM, Merzenich MM, Vinogradov S. Online Social Cognition Training in Schizophrenia: A Double-Blind, Randomized, Controlled Multi-Site Clinical Trial. Schizophr Bull 2020; 47:108-117. [PMID: 32614046 PMCID: PMC7825077 DOI: 10.1093/schbul/sbaa085] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Social cognition (SC), the mental operations underlying social functioning, are impaired in schizophrenia. Their direct link to functional outcome and illness status have made them an important therapeutic target. However, no effective treatment for these deficits is currently applied as a standard of care. To address this need, we have developed SocialVille-an online, plasticity-based training program that targets SC deficits in schizophrenia. Here we report the outcomes of a double-blind, controlled, randomized, multi-site clinical trial of SocialVille. Outpatients with schizophrenia were randomized to complete 40 sessions of either SocialVille (N = 55 completers) or active control (computer games; N = 53 completers) from home. The a priori co-primary outcome measures were a social cognitive composite and a functional capacity outcome (UCSD Performance-based Skills Assessment [UPSA-2]). Secondary outcomes included a virtual functional capacity measure (VRFCAT), social functioning, quality of life, and motivation. Linear mixed models revealed a group × time interaction favoring the treatment group for the social cognitive composite (b = 2.81; P < .001) but not for the UPSA-2 measure. Analysis of secondary outcome measures showed significant group × time effects favoring the treatment group on SC and social functioning, on the virtual functional capacity measure and a motivation subscale, although these latter findings were nonsignificant with FDR correction. These results provide support for the efficacy of a remote, plasticity-based social cognitive training program in improving SC and social functioning in schizophrenia. Such treatments may serve as a cost-effective adjunct to existing psychosocial treatments. Trial Registration: NCT02246426.
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Affiliation(s)
- Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel,Department of Research and Development, Posit Science Inc., San Francisco, CA,To whom correspondence should be addressed; School of Occupational Therapy, Faculty of Medicine, The Hebrew University, PO Box 24026, Mount Scopus, Jerusalem, 91240, Israel; tel: +972-54-732-6655, fax: +972-2-5325345, e-mail:
| | - Hyunkyu Lee
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Melissa Fisher
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Michael F Green
- VA Greater Los Angeles, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Christine I Hooker
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Joshua T Jordan
- Department of Psychiatry, University of California, San Francisco, CA
| | - Annika Rose
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Sarah-Jane Kim
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Kristen M Haut
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Michael M Merzenich
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
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30
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Reiter K, Ventura J, Lovell D, Augustine D, Barragan M, Blair T, Chesnut K, Dashtgard P, Gonzalez G, Pifer N, Strong J. Psychological Distress in Solitary Confinement: Symptoms, Severity, and Prevalence in the United States, 2017-2018. Am J Public Health 2020; 110:S56-S62. [PMID: 31967876 DOI: 10.2105/ajph.2019.305375] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To specify symptoms and measure prevalence of psychological distress among incarcerated people in long-term solitary confinement.Methods. We gathered data via semistructured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for 106 randomly selected people in solitary confinement in the Washington State Department of Corrections in 2017. We performed 1-year follow-up interviews and BPRS assessments with 80 of these incarcerated people, and we present the results of our qualitative content analysis and descriptive statistics.Results. BPRS results showed clinically significant symptoms of depression, anxiety, or guilt among half of our research sample. Administrative data showed disproportionately high rates of serious mental illness and self-harming behavior compared with general prison populations. Interview content analysis revealed additional symptoms, including social isolation, loss of identity, and sensory hypersensitivity.Conclusions. Our coordinated study of rating scale, interview, and administrative data illustrates the public health crisis of solitary confinement. Because 95% or more of all incarcerated people, including those who experienced solitary confinement, are eventually released, understanding disproportionate psychopathology matters for developing prevention policies and addressing the unique needs of people who have experienced solitary confinement, an extreme element of mass incarceration.
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Affiliation(s)
- Keramet Reiter
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Joseph Ventura
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - David Lovell
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Dallas Augustine
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Melissa Barragan
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Thomas Blair
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Kelsie Chesnut
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Pasha Dashtgard
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Gabriela Gonzalez
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Natalie Pifer
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
| | - Justin Strong
- Keramet Reiter is with the Department of Criminology, Law, and Society and the School of Law, University of California, Irvine. Joseph Ventura is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. David Lovell is with the School of Nursing, University of Washington, Seattle. Dallas Augustine, Melissa Barragan, Kelsie Chesnut, and Gabriela Gonzalez are doctoral candidates in the Department of Criminology, Law, and Society, University of California, Irvine. Thomas Blair is with the Department of Psychiatry, Southern California Permanente Medical Group, Downey. Pasha Dashtgard is a doctoral student in the Department of Psychological Science, University of California, Irvine. Natalie Pifer is with the Department of Criminology and Criminal Justice, University of Rhode Island, Kingston. Justin Strong is a doctoral student in the Department of Criminology, Law, and Society, University of California, Irvine
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Subotnik KL, Ventura J, Hellemann GS, Zito MF, Agee ER, Nuechterlein KH. Relationship of poor insight to neurocognition, social cognition, and psychiatric symptoms in schizophrenia: A meta-analysis. Schizophr Res 2020; 220:164-171. [PMID: 32334936 DOI: 10.1016/j.schres.2020.03.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/02/2020] [Accepted: 03/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Poor insight (unawareness) about having a mental disorder is considered to be a core feature of the disorder. Further, poor insight has been associated with another core feature of schizophrenia, neurocognitive deficits. However, previous meta-analyses have shown that poor insight is more strongly related to positive symptoms and social cognition than to neurocognitive functioning. METHOD A meta-analysis of 123 studies of schizophrenia patients (combined n = 14,932) was conducted to determine the magnitude of the relationship between poor insight and neurocognition, social cognition, and positive symptoms, as well as negative symptoms, disorganization, and depression. The neurocognitive constructs were defined empirically using dimensions identified by the MATRICS initiative. RESULTS Meta-analytic findings showed that relationships were weak between poor insight and the six neurocognitive domains (r's range from -0.04 to -0.13), but that poor insight was moderately correlated with one aspect of social cognition, theory of mind (r = -0.23, p < .01). In addition, poor insight was moderately associated with reality distortion (r = 0.28, p < .01), disorganization (r = 0.29, p < .01), and negative symptoms (r = 0.20, p < .01). DISCUSSION Organizing the neurocognitive variables using the MATRICS domains continues to demonstrate that the relationship between insight and neurocognition is relatively weak. In comparison, we found moderate correlations between insight and theory of mind and several symptom domains. These moderate relationships are generally consistent with previous meta-analyses but are demonstrated more rigorously by examining more studies within the same meta-analysis.
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Affiliation(s)
- Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Michael F Zito
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Elisha R Agee
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States of America
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32
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Dias C, Leitao DC, Freire CSR, Gomes HL, Cardoso S, Ventura J. Resistive switching of silicon-silver thin film devices in flexible substrates. Nanotechnology 2020; 31:135702. [PMID: 31801117 DOI: 10.1088/1361-6528/ab5eb7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Novel applications for memory devices demand nanoscale flexible structures. In particular, resistive switching (RS) devices are promising candidates for wearable and implantable technologies. Here, the Pt/Si/Ag/TiW metal-insulator-metal structure was fabricated and characterized on top of flexible substrates using a straightforward microfabrication process. We also showed that these substrates are compatible with sputtering deposition. RS was successfully achieved using both commercial cellulose cleanroom paper and bacterial cellulose, and polymer (PET) substrates. The bipolar switching behavior was observed for both flat and bent (under a radius of 3.5 mm) configurations. The observed phenomenon was explained by the formation/rupture of metallic Ag filaments in the otherwise insulating Si host layer.
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Affiliation(s)
- C Dias
- IFIMUP and Department of Physics and Astronomy of the Faculty of Sciences of the University of Porto, Portugal
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33
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Favre G, Horat SK, Herrmann FR, Gothuey I, Ventura J, Merlo MCG, Missonnier P. False memory production in schizophrenia: A neurophysiological investigation. Schizophr Res Cogn 2020; 20:100174. [PMID: 32154124 PMCID: PMC7052439 DOI: 10.1016/j.scog.2020.100174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
Background The topic of false memory in schizophrenia has been well documented in earlier research contributions. To date, there is no study exploring the implications of specific neural networks during this phenomenon in patients suffering from schizophrenia. Methods We compared 17 patients suffering from psychosis (SCZ) to 33 healthy controls (HC) performing a verbal memory task designed to produce false memories, i.e. the Deese-Roediger-McDermott paradigm (DRM). Electroencephalography was used to specifically analyze the P2 and N400 event-related potentials components. Results The SCZ patients showed a reduced ability to distinguish between true and false memories as assessed by the A' index which was calculated based on the false and true memory rates. The morphology of the P2 differed in frontal electrode region with a lower amplitude in SCZ. In addition, the amplitude of N400 was more pronounced (more negative) in HC than in SCZ in centro-parietal electrode site. Conclusions We suggest that the differences found in P2 amplitude are associated with difficulties of SCZ patients to efficiently compare item-specific features of a mnesic elements to incoming stimuli which impair the subsequent verbal memory information processing reflected by the N400 component amplitude decrease. These results are consistent with the idea that SCZ use a different strategy while they perform the DRM paradigm.
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Affiliation(s)
- Grégoire Favre
- Laboratory for Psychiatric Neuroscience and Psychotherapy, Department of Medicine, Faculty of Science & Medicine, University of Fribourg, Chemin du Musée 5, CH 1700 Fribourg, Switzerland.,Mental Health Network Fribourg (RFSM), Sector of psychiatry and psychotherapy for adults, L'Hôpital 140, Case postale 90, CH 1633 Marsens, Switzerland
| | - Sibylle K Horat
- Laboratory for Psychiatric Neuroscience and Psychotherapy, Department of Medicine, Faculty of Science & Medicine, University of Fribourg, Chemin du Musée 5, CH 1700 Fribourg, Switzerland
| | - François R Herrmann
- Division of geriatrics, Department of rehabilitation and geriatrics, Geneva University Hospitals and University of Geneva, CH 1226 Thônex, Switzerland
| | - Isabelle Gothuey
- Mental Health Network Fribourg (RFSM), Sector of psychiatry and psychotherapy for adults, L'Hôpital 140, Case postale 90, CH 1633 Marsens, Switzerland
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, CA, United States
| | - Marco C G Merlo
- Laboratory for Psychiatric Neuroscience and Psychotherapy, Department of Medicine, Faculty of Science & Medicine, University of Fribourg, Chemin du Musée 5, CH 1700 Fribourg, Switzerland
| | - Pascal Missonnier
- Laboratory for Psychiatric Neuroscience and Psychotherapy, Department of Medicine, Faculty of Science & Medicine, University of Fribourg, Chemin du Musée 5, CH 1700 Fribourg, Switzerland.,Mental Health Network Fribourg (RFSM), Sector of psychiatry and psychotherapy for adults, L'Hôpital 140, Case postale 90, CH 1633 Marsens, Switzerland
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Ventura J, Welikson T, Ered A, Subotnik KL, Keefe RSE, Hellemann GS, Nuechterlein KH. Virtual reality assessment of functional capacity in the early course of schizophrenia: Associations with cognitive performance and daily functioning. Early Interv Psychiatry 2020; 14:106-114. [PMID: 31183960 PMCID: PMC6901817 DOI: 10.1111/eip.12831] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/13/2018] [Revised: 01/22/2019] [Accepted: 04/14/2019] [Indexed: 12/01/2022]
Abstract
AIM Computer-based virtual reality assessments of functional capacity have shown promise as a reliable and valid way to assess individuals with multi-episode schizophrenia. However, there has been little research utilizing this innovative approach with young patients who are in the early phase of schizophrenia. METHODS Outpatients in the early course of schizophrenia (n = 42) were compared to controls (n = 13) at cross-sectional study points. Patients were within 2 years of their first psychotic episode, were an average of 22.2 years old and had an average of 12.3 years of education. We used the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and the University of California, San Diego (UCSD) Performance-Based Skills Assessment-2 (UPSA-2) to assess functional capacity. The MATRICS Consensus Cognitive Battery (MCCB) and the Cognitive Assessment Interview (CAI) were the measures of cognitive functioning. The Global Functioning Scale: Role (GFS-R) and Social (GFS-S), and the Role Functioning Scale (RFS) were the measures of daily functioning. RESULTS Early course patients vs controls were slower (patient M = 830.41 seconds vs control M = 716.84 seconds; t = 3.0, P < .01) and committed more errors (patient M = 3.2 vs control M = 1.7 seconds, t = 2.9, P < .01) on the VRFCAT. Total time was significantly correlated with the UPSA (r = -0.66, P < .01), MCCB (r = -0.70, P < .01), CAI (r = -0.51, P < .01), and GFS role (r = -0.52, P <. 01) and social functioning (r = -0.43, P = .03). CONCLUSIONS We extend previous findings to patients with first-episode schizophrenia. Virtual-reality-based performance was correlated with a standard test of functional capacity, indicating VRFCAT validity. Furthermore, correlations with cognitive functioning and occupational/school and social functioning indicate promise as a co-primary measure to track changes in response to treatment.
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Affiliation(s)
- Joseph Ventura
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Tamara Welikson
- Department of Psychology, Alliant University, Alhambra, California
| | - Arielle Ered
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Kenneth L Subotnik
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Richard S E Keefe
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - Gerhard S Hellemann
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Keith H Nuechterlein
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Department of Psychology, University of California at Los Angeles, Los Angeles, California
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Nuechterlein KH, Subotnik KL, Ventura J, Turner LR, Gitlin MJ, Gretchen-Doorly D, Becker DR, Drake RE, Wallace CJ, Liberman RP. Enhancing return to work or school after a first episode of schizophrenia: the UCLA RCT of Individual Placement and Support and Workplace Fundamentals Module training. Psychol Med 2020; 50:20-28. [PMID: 30606273 PMCID: PMC6620168 DOI: 10.1017/s0033291718003860] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 11/06/2022]
Abstract
BACKGROUND This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling. METHODS Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication. RESULTS The IPS-WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS-WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS-WFM intervention (45 v. 26 weeks, p < 0.004). CONCLUSIONS The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.
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Affiliation(s)
- Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Luana R. Turner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michael J. Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Denise Gretchen-Doorly
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Deborah R. Becker
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Robert E. Drake
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Charles J. Wallace
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Robert P. Liberman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Asín J, de Miguel R, Rodríguez A, Ventura J, Hilbe M, Schweizer M, Luján L. An Outbreak of Border Disease-Like Syndrome in Sheep Associated With a BVDV-II-Contaminated Orf Vaccine. J Comp Pathol 2020. [DOI: 10.1016/j.jcpa.2019.10.027] [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: 10/25/2022]
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Bonfils KA, Ventura J, Subotnik KL, Nuechterlein KH. Affective prosody and facial emotion recognition in first-episode schizophrenia: Associations with functioning & symptoms. Schizophr Res Cogn 2019; 18:100153. [PMID: 31497511 PMCID: PMC6718049 DOI: 10.1016/j.scog.2019.100153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/21/2018] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 11/30/2022]
Abstract
Studies indicate that people with schizophrenia experience deficits in their ability to accurately detect emotions, both through facial expressions and voice intonation (i.e., prosody), and that functioning and symptoms are associated with these deficits. This study aimed to examine how facial emotion and affective prosody recognition are related to functioning and symptoms in a first-episode schizophrenia sample. Further, in light of research suggesting variable emotion-specific performance in people with schizophrenia, this study explored emotion-specific performance. Participants were 49 people with a recent first episode of schizophrenia taking part in a larger RCT. Results revealed that affective prosody recognition was significantly correlated with both role and social functioning. Regarding associations with psychiatric symptoms, facial emotion recognition was significantly, negatively associated with all three positive symptom scales, whereas affective prosody recognition was significantly, negatively associated with disorganization only. Emotion-specific analyses revealed that for affective prosody, participants were most accurate in recognizing anger and least accurate for disgust. For facial emotion recognition, participants were most accurate in recognizing happiness and least accurate for fear. Taken together, results suggest that affective prosody recognition is important for social and role functioning in people with first-episode schizophrenia. Results also suggest that this group may struggle more to identify negative emotions, though additional work is needed to clarify this pattern in affective prosody and determine real-world impact on social interactions.
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Affiliation(s)
- Kelsey A. Bonfils
- VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, 4100 Allequippa St., Pittsburgh, PA, United States
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, United States
- Aftercare Research Program, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Los Angeles, CA, United States
| | - Joseph Ventura
- Aftercare Research Program, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Los Angeles, CA, United States
| | - Kenneth L. Subotnik
- Aftercare Research Program, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Los Angeles, CA, United States
| | - Keith H. Nuechterlein
- Aftercare Research Program, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Los Angeles, CA, United States
- Department of Psychology, UCLA, Los Angeles, CA, United States
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Mahncke HW, Kim SJ, Rose A, Stasio C, Buckley P, Caroff S, Duncan E, Yasmin S, Jarskog LF, Lamberti JS, Nuechterlein K, Strassnig M, Velligan D, Ventura J, Walker T, Stroup TS, Keefe RSE. Evaluation of a plasticity-based cognitive training program in schizophrenia: Results from the eCaesar trial. Schizophr Res 2019; 208:182-189. [PMID: 30930034 PMCID: PMC6544484 DOI: 10.1016/j.schres.2019.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cognitive impairment in schizophrenia is a core feature of the disorder. Computerized cognitive training has shown promise in pilot studies. A 26-week randomized blinded placebo-controlled trial was conducted to investigate the effect of a novel computerized cognitive training program on cognitive and functional capacity outcomes. METHOD The study followed MATRICS guidelines for the evaluation of interventions designed to improve cognitive function in schizophrenia. Participants (N = 150) were randomized to experimental (computerized cognitive training in a game-like format) or active control (computer games) groups. Training was conducted in-clinic, with an intended training schedule of 5 days per week, 1 h per day, for 26 weeks. Co-primary outcome measures were the MATRICS Consensus Cognitive Battery (MCCB) composite score and the UCSD Performance-Based Skills Assessment (UPSA-2) total score, secondary outcome measures included the Cognitive Assessment Interview (CAI) and the Short-Form-12 Mental Composite Score (SF-12 MCS). Target engagement was assessed with task-learning based assessment. RESULTS At baseline, the groups were well matched. No significant effect of the experimental treatment was seen on the primary or secondary outcome measures compared to the active control. Review of the task learning/target engagement data suggested inadequate target engagement. CONCLUSIONS Results do not support a cognitive or functional capacity benefit from this implementation of a computerized cognitive training program in people with schizophrenia. In future trials, careful consideration is merited of the assessment of task learning/target engagement, the effects of making the cognitive training game-like on motivation, and the implicit effects of trial requirements on participant selection.
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Affiliation(s)
| | | | | | | | - Peter Buckley
- Virginia Commonwealth University, United States of America
| | - Stanley Caroff
- Corporal Michael J. Crescenz VA Medical Center, The Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Erica Duncan
- Atlanta Veterans Affairs Medical Center, Emory University, United States of America
| | - Sarah Yasmin
- Palo Alto Veterans Affairs Medical Center, United States of America
| | - L Fredrik Jarskog
- University of North Carolina at Chapel Hill, United States of America
| | | | | | | | - Dawn Velligan
- University of Texas Health Science Center in Austin, United States of America
| | - Joseph Ventura
- University of California, Los Angeles, United States of America
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Clayson PE, Kern RS, Nuechterlein KH, Knowlton BJ, Bearden CE, Cannon TD, Fiske AP, Ghermezi L, Hayata JN, Hellemann GS, Horan WP, Kee K, Lee J, Subotnik KL, Sugar CA, Ventura J, Yee CM, Green MF. Social vs. non-social measures of learning potential for predicting community functioning across phase of illness in schizophrenia. Schizophr Res 2019; 204:104-110. [PMID: 30121183 PMCID: PMC6377348 DOI: 10.1016/j.schres.2018.07.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
Abstract
Studies demonstrate that dynamic assessment (i.e., learning potential) improves the prediction of response to rehabilitation over static measures in individuals with schizophrenia. Learning potential is most commonly assessed using neuropsychological tests under a test-train-test paradigm to examine change in performance. Novel learning potential approaches using social cognitive tasks may have added value, particularly for the prediction of social functioning, but this area is unexplored. The present study is the first to investigate whether patients with schizophrenia demonstrate social cognitive learning potential across phase of illness. This study included 43 participants at clinical high risk (CHR), 63 first-episode, and 36 chronic schizophrenia patients. Assessment of learning potential involved test-train-test versions of the Wisconsin Card Sorting Test (non-social cognitive learning potential) and the Facial Emotion Identification Test (social cognitive learning potential). Non-social and social cognition pre-training scores (static scores) uniquely predicted concurrent community functioning in patients with schizophrenia, but not in CHR participants. Learning potential showed no incremental explanation of variance beyond static scores. First-episode patients showed larger non-social cognitive learning potential than CHR participants and were similar to chronic patients; chronic patients and CHR participants were similar. Group differences across phase of illness were not observed for social cognitive learning potential. Subsequent research could explore whether non-social and social cognitive learning potential relate differentially to non-social versus social types of training and rehabilitation.
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Affiliation(s)
- Peter E. Clayson
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Corresponding author at: VA Greater Los Angeles Healthcare System, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
| | - Robert S. Kern
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Barbara J. Knowlton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | | | - Alan P. Fiske
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA
| | - Livon Ghermezi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacqueline N. Hayata
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William P. Horan
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kimmy Kee
- Department of Psychology, California State University Channel Islands, Los Angeles, CA
| | - Junghee Lee
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Catherine A. Sugar
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Cindy M. Yee
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Michael. F. Green
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Ventura J, Oliva F, Frizziero A, Maffulli N. Muscles, Ligaments and Tendons Journal – Basic principles and recommendations in clinical and field Science Research: 2016 Update. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2016.01] [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: 11/05/2022]
Affiliation(s)
- J. Ventura
- University e-Campus, Novedrate, Italy
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - F. Oliva
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Rome, Italy
| | - A. Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | - N. Maffulli
- Head of Department of Orthopaedic and Trauma Surgery, University of Salerno, Italy
- Centre for Sports and Exercise Medicine, Queen Mary University of London Bart and The London School of Medicine and Dentistry, Mile End Hospital London, UK
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Ventura J, Subotnik KL, Gretchen-Doorly D, Casaus L, Boucher M, Hellemann GH, Nuechterlein KH, Hellemann GS, Nuechterlein KH. Cognitive remediation can improve negative symptoms and social functioning in first-episode schizophrenia: A randomized controlled trial. Schizophr Res 2019; 203:24-31. [PMID: 29128326 PMCID: PMC6589092 DOI: 10.1016/j.schres.2017.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 05/19/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Meta-analyses have reported that the effects of cognitive remediation might go beyond improvement in cognition to include unexpected benefits for schizophrenia patients such as negative symptom reduction and improvements in functioning. In addition, some evidence indicated that these potentially beneficial effects are also present in the initial course of schizophrenia, but work in this area is still developing. METHOD A RCT compared Cognitive Remediation (CR) to Healthy Behaviors Training (HBT) in 80 patients (78% male) with a mean age of 21.9years and mean education of 12.3years who had a first psychotic episode within two years of study entry. Participants were trained using CR programs or received HBT involving 50 sessions over 6months and then booster sessions over the next 6months. The SANS and BPRS were used to assess symptoms. The UCLA Social Attainment Survey assessed social functioning. RESULTS Using GLMM, improvements over 12months were found favoring CR for SANS Expressive Symptoms (p<0.01), which was composed of Affective Flattening (p<0.01) and Alogia (p=0.04), and for SANS Experiential Symptoms, composed of Avolition/Apathy (p=0.04) and Anhedonia/Asociality (p<0.01). CR was associated with improvements in social functioning (p=0.05) as compared to HBT. CONCLUSIONS We confirmed that the beneficial effects of CR appear to extend beyond cognition to improvements in negative symptoms and social functioning in early course schizophrenia patients. These results suggest that cognitive remediation might have an impact when the reduction of risk factors for chronicity is most critical for promoting recovery.
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Affiliation(s)
- Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Denise Gretchen-Doorly
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Laurie Casaus
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Michael Boucher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Gerhard H. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles,Department of Psychology, University of California, Los Angeles
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Department of Psychology, University of California, Los Angeles, United States
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Hurford IM, Ventura J, Marder SR, Reise SP, Bilder RM. A 10-minute measure of global cognition: Validation of the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS). Schizophr Res 2018; 195:327-333. [PMID: 28918221 DOI: 10.1016/j.schres.2017.08.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Schizophrenia is marked by a global cognitive impairment that contributes significantly to chronic disability and unemployment. As new treatments are developed for cognition in schizophrenia, clinicians require easily administered instruments to assess cognition. We previously developed a very brief cognitive battery (Bell et al., 2005). The Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) was developed specifically to provide clinicians with a way to assess cognition in their patients with schizophrenia. Here, we report the results of a validity study comparing B-CATS to a larger neurocognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery. METHODS Outpatients with schizophrenia (N=91) were administered the B-CATS and the non-overlapping tests of the MATRICS battery at two time points separated by 1month. They were also administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B), a measure of functional capacity. RESULT The B-CATS has an administration time of approximately 10min. It demonstrates good test-retest reliability and internal consistency. It correlates 0.76 (p<0.01) with the MATRICS battery. The shorter B-CATS and the MATRICS battery correlate with the UPSA-B at 0.50 and 0.58 respectively. CONCLUSION A 10-minute version of the B-CATS correlates highly with the "gold standard" neurocognitive battery that has an administration time of over 60min. Both measures correlate moderately with a measure of functional capacity. This brief battery was designed to allow clinicians to monitor cognitive change and better inform treatment decisions.
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Affiliation(s)
- Irene M Hurford
- Department of Psychiatry, University of Pennsylvania, United States.
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, United States
| | - Stephen R Marder
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, United States; VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, United States
| | | | - Robert M Bilder
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, United States; Department of Psychology, UCLA, United States
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43
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Glenthøj LB, Fagerlund B, Bak N, Hjorthøj C, Gregersen M, Kristensen TD, Wenneberg C, Krakauer K, Ventura J, Jepsen JRM, Nordentoft M. Examining speed of processing of facial emotion recognition in individuals at ultra-high risk for psychosis: Associations with symptoms and cognition. Schizophr Res 2018; 195:562-563. [PMID: 29102222 DOI: 10.1016/j.schres.2017.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Louise Birkedal Glenthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark.
| | - Birgitte Fagerlund
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark
| | - Nikolaj Bak
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark
| | - Carsten Hjorthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark
| | - Maja Gregersen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark
| | - Tina Dam Kristensen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark
| | - Christina Wenneberg
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Functional Imaging Unit, Dep. of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Kristine Krakauer
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Functional Imaging Unit, Dep. of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, CA, USA
| | - Jens Richardt Møllegaard Jepsen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark
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44
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Lee J, Nuechterlein KH, Knowlton BJ, Bearden CE, Cannon TD, Fiske AP, Ghermezi L, Hayata JN, Hellemann GS, Horan WP, Kee K, Kern RS, Subotnik KL, Sugar CA, Ventura J, Yee CM, Green MF. Episodic Memory for Dynamic Social Interaction Across Phase of Illness in Schizophrenia. Schizophr Bull 2018; 44:620-630. [PMID: 29106694 PMCID: PMC5890490 DOI: 10.1093/schbul/sbx081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/13/2022]
Abstract
Although a number of studies examined recollection and familiarity memory in schizophrenia, most of studies have focused on nonsocial episodic memory. Little is known about how schizophrenia patients remember social information in everyday life and whether social episodic memory changes over the course of illness. This study aims to examine episodic memory for dynamic social interaction with multimodal social stimuli in schizophrenia across phase of illness. Within each phase of illness, probands and demographically matched controls participated: 51 probands at clinical high risk (CHR) for psychosis and 36 controls, 80 first-episode schizophrenia patients and 49 controls, and 50 chronic schizophrenia patients and 39 controls. The participants completed the Social Remember-Know Paradigm that assessed overall social episodic memory, social recollection and familiarity memory, and social context memory, in addition to social cognitive measures and measures on community functioning. Probands showed impairment for recollection but not in familiarity memory and this pattern was similar across phase of illness. In contrast, impaired social context memory was observed in the first-episode and chronic schizophrenia samples, but not in CHR samples. Social context memory was associated with community functioning only in the chronic sample. These findings suggest that an impaired recollection could be a vulnerability marker for schizophrenia whereas impaired social context memory could be a disease-related marker. Further, a pattern of impaired recollection with intact familiarity memory for social stimuli suggests that schizophrenia patients may have a different pattern of impaired episodic memory for social vs nonsocial stimuli.
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Affiliation(s)
- Junghee Lee
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,To whom correspondence should be addressed; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, 72–460, Los Angeles, CA 90024, US; tel: 310-794-9010, fax: 310-268-4056, e-mail:
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Barbara J Knowlton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | | | - Alan P Fiske
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA
| | - Livon Ghermezi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacqueline N Hayata
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William P Horan
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kimmy Kee
- Department of Psychology, California State University Channel Islands, Los Angeles, CA
| | - Robert S Kern
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Catherine A Sugar
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Cindy M Yee
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
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45
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Hamilton HK, Williams TJ, Ventura J, Jasperse LJ, Owens EM, Miller GA, Subotnik KL, Nuechterlein KH, Yee CM. Clinical and Cognitive Significance of Auditory Sensory Processing Deficits in Schizophrenia. Am J Psychiatry 2018; 175:275-283. [PMID: 29202656 PMCID: PMC5832530 DOI: 10.1176/appi.ajp.2017.16111203] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 12/27/2022]
Abstract
OBJECTIVE Although patients with schizophrenia exhibit impaired suppression of the P50 event-related brain potential in response to the second of two identical auditory stimuli during a paired-stimulus paradigm, uncertainty remains over whether this deficit in inhibitory gating of auditory sensory processes has relevance for patients' clinical symptoms or cognitive performance. The authors examined associations between P50 suppression deficits and several core features of schizophrenia to address this gap. METHOD P50 was recorded from 52 patients with schizophrenia and 41 healthy comparison subjects during a standard auditory paired-stimulus task. Clinical symptoms were assessed with the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. The MATRICS Consensus Cognitive Battery was utilized to measure cognitive performance in a subsample of 39 patients. Correlation and regression analyses were conducted to examine P50 suppression in relation to clinical symptom and cognitive performance measures. RESULTS Schizophrenia patients demonstrated a deficit in P50 suppression when compared with healthy subjects, replicating prior research. Within the patient sample, impaired P50 suppression covaried reliably with greater difficulties in attention, poorer working memory, and reduced processing speed. CONCLUSIONS Impaired suppression of auditory stimuli was associated with core pathological features of schizophrenia, increasing confidence that P50 inhibitory processing can inform the development of interventions that target cognitive impairments in this chronic and debilitating mental illness.
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Affiliation(s)
- Holly K. Hamilton
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Health Care System and the Department of Psychiatry, University of California, San Francisco,Department of Psychology, University of California, Los Angeles
| | | | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - Emily M. Owens
- Department of Psychology, University of California, Los Angeles
| | - Gregory A. Miller
- Department of Psychology, University of California, Los Angeles,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Keith H. Nuechterlein
- Department of Psychology, University of California, Los Angeles,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Cindy M. Yee
- Department of Psychology, University of California, Los Angeles,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Shafer A, Dazzi F, Ventura J. Factor structure of the Brief Psychiatric Rating Scale - Expanded (BPRS-E) in a large hospitalized sample. J Psychiatr Res 2017; 93:79-86. [PMID: 28605626 DOI: 10.1016/j.jpsychires.2017.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 03/02/2017] [Revised: 04/21/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
Meta-analytically derived models of the BPRS-E factor structure were tested on a large (n = 33,903) hospitalized sample using confirmatory factor analysis. A modified four factor model (Positive symptoms, Negative symptoms, Affect, and Activation) containing 12 core BPRS-E symptoms based on the meta-analytic models had excellent model fit. An additional five factor, 15 core symptom model, which added a Disorganization factor consistent with the pentagonal model of schizophrenic symptoms also had support with generally good fit. These factors demonstrated acceptable reliability as measured by coefficient alpha (M = 0.77). These factors were compared across three major diagnostic classes and indicated clinically relevant differences between these groups such as depressed patients having higher Affect scores (d = 1.03), manic-mixed episode patients having higher Activation scores (d = 0.83) and schizophrenic patients having higher Positive Symptom scores (d = 0.89) providing evidence for the validity of these factors. Further exploratory factor analyses provided support for the factors of Positive symptoms, Negative symptoms, Affect, and Activation with additional smaller and less robust factors corresponding to Resistance emerging as a fifth factor and Disorganization emerging as a sixth factor.
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Affiliation(s)
- Alan Shafer
- Texas Department of State Health Services, Austin, Texas, United States.
| | - Federico Dazzi
- TECOS Department, Guglielmo Marconi University, Rome, Italy
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47
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Rosenfarb IF, Triana S, Nuechterlein KH, Ventura J, Breitborde NJK. Expressed emotion and the escalation of depressive symptoms in individuals with recent-onset schizophrenia. Early Interv Psychiatry 2017; 11:351-353. [PMID: 26801739 DOI: 10.1111/eip.12307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study examined whether expressed emotion (EE) predicts the emergence of depressive symptoms over a 1-year period in 109 individuals with recent-onset schizophrenia. METHODS AND RESULTS Cox proportional hazards regression analyses indicated that EE did not predict the emergence of depressive symptoms. The results also indicated that the EE factors (criticism, hostility and emotional overinvolvement), when examined individually, also did not predict the emergence of depressive symptoms. CONCLUSIONS Given the large number of patients in the study who were followed up for 1 year and another study's finding, using a subset of patients from the current study, of a significant relationship between EE and psychotic relapse, the data suggest that whereas EE is related to both psychotic relapse in individuals with recent-onset schizophrenia and depressive relapse in individuals with major depressive disorder, EE does not appear to predict depressive exacerbation in individuals with recent-onset schizophrenia.
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Affiliation(s)
- Irwin Ford Rosenfarb
- California School of Professional Psychology, Alliant International University, San Diego, California, USA
| | - Stephanie Triana
- California School of Professional Psychology, Alliant International University, San Diego, California, USA
| | - Keith H Nuechterlein
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Joseph Ventura
- Department of Psychiatry, University of California, Los Angeles, California, USA
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48
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Pauley T, Matienzo J, Ventura J, Barbita J. Cost of an Integrated Care Program to Reduce ED Visits During Diabetic Prisoner Court Hearings. J Correct Health Care 2017; 23:283-296. [PMID: 28715984 DOI: 10.1177/1078345817709804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Abstract
Diabetic events occurring during court hearings previously required emergency medical services (EMS) transport to the emergency department (ED). A new process was implemented whereby the provincial court (PC) was notified by the detention center of diabetes status of prisoners scheduled for court later that day, enabling a community nursing services provider to provide on-site diabetes assessment and treatment at the PC. During the 13-month pre-implementation phase, there were 10 incidents of diabetic distress resulting in an ED visit at a total cost of $797.58/prisoner, including police service personnel, EMS, and ED staff/physician. During the 12.5-month postimplementation phase, insulin was administered on-site during 72 court dates at a cost of $161.93/prisoner. The new process for managing diabetic needs of prisoners during court dates resulted in a substantial cost savings in terms of police services and health care personnel and improved the immediacy and quality of care for prisoners.
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Affiliation(s)
- Tim Pauley
- 1 Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
| | - Joy Matienzo
- 1 Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
| | | | - Josie Barbita
- 1 Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
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49
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Missonnier P, Curtis L, Ventura J, Herrmann FR, Merlo MCG. Differences of temporal dynamics and signal complexity of gamma band oscillations in first-episode psychosis during a working memory task. J Neural Transm (Vienna) 2017; 124:853-862. [PMID: 28466380 DOI: 10.1007/s00702-017-1728-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/22/2016] [Accepted: 04/18/2017] [Indexed: 01/01/2023]
Abstract
Gamma band oscillations participate in the temporal binding needed to synchronize cortical networks, involved in early sensory and short term memory processes. In earlier studies, alterations of these neurophysiological parameters have been found in psychotic disorders. To date no study has explored the temporal dynamics and signal complexity of gamma band oscillations in first episode psychosis (FEP). To address this issue, gamma band analysis was performed in 15 FEP patients and 18 healthy controls who successfully performed an adapted 2-back working memory task. Multiple linear and logistic regression models were computed to explore the relationship between the cognitive status and gamma oscillation changes over time. Based on regression model results, phase diagrams were constructed and their complexity was estimated using fractal dimension, a mathematical tool that describes shapes as numeric values. When adjusted for gamma values at time lags -3 to -4 ms and -15 to -16 ms, FEP patients displayed significantly higher time-dependent changes than controls, independently of the nature of the task. The present results are consistent with a discoordination of the activity of cortical generators engaged by the stimulus apparition in FEP patients, leading to a global binding deficit. In addition, fractal analysis showing higher complexity of gamma signal, confirmed this deficit. Our results provide evidence for recruitment of supplementary cortical generators as compensating mechanisms and yield further understanding for the pathophysiology cognitive impairments in FEP.
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Affiliation(s)
- Pascal Missonnier
- Unit of Psychiatric Neuroscience and Psychotherapy, Department of Medicine, Faculty of Science, University of Fribourg, Chemin du Musée 5, 1700, Fribourg, Switzerland. .,Mental Health Network Fribourg (RFSM), Sector of Psychiatry and Psychotherapy for Adults, L'Hôpital 140, Case postale 90, 1633, Marsens, Switzerland.
| | - Logos Curtis
- Young Adult Psychiatry Unit, Division of Specialized Psychiatry, Department of Mental Health and Psychiatry, Faculty of Medicine of the University of Geneva, University Hospitals of Geneva, Rue de Lausanne 67, Genève, 1202, Geneva, Switzerland
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, UCLA Department of Psychiatry, 300 Medical Plaza, Room 2243, Los Angeles, CA, 90095-6968, USA
| | - François R Herrmann
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva, 3 chemin Pont-Bochet, Thônex, 1226, Geneva, Switzerland
| | - Marco C G Merlo
- Unit of Psychiatric Neuroscience and Psychotherapy, Department of Medicine, Faculty of Science, University of Fribourg, Chemin du Musée 5, 1700, Fribourg, Switzerland
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50
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Smyth L, Crosbie J, Ventura J, Donoghue J, Senthi S, Rogers P. OC-0080: Normal tissue toxicity and in vivo dose-equivalence of synchroton radiotherapy modalities. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30524-8] [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: 11/28/2022]
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