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Fiszdon JM, Wang K, Lê K, Parente L, Choi J. Efficacy of cognitive training on cognition, symptoms and functioning: Impact of motivation and attendance. Schizophr Res Cogn 2024; 37:100313. [PMID: 38680994 PMCID: PMC11046296 DOI: 10.1016/j.scog.2024.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
While cognitive remediation therapy (CRT) and compensatory strategy training both have large literature bases supporting their efficacy on both proximal and distal outcomes, the research base on stand-alone cognitive training (CT) is smaller and less consistent, with little information about factors associated with better outcomes. In this study, we examined the efficacy of CT on training task, cognitive, symptom, and functional ability measures as well as the impact of motivational interviewing (MI), motivation level, and session attendance on treatment outcomes. Adults with psychotic spectrum disorders (n = 114) were randomized to MI or a sham control interview (CI), followed by 4 months of computerized CT. In whole sample analyses, participants improved on training tasks, cognitive performance, and psychiatric symptoms, but self-reported cognition, self-reported depression, and functional ability did not change. Compared to CI, MI was associated with greater reductions in self-reported depressive symptoms. Motivation level and session attendance did not significantly influence outcomes. Findings support the efficacy of CT on several key outcomes, and its simplicity may be advantageous in uptake in community clinics with limited staffing. The lack of functional gains underscores the need to incorporate treatment ingredients that promote generalization and real-world implementation of learned skills. We also speculate that engagement during course of training may be a better predictor of training success than baseline task-specific motivation.
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Affiliation(s)
- Joanna M. Fiszdon
- VA Connecticut Healthcare System, Psychology Service, 116B, 950 Campbell Ave, West Haven, CT 06516, United States of America
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States of America
| | - Kaicheng Wang
- Yale School of Public Health, New Haven, CT 06511, United States of America
| | - Karen Lê
- VA Connecticut Healthcare System, Psychology Service, 116B, 950 Campbell Ave, West Haven, CT 06516, United States of America
| | - Lori Parente
- VA Connecticut Healthcare System, Psychology Service, 116B, 950 Campbell Ave, West Haven, CT 06516, United States of America
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, The Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, United States of America
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Redlich Bossy M, Müller DR, Niedermoser DW, Burrer A, Spiller TR, Vetter S, Seifritz E, Egger ST. Impact of psychopathology on day-to-day living in patients with schizophrenia: A network analysis. Compr Psychiatry 2024; 133:152501. [PMID: 38820645 DOI: 10.1016/j.comppsych.2024.152501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/26/2024] [Accepted: 05/11/2024] [Indexed: 06/02/2024] Open
Abstract
Although the relationship between schizophrenia and disability is well established, the association between the symptoms of the disorder and functional domains remains unclear. The current study explored the nuances of the relationship between symptoms and domains of functioning in a sample of 1127 patients with schizophrenia. We assessed the symptoms of schizophrenia with the Positive and Negative Syndrome Scale (PANSS) and psychosocial functioning with the mini-ICF-APP (mini-International Classification of Functioning Rating for Limitations of Activities and Participation in Psychological Disorders). The mean PANSS score was 94.28 (27.20), and the mean mini-ICF-APP score was 25.25 (8.96), both of which are indicative of severe symptom load and impairment. We were able to show a strong relationship and overlap between symptoms and disability in patients with schizophrenia. We identified several symptoms related to functional impairment. Deficits in judgment and abstract thinking contribute to impairment through poor adherence (to routines and compliance with rules) and difficulties in planning and organizing. We believe that in schizophrenia, symptoms and their interactions constitute a disorder beyond any single manifestation. Furthermore, we suggest that cognitive testing and cognitive treatment should become part of the standard of care for patients with schizophrenia.
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Affiliation(s)
- Mona Redlich Bossy
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Psychology, Faculty of Humanities, University of Fribourg, Fribourg, Switzerland
| | - Daniel R Müller
- Department of Psychology, Faculty of Humanities, University of Fribourg, Fribourg, Switzerland; Department of Psychiatry and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Faculty of Medice, University of Bern, Bern, Switzerland
| | | | - Achim Burrer
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Frileux S, Boltri M, Doré J, Leboyer M, Roux P. Cognition and gut microbiota in schizophrenia spectrum and mood disorders: A systematic review. Neurosci Biobehav Rev 2024; 162:105722. [PMID: 38754717 DOI: 10.1016/j.neubiorev.2024.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/11/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
FRILEUX, M., BOLTRI M. and al. Cognition and Gut microbiota in schizophrenia spectrum and mood disorders: a Systematic Review. NEUROSCI BIOBEHAV REV (1) 2024 Schizophrenia spectrum disorders and major mood disorders are associated with cognitive impairments. Recent studies suggest a link between gut microbiota composition and cognitive functioning. Here, we review the relationship between gut microbiota and cognition in these disorders. To do this, we conducted a systematic review, searching Cochrane Central Register of Controlled Trials, EBSCOhost, Embase, Pubmed, Scopus, and Web of Science. Studies were included if they investigated the relationship between gut microbiota composition and cognitive function through neuropsychological assessments in patients with bipolar, depressive, schizophrenia spectrum, and other psychotic disorders. Ten studies were identified. Findings underscore a link between gut dysbiosis and cognitive impairment. This relationship identified specific taxa (Haemophilus, Bacteroides, and Alistipes) as potential contributors to bolstered cognitive performance. Conversely, Candida albicans, Toxoplasma gondii, Streptococcus and Deinococcus were associated with diminished performance on cognitive assessments. Prebiotics and probiotics interventions were associated with cognitive enhancements, particularly executive functions. These results emphasize the role of gut microbiota in cognition, prompting further exploration of the underlying mechanisms paving the way toward precision psychiatry.
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Affiliation(s)
- S Frileux
- Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177, rue de Versailles, Le Chesnay-Rocquencourt 78157, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif 94807, France.
| | - M Boltri
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy; I.R.C.C.S. Istituto Auxologico Italiano, Experimental Laboratory for Metabolic Neurosciences Research, Piancavallo, Italy
| | - J Doré
- Université Paris-Saclay, INRA, MetaGenoPolis, AgroParisTech, MICALIS, Jouy-en-Josas 78350, France
| | - M Leboyer
- Inserm U955 IMRB, Translational Neuropsychiatry Laboratory, AP-HP, DMU IMPACT, Fédération Hospitalo-Universitaire de médecine de précision en psychiatrie (FHU ADAPT), Paris Est Créteil University and Fondation FondaMental, Créteil 94010, France; Fondation Fondamental, Créteil 94010, France
| | - P Roux
- Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177, rue de Versailles, Le Chesnay-Rocquencourt 78157, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif 94807, France
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Salazar de Pablo G, Rodriguez V, Besana F, Civardi SC, Arienti V, Maraña Garceo L, Andrés-Camazón P, Catalan A, Rogdaki M, Abbott C, Kyriakopoulos M, Fusar-Poli P, Correll CU, Arango C. Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis. J Am Acad Child Adolesc Psychiatry 2024; 63:684-697. [PMID: 38280414 DOI: 10.1016/j.jaac.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. METHOD We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. RESULTS A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. CONCLUSION EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. PLAIN LANGUAGE SUMMARY This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. STUDY PREREGISTRATION INFORMATION Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
| | - Victoria Rodriguez
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | | | | | - P Andrés-Camazón
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Ana Catalan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Biobizkaia Health Research Institute. Basurto University Hospital, OSI Bilbao-Basurto, and the University of the Basque Country UPV/EHU. Centro de Investigación en Red de Salud Mental (CIBERSAM), Vizcaya, Spain
| | - Maria Rogdaki
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Francis Crick Institute, London, United Kingdom
| | - Chris Abbott
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Marinos Kyriakopoulos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom; National and Kapodistrian University of Athens, Athens, Greece
| | - Paolo Fusar-Poli
- University of Pavia, Pavia, Italy; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; LMU Munich, Munich, Germany; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; and National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Christoph U Correll
- Charité Universitätsmedizin, Berlin, Germany; The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York; and the German Center for Mental Health (DZPG), partner site Berlin, Germany
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
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Shimada T, Morimoto T, Nagayama H, Nakamura N, Aisu K, Kito A, Kojima R, Yamanushi A, Kawano K, Hikita N, Yotsumoto K, Ebisu T, Kawamura M, Inoue T, Orui J, Asakura T, Akazawa M, Kobayashi M. Effect of individualized occupational therapy on cognition among patients with schizophrenia: A randomized controlled trial. Schizophr Res 2024; 269:18-27. [PMID: 38718691 DOI: 10.1016/j.schres.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/30/2024] [Accepted: 04/22/2024] [Indexed: 06/17/2024]
Abstract
This study aimed to evaluate the feasibility and efficacy of individualized occupational therapy (IOT) plus group occupational therapy (GOT) as standard care for cognition compared to GOT alone, and to determine which IOT component has the greatest effect on cognitive outcome in patients with schizophrenia. This study was conducted at 14 clinical sites across Japan and enrolled recently hospitalized patients with schizophrenia. The IOT consisted of motivational interview, self-monitoring, individualized visits, craft activities, individualized psychoeducation, and discharge planning. Among the 68 patients who were randomized to the GOT + IOT group (n = 34) and GOT alone group (n = 34), 67 completed the trial (GOT + IOT group, n = 34; GOT alone group, n = 33). There were significant improvements in change from baseline to post-treatment between the groups in verbal memory, working memory, verbal fluency, attention, executive function domains, and the composite score of the Brief Assessment of Cognition in Schizophrenia (BACS). The BACS composite score was significantly associated with the number of craft activity sessions. The addition of IOT to GOT has a favorable feasibility profile and efficacy for cognition in schizophrenia. Craft activity is the most effective IOT component in improving cognition.
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Affiliation(s)
- Takeshi Shimada
- Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan.
| | - Takafumi Morimoto
- Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan
| | - Naoko Nakamura
- Specified Medical Corporation, Hayashishita Hospital, Sapporo, Japan
| | - Kaori Aisu
- Kinan Mental Medical Center, Wakayama, Japan
| | - Aki Kito
- Sakakibara Hospital, National Hospital Organization, Mie, Japan
| | - Ryo Kojima
- Medical Corporation Okakai, Okakai Clinic Day-care Center, Kyoto, Japan
| | - Ayumi Yamanushi
- Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
| | - Kojiro Kawano
- Medical Corporation Yuaikai, Tikumaso Mental Hospital, Nagano, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan
| | - Noriaki Hikita
- Iwamizawa Municipal General Hospital, Iwamizawa, Japan; Scientific Department, Japanese Association of Occupational Therapists, Tokyo, Japan
| | - Kayano Yotsumoto
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Tomoe Ebisu
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Masashi Kawamura
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takao Inoue
- Kinan Mental Medical Center, Wakayama, Japan; Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan; Medical Corporation Kawasakikai, Mizuma Hospital, Osaka, Japan
| | - Junya Orui
- Osaka Health Science University, Osaka, Japan; Social Medical Corporation Mikamikai, Higashikouri Hospital, Osaka, Japan; Social Medical Corporation Mikamikai, Higashikouri Second Hospital, Osaka, Japan
| | - Tatsumi Asakura
- Specified Medical Corporation Kyowakai, Kyowa Hospital, Aichi, Japan
| | | | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
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Poppe A, Tiles-Sar N, Konings SRA, Habtewold TD, Bruggeman R, Alizadeh BZ, van der Meer L. Moving from supported to independent living: what are the barriers and facilitators for individuals with psychosis? Soc Psychiatry Psychiatr Epidemiol 2024; 59:1243-1254. [PMID: 38189942 DOI: 10.1007/s00127-023-02586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Living independently, as opposed to in sheltered housing or with caregivers, is an important aim in the recovery of individuals with psychosis, but the transition to independence can be challenging. This study aims to investigate how individuals with psychosis move between living arrangements and to identify the barriers and facilitators of moving towards independence. METHODS The living arrangements of 1119 individuals with non-affective psychosis from the Genetic Risk and Outcome of Psychosis study were assessed at baseline, at three- and six-year follow-ups and further categorized as either supported (sheltered housing or with parents) or independent (single or with partner/family). We estimated the probabilities of transitioning between the living statuses and investigated the influence of demographic characteristics, symptomatology, cognition, social support, and premorbid social adjustment on transition using Markov chain modelling. RESULTS The majority of individuals living in supported housing remained there during the six-year follow-up period (~ 60%). The likelihood of moving from supported to independent living was twice as high for participants who were younger, five-to-six times higher for women, twice as high for individuals with better overall cognition, and five times higher for those with a course of low positive symptoms. CONCLUSION This study highlights that a large group of individuals with psychosis in supported housing is unlikely to move to independent living. Older men with cognitive impairments and who show continuous severe positive symptoms are the least likely to move living independently. Tailored interventions for these at-risk individuals could increase their chances of moving to independent living.
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Affiliation(s)
- Anika Poppe
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands.
| | - Natalia Tiles-Sar
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Stefan R A Konings
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
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Chen CS, Vinogradov S. Personalized Cognitive Health in Psychiatry: Current State and the Promise of Computational Methods. Schizophr Bull 2024:sbae108. [PMID: 38934792 DOI: 10.1093/schbul/sbae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND Decades of research have firmly established that cognitive health and cognitive treatment services are a key need for people living with psychosis. However, many current clinical programs do not address this need, despite the essential role that an individual's cognitive and social cognitive capacities play in determining their real-world functioning. Preliminary practice-based research in the Early Psychosis Intervention Network early psychosis intervention network shows that it is possible to develop and implement tools that delineate an individuals' cognitive health profile and that help engage the client and the clinician in shared decision-making and treatment planning that includes cognitive treatments. These findings signify a promising shift toward personalized cognitive health. STUDY DESIGN Extending upon this early progress, we review the concept of interindividual variability in cognitive domains/processes in psychosis as the basis for offering personalized treatment plans. We present evidence from studies that have used traditional neuropsychological measures as well as findings from emerging computational studies that leverage trial-by-trial behavior data to illuminate the different latent strategies that individuals employ. STUDY RESULT We posit that these computational techniques, when combined with traditional cognitive assessments, can enrich our understanding of individual differences in treatment needs, which in turn can guide evermore personalized interventions. CONCLUSION As we find clinically relevant ways to decompose maladaptive behaviors into separate latent cognitive elements captured by model parameters, the ultimate goal is to develop and implement approaches that empower clients and their clinical providers to leverage individual's existing learning capacities to improve their cognitive health and well-being.
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Affiliation(s)
- Cathy S Chen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sophia Vinogradov
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
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Correll CU, Arango C, Fagiolini A, Giordano GM, Leucht S, Salazar de Pablo G. Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline. Neuropsychiatr Dis Treat 2024; 20:1293-1307. [PMID: 38911102 PMCID: PMC11194005 DOI: 10.2147/ndt.s459450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Schizophrenia is most times a chronic and often debilitating illness associated with poor mental health outcomes. Early and effective treatment of schizophrenia in the most appropriate setting can make a significant difference in the long-term recovery. The aim of this narrative review was to provide suggestions and recommendations for effectively managing patients with schizophrenia during acute exacerbations and to enhance awareness and skills related to personalized medicine. Methods A panel of academics and clinicians with experience in the field of psychosis met virtually on July 13th 2023 to narratively review and discuss the research evidence and their clinical experience about the most appropriate acute treatments for patients with schizophrenia. This manuscript represents a synthesis of the panel analysis and discussion. Results First contact is very important for service users, as is finding the most adequate treatment setting. If patients present to the emergency department, which may be a traumatic setting for service users, a dedicated environment with adequate space and specialized mental health support, including personnel trained in de-escalation techniques, is recommended. A well-connected continuum of care is strongly recommended, possibly with seamless links between inpatient units, day hospital services, outpatient facilities and rehabilitation services. Ideally, this should be structured as part of a coordinated step-down service line. Treatment challenges include suboptimal response, side effects, and nonadherence, which is reduced by the use of long-acting injectable antipsychotics. Conclusion Individual circumstances, including age, gender, and presence of hostility/aggression or self-harm, cognitive impairment and negative symptoms, comorbidities (depression, substance use disorders) or associated symptoms (anxiety, insomnia), should be considered when selecting the most appropriate treatment for the acute phase of schizophrenia. Efficacy and feasibility, as well as acceptability and tolerability of treatments, require joint consideration from the early stages of schizophrenia, thereby enhancing the possibility of improved short- and long-term outcomes.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | | | - Stefan Leucht
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
- Child and Adolescent Mental Health Services (CAMHS) South London and Maudsley NHS Foundation Trust London, London, UK
- Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
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Nibbio G, Pinton IC, Barlati S, Stanga V, Bertoni L, Necchini N, Zardini D, Lisoni J, Deste G, Vita A. Predictors of psychosocial functioning in people diagnosed with schizophrenia spectrum disorders that committed violent offences and in those that did not: Results of the Recoviwel study. Schizophr Res 2024; 270:112-120. [PMID: 38896937 DOI: 10.1016/j.schres.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 04/07/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
Psychosocial functioning represents a core treatment target of Schizophrenia Spectrum Disorders (SSD), and several clinical and cognitive factors contribute to its impairment. However, determinants of psychosocial functioning in people living with SSD that committed violent offences remain to be more thoroughly explored. This study aims to separately assess and compare predictors of psychosocial functioning in people with SSD that did and that did not commit violent offences considering several clinical, cognitive and violence-related parameters. Fifty inmates convicted for violent crimes in a forensic psychiatry setting diagnosed with SSD (OP group) and fifty participants matched for age, gender, education, and diagnosis (Non-OP group) were included in the study. A higher risk of violent relapse as measured by HCR-20 clinical subscale scores (p < 0.002) and greater global clinical severity as measured by CGI-S scores (p = 0.023) emerged as individual predictors of worse psychosocial functioning, as measured by PSP scores, in the OP group. Greater global clinical severity (p < 0.001), worse performance in the processing speed domain as measured by the BACS Symbol Coding (p = 0.002) and TMT-A tests (p = 0.016) and higher levels of non-planning impulsivity as measured by BIS-11 scores (p < 0.001) emerged as individual predictors of worse psychosocial functioning in the Non-OP group. These results confirm that clinical severity impacts psychosocial functioning in all individuals diagnosed with SSD and suggest that while cognitive impairment clearly represents a determinant of worse functional outcomes in most patients, the risk of violent relapse is a specific predictor of worse psychosocial functioning in people with SSD that committed criminal offences.
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Affiliation(s)
- Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Valentina Stanga
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Zardini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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10
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Richa S, Choueifati D, Chemali N, Amado I. [Ethical stakes of psychosocial rehabilitation]. L'ENCEPHALE 2024; 50:348-350. [PMID: 38423859 DOI: 10.1016/j.encep.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/14/2023] [Indexed: 03/02/2024]
Abstract
Psychosocial rehabilitation (PSR) is a therapeutic approach which aims to improve the overall functioning of people with severe mental disorders. We detail the principles of bioethics applied to care and seek to demonstrate how PSR meets the requirements of a humanistic psychiatry. The four fundamental principles of the ethics of care - autonomy, beneficence, non-maleficence and justice - are found in the practice of PSR. The practice and implementation of PSR is strongly encouraged in universal codes of ethics.
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Affiliation(s)
- Sami Richa
- Faculté de médecine, université Saint-Joseph, B.P. 11-5076, rue de Damas, Beyrouth, Liban.
| | - Doris Choueifati
- Faculté des sciences infirmières, université Saint-Joseph, B.P. 11-5076, Beyrouth, Liban
| | - Nathalie Chemali
- Association francophone pour les malades mentaux (AFMM), B.P. 11-5076, Beyrouth, Liban
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11
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Kurtz MM. Cognitive Remediation in Schizophrenia Spectrum Illness: Evidence for Treatment Persistence. Am J Psychiatry 2024; 181:471-473. [PMID: 38822589 DOI: 10.1176/appi.ajp.20240281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Affiliation(s)
- Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, Conn
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Vita A, Barlati S, Ceraso A, Nibbio G, Durante F, Facchi M, Deste G, Wykes T. Durability of Effects of Cognitive Remediation on Cognition and Psychosocial Functioning in Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Am J Psychiatry 2024; 181:520-531. [PMID: 38476043 DOI: 10.1176/appi.ajp.20230396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Cognitive remediation provides substantial improvements in cognitive performance and real-world functioning for people living with schizophrenia, but the durability of these benefits needs to be reassessed and better defined. The aims of this study were to provide a comprehensive assessment of the durability of the benefits of cognitive remediation for cognition and functioning in people living with schizophrenia and evaluating potential moderators of effects. METHODS A systematic search was conducted in PubMed, Scopus, and PsycINFO, and reference lists of included articles and Google Scholar were inspected. Eligible studies were randomized clinical trials of cognitive remediation in patients diagnosed with schizophrenia spectrum disorders in which follow-up assessments were included. Screening and data extraction were performed by at least two independent reviewers. Cohen's d was used to measure outcomes. Primary outcomes were changes in cognition and functioning from baseline to conclusion of follow-up. Moderators of the durability of effects were assessed. RESULTS Of 2,840 identified reports, 281 full texts were assessed and 130 reports on 67 studies with 5,334 participants were included. Cognitive remediation produced statistically significant positive effects that persisted at the end of follow-up in global cognition (d=0.23) and in global functioning (d=0.26). Smaller study samples and single-center studies were associated with better cognitive outcomes; longer treatment and follow-up duration, techniques for transferring cognitive gains to the real world, integration with psychiatric rehabilitation, group format of delivery, and more female participants in the sample were associated with better functional outcomes. CONCLUSIONS Cognitive remediation provides durable improvements in cognition and functioning in schizophrenia. This finding corroborates the notion that cognitive remediation should be implemented more widely in clinical and rehabilitation practice.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
| | - Anna Ceraso
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
| | - Francesca Durante
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
| | - Michele Facchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
| | - Til Wykes
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes)
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Bogie BJ, Noël C, Gu F, Nadeau S, Shvetz C, Khan H, Rivard MC, Bouchard S, Lepage M, Guimond S. Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial. Schizophr Res Cogn 2024; 36:100305. [PMID: 38486790 PMCID: PMC10937232 DOI: 10.1016/j.scog.2024.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
Background Schizophrenia is associated with impairments in verbal episodic memory. Strategy for Semantic Association Memory (SESAME) training represents a promising cognitive remediation program to improve verbal episodic memory. Virtual reality (VR) may be a novel tool to increase the ecological validity and transfer of learned skills of traditional cognitive remediation programs. The present proof-of-concept study aimed to assess the feasibility, acceptability, and preliminary efficacy of a VR-based cognitive remediation module inspired by SESAME principles to improve the use of verbal episodic memory strategies in schizophrenia. Methods Thirty individuals with schizophrenia/schizoaffective disorder completed this study. Participants were randomized to either a VR-based verbal episodic memory training condition inspired by SESAME principles (intervention group) or an active control condition (control group). In the training condition, a coach taught semantic encoding strategies (active rehearsal and semantic clustering) to help participants remember restaurant orders in VR. In the active control condition, participants completed visuospatial puzzles in VR. Attrition rate, participant experience ratings, and cybersickness questionnaires were used to assess feasibility and acceptability. Trial 1 of the Hopkins Verbal Learning Test - Revised was administered pre- and post-intervention to assess preliminary efficacy. Results Feasibility was demonstrated by a low attrition rate (5.88 %), and acceptability was demonstrated by limited cybersickness and high levels of enjoyment. Although the increase in the number of semantic clusters used following the module did not reach conventional levels of statistical significance in the intervention group, it demonstrated a notable trend with a medium effect size (t = 1.48, p = 0.15, d = 0.54), in contrast to the control group where it remained stable (t = 0.36, p = 0.72, d = 0.13). These findings were similar for the semantic clustering ratio in the intervention (t = 1.61, p = 0.12, d = 0.59) and control (t = 0.36, p = 0.72, d = 0.13) groups. There was no significant change in the number of recalled words in either group following VR immersion. Discussion This VR intervention was feasible, acceptable, and may be useful for improving the use of semantic encoding strategies. These findings support the use of more ecological approaches for the treatment of cognitive impairments in schizophrenia, such as VR-based cognitive remediation.
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Affiliation(s)
- Bryce J.M. Bogie
- MD/PhD Program, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Chelsea Noël
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Feng Gu
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Sébastien Nadeau
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Cecelia Shvetz
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Hassan Khan
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Christine Rivard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche, Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Martin Lepage
- Douglas Research Centre, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Synthia Guimond
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
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14
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Espinosa V, Bagaeva A, López-Carrilero R, Barajas A, Barrigón ML, Birulés I, Frígola-Capell E, Díaz-Cutraro L, González-Higueras F, Grasa E, Gutiérrez-Zotes A, Lorente-Rovira E, Pélaez T, Pousa E, Ruiz-Delgado I, Verdaguer-Rodríguez M, Ochoa S. Neuropsychological profiles in first-episodes psychosis and their relationship with clinical, metacognition and social cognition variables. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01813-z. [PMID: 38806850 DOI: 10.1007/s00406-024-01813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/19/2024] [Indexed: 05/30/2024]
Abstract
An increasing interest in the assessment of neuropsychological performance variability in people with first-episode psychosis (FEP) has emerged. However, its association with clinical and functional outcomes requires further study. Furthermore, FEP neuropsychological subgroups have not been characterized by clinical insight or metacognition and social cognition domains. The aim of this exploratory study was to identify specific groups of patients with FEP based on neuropsychological variables and to compare their sociodemographic, clinical, metacognition and social cognition profiles. A sample of 149 FEP was recruited from adult mental health services. Neuropsychological performance was assessed by a neuropsychological battery (WAIS-III; TMT; WSCT; Stroop Test; TAVEC). The assessment also included sociodemographic characteristics, clinical, functional, metacognition and social cognition variables. Two distinct neuropsychological profiles emerged: one neuropsychological impaired cluster (N = 56) and one relatively intact cluster (N = 93). Significant differences were found between both profiles in terms of sociodemographic characteristics (age and level of education) (p = 0.001), clinical symptoms (negative, positive, disorganized, excitement and anxiety) (p = 0.041-0.001), clinical insight (p = 0.038-0.017), global functioning (p = 0.014), as well as in social cognition domains (emotional processing and theory of mind) (p = 0.001; p = 0.002). No significant differences were found in metacognitive variables (cognitive insight and 'jumping to conclusions' bias). Relationship between neurocognitive impairment, social cognition and metacognition deficits are discussed. Early identifying of neuropsychological profiles in FEP, characterized by significant differences in clinical and social cognition variables, could provide insight into the prognosis and guide the implementation of tailored early-intervention.
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Affiliation(s)
- Victoria Espinosa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
| | - Alana Bagaeva
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de la Salut. Serra Húnter Programme, Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain
| | - María Luisa Barrigón
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Departament of Psychiatry, University Hospital Virgen del Rocio, Sevilla, Spain
- Psychiatry Service, Area de Gestión Sanitaria Sur Granada, Motril, Granada, Spain
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Facultat de Psicologia Departament de Cognició, Desenvolupament i Psicologia de l'Educació, Universitat de Barcelona, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Eva Frígola-Capell
- Mental Health and Addiction Research Group, Fundació Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
- Institut d'Assistencia Sanitària, Girona, Spain
| | - Luciana Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | | | - Eva Grasa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira I Virgili, Reus, Spain
| | - Ester Lorente-Rovira
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Psychiatry Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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15
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Wykes T, Bowie CR, Cella M. Thinking About the Future of Cognitive Remediation Therapy Revisited: What Is Left to Solve Before Patients Have Access? Schizophr Bull 2024:sbae075. [PMID: 38780191 DOI: 10.1093/schbul/sbae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
In our previous paper on the Future of Cognitive Remediation published more than 10 years ago, we envisaged an imminent and wide implementation of cognitive remediation therapies into mental health services. This optimism was misplaced. Despite evidence of the benefits, costs, and savings of this intervention, access is still sparse. The therapy has made its way into some treatment guidance, but these documents weight the same evidence very differently, causing confusion, and do not consider barriers to implementation. This paper revisits our previous agenda and describes how some challenges were overcome but some remain. The scientific community, with its commitment to Open Science, has produced promising sets of empirical data to explore the mechanisms of treatment action. This same community needs to understand the specific and nonspecific effects of cognitive remediation if we are to provide a formulation-based approach that can be widely implemented. In the last 10 years we have learned that cognitive remediation is not "brain training" but is a holistic therapy that involves an active therapist providing motivation support, and who helps to mitigate the impact of cognitive difficulties through metacognition to develop awareness of cognitive approaches to problems. We conclude that, of course, more research is needed but, in addition and perhaps more importantly at this stage, we need more public and health professionals' understanding of the benefits of this therapy to inform and include this approach as part of treatment regimens.
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Affiliation(s)
- Til Wykes
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Matteo Cella
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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16
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Jones R, Malouf P, Talbot D, Elhindi J, Baker R, Harris A. Examining the impact of a group treatment using cognitive and social cognition remediation for young offenders: The justice health NSW school-link advantage pilot study. Early Interv Psychiatry 2024. [PMID: 38764141 DOI: 10.1111/eip.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024]
Abstract
AIM Young offenders experience higher rates of neurodevelopmental and mental health disorders than the general population, and significant access barriers to health treatment. Treatment combining Cognitive Remediation Therapy (CRT) and Social Cognition Remediation Therapy (SCRT) has demonstrated benefits for functional improvements and social development. However, there is limited information regarding group treatment programs in custodial settings for young offenders. This pilot study explores the effectiveness and feasibility of a group treatment program for youth offenders with cognitive deficits and mental health concerns in youth detention. METHODS The School-Link Advantage pilot study designed and tested a 10-week group treatment program combining CRT and SCRT for young offenders in custody. The closed groups incorporated interactive activities focussed on emotional recognition and regulation skills, optimizing executive functioning, understanding values, exploring belief systems, improving relationships, and safety planning. RESULTS Of the 22 male participants recruited in an Australian Youth Justice Centre, 12 completed all aspects of the treatment program, reflecting a 54.5% completion rate in a typically challenging to engage population cohort. Results demonstrated significant improvements in the ability to store and retrieve information, recognize information, and control emotions. Planning and organizing skills also showed considerable development. CONCLUSIONS This pilot study suggests that a combined CRT and SCRT group treatment program has the potential to effectively target cognitive challenges associated with mental health disorders in young offenders in custody. These promising outcomes suggest exploring randomized controlled trials with increased cultural sensitivity for diverse populations.
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Affiliation(s)
- Rene Jones
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Justice Health Forensic Mental Health Network, Sydney, New South Wales, Australia
| | - Peter Malouf
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Talbot
- Department of Psychiatry, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Richard Baker
- Justice Health Forensic Mental Health Network, Sydney, New South Wales, Australia
- Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Harris
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Department of Psychiatry, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Depatment of Psychiatry, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
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Dark FL, Amado I, Erlich MD, Ikezawa S. International Experience of Implementing Cognitive Remediation for People With Psychotic Disorders. Schizophr Bull 2024:sbae071. [PMID: 38758086 DOI: 10.1093/schbul/sbae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Cognitive remediation (CR) is an effective therapy for the cognitive impact of mental illness, especially schizophrenia. Global efforts are being made to implement CR into routine mental health services with the aim of improving functional outcomes for the population of people recovering from mental illness. Implementation and dissemination of CR in heterogeneous settings require knowledge gleaned from formal implementation research and pragmatic experiential learning. This article describes cross-cultural approaches to CR implementation, focusing on initiatives in France, the United States, Australia, and Japan. METHOD Key leaders in the implementation of CR in France, the United States, Australia, and Japan were asked to describe the implementation and dissemination process in their settings with respect to the categories of context, implementation, outcomes, facilitators, and barriers. RESULTS All 4 sites noted the role of collaboration to leverage the implementation of CR into mental health rehabilitation services. In France, high-level, government organizational backing enhanced the dissemination of CR. Academic and clinical service partnerships in the United States facilitated the dissemination of programs. The advocacy from service users, families, and carers can aid implementation. The support from international experts in the field can assist in initiating programs but maintenance and dissemination require ongoing training and supervision of staff. CONCLUSIONS CR is an effective intervention for the cognitive impact of schizophrenia. Programs can be implemented in diverse settings globally. Adaptations of CR centering upon the core components of effective CR therapy enhance outcomes and enable programs to integrate into diverse settings.
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Affiliation(s)
- Frances L Dark
- The University of Queensland Medical School, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Isabelle Amado
- Ressource Centre in Ile de France for Cognitive Remediation and Psychosocial Rehabilitation (C3RP), GHU Paris Psychiatry Neurosciences, Paris, France
- Department for Cognitive Remediation and Rehabilitation, Paris Cité University
| | - Matthew D Erlich
- New York State Office of Mental Health, New York, NY, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Satoru Ikezawa
- Department of Psychiatry, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Psychiatry, National Centre of Neurology and Psychiatry, Tokyo, Japan
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Hirsch F, Bumanglag Â, Zhang Y, Wohlschlaeger A. Diverging functional connectivity timescales: Capturing distinct aspects of cognitive performance in early psychosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.07.24306932. [PMID: 38766002 PMCID: PMC11100938 DOI: 10.1101/2024.05.07.24306932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Psychosis spectrum disorders (PSDs) are marked by cognitive impairments, the neurobiological correlates of which remain poorly understood. Here, we investigate the entropy of time-varying functional connectivity (TVFC) patterns from resting-state fMRI (rfMRI) as potential biomarker for cognitive performance in PSDs. By combining our results with multimodal reference data, we hope to generate new insights into the mechanisms underlying cognitive dysfunction in PSDs. We hypothesized that low-entropy TVFC patterns (LEN) would be more behaviorally informative than high-entropy TVFC patterns (HEN), especially for tasks that require extensive integration across diverse cognitive subdomains. Methods rfMRI and behavioral data from 97 patients in the early phases of psychosis and 53 controls were analyzed. Positron-Emission Tomography (PET) and magnetoencephalography (MEG) data were taken from a public repository (Hansen et al., 2022). Multivariate analyses were conducted to examine relationships between TVFC patterns at multiple spatial scales and cognitive performance in patients. Results Compared to HEN, LEN explained significantly more cognitive variance on average in PSD patients, driven by superior encoding of information on psychometrically more integrated tasks. HEN better captured information in specific subdomains of executive functioning. Nodal HEN-LEN transitions were spatially aligned with neurobiological gradients reflecting monoaminergic transporter densities and MEG beta power. Exploratory analyses revealed a close statistical relationship between LEN and positive PSD symptoms. Conclusion Our entropy-based analysis of TVFC patterns dissociates distinct aspects of cognition in PSDs. By linking topographies of neurotransmission and oscillatory dynamics with cognitive performance, it enhances our understanding of the mechanisms underlying cognitive deficits in PSDs. CRediT Authorship Contribution Statement Fabian Hirsch: Conceptualization, Methodology, Software, Formal analysis, Writing - Original Draft, Writing - Review & Editing, Visualization; Ângelo Bumanglag: Methodology, Software, Formal analysis, Writing - Review & Editing; Yifei Zhang: Methodology, Software, Formal analysis, Writing - Review & Editing; Afra Wohlschlaeger: Methodology, Writing - Review & Editing, Supervision, Project administration.
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Cella M, Parri L, Wang K, Quinn R, Oyeleye O, Jin H, Wykes T. Evaluating remote delivery of cognitive remediation in people with psychosis. Schizophr Res 2024; 267:367-372. [PMID: 38631111 DOI: 10.1016/j.schres.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Cognitive Remediation (CR) is an evidence-based therapy targeting cognitive difficulties in people with psychosis to promote functional recovery, but it is rarely implemented routinely. To reach more individuals, CR is beginning to be delivered remotely, but there is limited evidence to support the acceptability of this method. AIMS To evaluate the acceptability and feasibility of remote therapist-supported CR in people with psychosis and estimate its cost and potential benefits. METHODS A case-series with all participants assessed before and after therapy with measures of personal goal attainment (main outcome), cognition, functioning and symptoms. Acceptability was assessed with post-therapy interviews. Feasibility was assessed using proportions and confidence intervals on pre-specified parameters. Indication of benefits was assessed with exploratory analyses comparing baseline and post-therapy scores on the pre-specified outcomes. The cost of providing remote CR was assessed from both healthcare and societal perspectives. RESULTS Twenty-nine participants started therapy with two dropping out; on average participants attended 25.5 sessions. Interviews suggested that remote CR had good acceptability and led to perceived benefits. Significant and large improvements were observed on goal attainment. Cost analyses suggest that remote CR has the same health care cost as face-to-face therapy but a lower societal cost. CONCLUSIONS Our results support the use of remote CR in psychosis services as an alternative delivery modality. This method may improve adherence, attendance and be more convenient for service users. Possible barriers such as poor digital literacy or appropriate device ownership should be addressed before starting therapy.
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Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and the Maudsley NHS Trust, UK.
| | - Lois Parri
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kang Wang
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | | | - Huajie Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and the Maudsley NHS Trust, UK
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20
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Penadés R, Almodóvar-Payá C, García-Rizo C, Ruíz V, Catalán R, Valero S, Wykes T, Fatjó-Vilas M, Arias B. Changes in BDNF methylation patterns after cognitive remediation therapy in schizophrenia: A randomized and controlled trial. J Psychiatr Res 2024; 173:166-174. [PMID: 38537483 DOI: 10.1016/j.jpsychires.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
Although cognitive remediation therapy (CRT) produces cognitive benefits in schizophrenia, we do not yet understand whether molecular changes are associated with this cognitive improvement. A gene central to synaptic plasticity, the BDNF, has been proposed as one potential route. This study assesses whether BDNF methylation changes following CRT-produced cognitive improvement are detected. A randomized and controlled trial was performed with two groups (CRT, n = 40; TAU: Treatment as Usual, n = 20) on a sample of participants with schizophrenia. CRT was delivered by trained therapists using a web-based computerized program. Mixed Models, where the interaction of treatment (CRT, TAU) by time (T0: 0 weeks, T1: 16 weeks) was the main effect were used. Then, we tested the association between the treatment and methylation changes in three CpG islands of the BDNF gene. CRT group showed significant improvements in some cognitive domains. Between-groups differential changes in 5 CpG units over time were found, 4 in island 1 (CpG1.2, CpG1.7, CpG1.10, CpG1.17) and 1 in island 3 (CpG3.2). CRT group showed increases in methylation in CpG1.2, CpG1.7 and decreases in pG1.10, CpG1.17, and CpG3.2. Differences in the degree of methylation were associated with changes in Speed of Processing, Working Memory, and Verbal Learning within the CRT group. Those findings provide new data on the relationship between cognitive improvement and changes in peripheral methylation levels of BDNF gene, a key factor involved in neuroplasticity regulation. Trial Registration: NCT04278027.
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Affiliation(s)
- Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain; Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Carmen Almodóvar-Payá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain; Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Victoria Ruíz
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Rosa Catalán
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain; Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Sergi Valero
- ACE Alzheimer Center Barcelona, Barcelona, Spain; Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London & Maudsley NHS Foundation Trust, London Hospital, London, United Kingdom
| | - Mar Fatjó-Vilas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Bárbara Arias
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
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21
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Kotov R, Carpenter WT, Cicero DC, Correll CU, Martin EA, Young JW, Zald DH, Jonas KG. Psychosis superspectrum II: neurobiology, treatment, and implications. Mol Psychiatry 2024; 29:1293-1309. [PMID: 38351173 DOI: 10.1038/s41380-024-02410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Alternatives to traditional categorical diagnoses have been proposed to improve the validity and utility of psychiatric nosology. This paper continues the companion review of an alternative model, the psychosis superspectrum of the Hierarchical Taxonomy of Psychopathology (HiTOP). The superspectrum model aims to describe psychosis-related psychopathology according to data on distributions and associations among signs and symptoms. The superspectrum includes psychoticism and detachment spectra as well as narrow subdimensions within them. Auxiliary domains of cognitive deficit and functional impairment complete the psychopathology profile. The current paper reviews evidence on this model from neurobiology, treatment response, clinical utility, and measure development. Neurobiology research suggests that psychopathology included in the superspectrum shows similar patterns of neural alterations. Treatment response often mirrors the hierarchy of the superspectrum with some treatments being efficacious for psychoticism, others for detachment, and others for a specific subdimension. Compared to traditional diagnostic systems, the quantitative nosology shows an approximately 2-fold increase in reliability, explanatory power, and prognostic accuracy. Clinicians consistently report that the quantitative nosology has more utility than traditional diagnoses, but studies of patients with frank psychosis are currently lacking. Validated measures are available to implement the superspectrum model in practice. The dimensional conceptualization of psychosis-related psychopathology has implications for research, clinical practice, and public health programs. For example, it encourages use of the cohort study design (rather than case-control), transdiagnostic treatment strategies, and selective prevention based on subclinical symptoms. These approaches are already used in the field, and the superspectrum provides further impetus and guidance for their implementation. Existing knowledge on this model is substantial, but significant gaps remain. We identify outstanding questions and propose testable hypotheses to guide further research. Overall, we predict that the more informative, reliable, and valid characterization of psychopathology offered by the superspectrum model will facilitate progress in research and clinical care.
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Affiliation(s)
- Roman Kotov
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA.
| | | | - David C Cicero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - David H Zald
- Rutgers University, The State University of New Jersey, New Brunswick, NJ, USA
| | - Katherine G Jonas
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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22
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Correll CU, Arango C, Fagerlund B, Galderisi S, Kas MJ, Leucht S. Identification and treatment of individuals with childhood-onset and early-onset schizophrenia. Eur Neuropsychopharmacol 2024; 82:57-71. [PMID: 38492329 DOI: 10.1016/j.euroneuro.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
Approximately 8 % of patients with schizophrenia are diagnosed before age 18, and 18 % experience their first symptoms before age 18. This narrative review explores the management of patients with early-onset schizophrenia (EOS) and childhood-onset schizophrenia (COS) from diagnosis to their transition to adult care settings. Early diagnosis of schizophrenia in children and adolescents is essential for improving outcomes, but delays are common due to overlapping of symptoms with developmental phenomena and other psychiatric conditions, including substance use, and lack of clinicians' awareness. Once diagnosed, antipsychotic treatment is key, with specific second-generation agents generally being preferred due to better tolerability and their broader efficacy evidence-base in youth. Dosing should be carefully individualized, considering age-related differences in drug metabolism and side effect liability. Clinicians must be vigilant in detecting early non-response and consider switching or dose escalation when appropriate. Since early age of illness onset is a consistent risk factor for treatment-resistant schizophrenia (TRS), clinicians need to be competent in diagnosing TRS and using clozapine. Since COS and EOS are associated with cognitive deficits and impaired functioning, psychosocial interventions should be considered to improve overall functioning and quality of life. Good long-term outcomes depend on continuous treatment engagement, and successful transitioning from pediatric to adult care requires careful planning, early preparation, and collaboration between pediatric and adult clinicians. Targeting functional outcomes and quality of life in addition to symptom remission can improve overall patient well-being. Comprehensive evaluations, age-specific assessments, and targeted interventions are needed to address the unique challenges of EOS and COS.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Birgitte Fagerlund
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences (GELIFES), Neurobiology, University of Groningen, the Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Germany; Department of Psychiatry, Department of Psychosis Studies, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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23
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Timko CA, Schnabel J, Orloff NC. The importance of improving cognitive flexibility in adolescents with anorexia nervosa: The case for cognitive remediation therapy. Int J Eat Disord 2024; 57:1109-1118. [PMID: 38333943 DOI: 10.1002/eat.24164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style, are frequently observed in individuals with Anorexia Nervosa (AN) and have been identified as potential targets in treatment. Cognitive Remediation Therapy (CRT) is an adjunctive treatment approach specifically designed to have a positive impact on EF. Mainly evaluated in adults, CRT has been criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms. METHOD We argue that we need to refocus our conceptual framework for using CRT as an adjunctive treatment and specifically explore its potential benefit in adolescents. RESULTS Adolescence is a critical window for EF development during which CRT has the potential to have the most impact. While it may not specifically ameliorate eating disorder symptoms and directly improve weight gain, CRT may mitigate the impact of malnutrition on adolescent brain development, reduce attrition rates in treatment, and improve cognitive flexibility and (indirectly) other maintaining factors, thereby improving global functioning. DISCUSSION More research needs to be done to understand the development of EF in adolescents with AN and how best to employ CRT as an adjunctive treatment to support development and target maintaining factors. The current article broadly reviews findings on executive functioning inefficiencies in adolescents with AN and discusses the purpose and role of CRT in treating AN. Finally, we highlight key critiques of using CRT and pose questions for future research. PUBLIC SIGNIFICANCE Treatments targeting executive functioning in adolescents with AN are limited. We need to better understand how CRT can benefit adolescents in treatment. Increasing treatment options, including adjunctive treatments, is necessary to reduce the long-term impact of AN.
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Affiliation(s)
- C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jiana Schnabel
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania, USA
| | - Natalia C Orloff
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Equip Health, Carlsbad, California, USA
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24
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Barlati S, Nibbio G, Vita A. Evidence-based psychosocial interventions in schizophrenia: a critical review. Curr Opin Psychiatry 2024; 37:131-139. [PMID: 38410981 PMCID: PMC10990032 DOI: 10.1097/yco.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW Schizophrenia Spectrum Disorders (SSD) are severe conditions that frequently produce significant impairment in cognitive performance, social skills and psychosocial functioning. As pharmacological treatment alone often provides only limited improvements on these outcomes, several psychosocial interventions are employed in psychiatric rehabilitation practice to improve of real-world outcomes of people living with SSD: the present review aims to provide a critical overview of these treatments, focusing on those that show consistent evidence of effectiveness. RECENT FINDINGS Several recent systematic reviews and meta-analyses have investigated in detail the acceptability, the effectiveness on several specific outcomes and moderators of response of different psychosocial interventions, and several individual studies have provided novel insight on their implementation and combination in rehabilitation practice. SUMMARY Cognitive remediation, metacognitive training, social skills training, psychoeducation, family interventions, cognitive behavioral therapy, physical exercise and lifestyle interventions, supported employment and some other interventions can be fully considered as evidence-based treatments in SSD. Psychosocial interventions could be of particular usefulness in the context of early intervention services. Future research should focus on developing newer interventions, on better understanding the barriers and the facilitators of their implementation in clinical practice, and exploring the opportunities provided by novel technologies.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Zhang S, Ouyang X, Yang K, Shen Y, Zheng S, Wang R, Sheng X, Ge M, Yang M, Zhou X. An Exploration of Depression and Aggression Among Patients with Schizophrenia in China Rural Community. Psychol Res Behav Manag 2024; 17:1717-1726. [PMID: 38660458 PMCID: PMC11041961 DOI: 10.2147/prbm.s453891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose In schizophrenia, aggressive conduct is frequent. And depressed mood can also contribute to the occurrence of aggressive behaviors. The aim of this study was to investigate the risk factors for the occurrence of aggression in stable schizophrenia patients in rural China, mainly to investigate the role of depressed mood in the occurrence of aggression in schizophrenia patients. Patients and Methods This is a cross-sectional study conducted in the townships surrounding Chaohu City, Anhui Province, China. Patients' depressive mood was evaluated using the PHQ-9 (The 9-item Patient Health Questionnaire). Patients' aggressiveness was evaluated using the Modified Overt Aggression Scale (MOAS). A score of ≥4 was used as a threshold and divided into aggressive and non-aggressive groups. Results This study comprised a total of 821 schizophrenia patients. Among them, the prevalence of having aggressive behavior was 18.8%. After correcting for confounders, logistic regression analysis showed that low education level (OR=0.470, 95% CI 0.254-0.870; p=0.016), living with family (OR=0.383, 95% CI 0.174-0.845; p=0.017) depressed mood (OR=1.147, 95% CI 1.112-1.184; p<0.001) was significantly associated with the risk of aggressive behavior in patients with schizophrenia. Multivariate linear regression indicated that higher levels of aggression were linked with lower levels of education and higher depressive mood. Conclusion This study suggests that aggression is more common in patients with stable schizophrenia, and lower levels of education and higher levels of depression are associated risk factors for its occurrence. Living alone may be helpful in reducing the likelihood of aggression.
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Affiliation(s)
- Shaofei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xu Ouyang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Kefei Yang
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Yunyun Shen
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Siyuan Zheng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Ruoqi Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xuanlian Sheng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Menglin Ge
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Meng Yang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xiaoqin Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
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Zhu J, Li J, Zhou L, Xu L, Pu C, Huang B, Zhou Q, Lin Y, Tang Y, Yang L, Shi C. Eye movements as predictor of cognitive improvement after cognitive remediation therapy in patients with schizophrenia. Front Psychiatry 2024; 15:1395198. [PMID: 38690204 PMCID: PMC11059054 DOI: 10.3389/fpsyt.2024.1395198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
Aim Baseline cognitive functions of patients predicted the efficacy of cognitive remediation therapy (CRT), but results are mixed. Eye movement is a more objective and advanced assessment of cognitive functions than neuropsychological testing. We aimed to investigate the applicability of eye movements in predicting cognitive improvement after patients with schizophrenia were treated with CRT. Methods We recruited 79 patients with schizophrenia to complete 8 weeks of CRT and assessed their cognitive improvement outcomes. Eye movements were assessed by prosaccades, antisaccades, and free-viewing tasks at baseline, and neuropsychological tests in four cognitive domains were assessed before and after treatment to calculate treatment outcomes. Predictors of demographic information, clinical characteristics, and eye movement measures at baseline on cognitive improvement outcomes were analyzed using logistic regression analysis. We further compared the predictive performance between eye movement measurements and neuropsychological test regarding the effect of CRT on cognitive improvement, and explored factors that could be affect the treatment outcomes in different cognitive domains. Results As operationally defined, 33 patients showed improved in cognition (improved group) and 46 patients did not (non-improved group) after CRT. Patients with schizophrenia being employed, lower directional error rate in antisaccade task, and lower the gap effect (i.e., the difference in saccadic latency between the gap condition and overlap condition) in prosaccade task at baseline predicted cognitive improvement in CRT. However, performance in the free-viewing task not associated with cognitive improvement in patients in CRT. Our results show that eye-movement prediction model predicted the effect of CRT on cognitive improvement in patients with schizophrenia better than neuropsychological prediction model in CRT. In addition, baseline eye-movements, cognitive reserve, antipsychotic medication dose, anticholinergic cognitive burden change, and number of training sessions were associated with improvements in four cognitive domains. Conclusion Eye movements as a non-invasiveness, objective, and sensitive method of evaluating cognitive function, and combined saccadic measurements in pro- and anti-saccades tasks could be more beneficial than free-viewing task in predicting the effect of CRT on cognitive improvement in patients with schizophrenia.
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Affiliation(s)
- Jiahui Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Jinhao Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Li Zhou
- Faculty of Education, East China Normal University, Shanghai, China
| | - Lingzi Xu
- Research and Development Department, Infinite Brain Technologies, Beijing, China
| | - Chengcheng Pu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Bingjie Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Qi Zhou
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yunhan Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Yajing Tang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Liu Yang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, China
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Buchwald K, Narayanan A, Siegert RJ, Vignes M, Arrowsmith K, Sandham M. Centrality statistics of symptom networks of schizophrenia: a systematic review. Psychol Med 2024; 54:1061-1073. [PMID: 38174555 DOI: 10.1017/s003329172300363x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The network theory of psychological disorders posits that systems of symptoms cause, or are associated with, the expression of other symptoms. Substantial literature on symptom networks has been published to date, although no systematic review has been conducted exclusively on symptom networks of schizophrenia, schizoaffective disorder, and schizophreniform (people diagnosed with schizophrenia; PDS). This study aims to compare statistics of the symptom network publications on PDS in the last 21 years and identify congruences and discrepancies in the literature. More specifically, we will focus on centrality statistics. Thirty-two studies met the inclusion criteria. The results suggest that cognition, and social, and occupational functioning are central to the network of symptoms. Positive symptoms, particularly delusions were central among participants in many studies that did not include cognitive assessment. Nodes representing cognition were most central in those studies that did. Nodes representing negative symptoms were not as central as items measuring positive symptoms. Some studies that included measures of mood and affect found items or subscales measuring depression were central nodes in the networks. Cognition, and social, and occupational functioning appear to be core symptoms of schizophrenia as they are more central in the networks, compared to variables assessing positive symptoms. This seems consistent despite heterogeneity in the design of the studies.
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Affiliation(s)
- Khan Buchwald
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Ajit Narayanan
- Engineering, Computer, and Mathematical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Richard John Siegert
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Matthieu Vignes
- School of Mathematical and Computational Sciences, Massey University, Tennent Drive, Palmerston North, New Zealand
| | - Kim Arrowsmith
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
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Pepe M, Di Nicola M, Cocciolillo F, Chiappini S, Martinotti G, Calcagni ML, Sani G. 3-Methoxy-Phencyclidine Induced Psychotic Disorder: A Literature Review and an 18F-FDG PET/CT Case Report. Pharmaceuticals (Basel) 2024; 17:452. [PMID: 38675413 PMCID: PMC11053433 DOI: 10.3390/ph17040452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
New Psychoactive Substances (NPS) are modifying the drug scenario worldwide and have become a public health concern because of their toxicological profiles and their harmful physical/psychological effects. 3-Methoxy-Phencyclidine (3-MeO-PCP), a non-competitive antagonist of glutamate N-methyl-D-aspartate (NMDA) receptors, belongs to the phencyclidine-like subfamily of arylcyclohexylamines and has gained attention for its toxic, sometimes fatal, effects. Despite several cases of intoxication and death reported in the literature, little is known about substance-induced psychotic disorders (SIP) and potential cognitive impairment following 3-MeO-PCP intake. This literature review aimed to summarize available evidence about 3-MeO-PCP mechanisms of action and physical and psychotropic effects and to spread preliminary findings about persistent psychotic symptoms and impaired cognitive functioning. Additionally, the case of an SIP is reported in a 29-year-old man with small oral intakes of 3-MeO-PCP over two weeks until a high dose ingestion. Psychometric and neuropsychological assessment and brain [18F]-fluorodeoxyglucose positron emission tomography integrated with computed tomography were used to support clinical description. Identifying and addressing the characteristic clinical features and neural substrates of NPS-induced psychoses might help clinicians with a more precise differentiation from other psychotic disorders. Although further studies are required, phenotyping the cognitive profile of NPS users might provide targets for tailored therapeutic approaches.
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Affiliation(s)
- Maria Pepe
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Fabrizio Cocciolillo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy
- School of Medical Sciences, UniCamillus International University of Medical Sciences, Via di S. Alessandro 8, 00131 Rome, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Maria Lucia Calcagni
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
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Vita A, Barlati S, Porcellana M, Sala E, Lisoni J, Brogonzoli L, Percudani ME, Iardino R. The patient journey project in Italian mental health services: results from a co-designed survey on clinical interventions and current barriers to improve the care of people living with schizophrenia. Front Psychiatry 2024; 15:1382326. [PMID: 38606407 PMCID: PMC11007707 DOI: 10.3389/fpsyt.2024.1382326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction The Patient Journey Project aimed to analyze the scenario among Italian Mental Health Services (MHS) to understand the clinical interventions that are properly implemented and the ones deserving further implementation to design an effective treatment plan for patients living with schizophrenia (PLWS). Methods The 60-items survey was co-designed with all the stakeholders (clinicians, expert patients and caregivers) involved in the Patient Journey and focused on three phases of schizophrenia course: early detection and management, acute phase management, long-term management/continuity of care. Respondents were Heads of the Mental Health Departments and Addiction Services (MHDAS) or facilities directors throughout Italian MHS. For each statement, respondents expressed the consensus on the importance and the degree of implementation in clinical practice. Results Considering the importance of the statement, strong consensus was reached for most of the statements. Good levels of implementation were found on 2/17 statements of early detection and management, on 3/16 statements for acute phase management and on 1/27 statements of long-term management/continuity of care. Poor levels of implementation were found on 1/17 statements of early detection and management, none of acute phase management, and 4/27 statements for long-term management/continuity of care. Moderate levels of implementation were found on 14/17 statements for early detection and management, on 13/16 statements of acute phase management, and on 22/27 statements of long-term management/continuity of care. Thus, among Italian MHDAS, most interventions for PLWS were moderately implemented in clinical practice. Discussion Italian MHS have to provide new strategies and structural actions to overcome these current limitations and barriers to effectively improve the journey of PLWS. The areas that deserve most implementation include interventions during the early stage (especially the continuity of care between Child and Adolescent Mental Health Services and Adult Mental Health Services), the evidence-based psychosocial interventions during the chronic stages of the disorder, and the continuity of care after acute hospitalization.
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Affiliation(s)
- Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Porcellana
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Elisa Sala
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Gonzales L, Jones N. Service User Representation in Qualitative Research on Cognitive Health and Related Interventions for Psychosis: A Scoping Review. Schizophr Bull 2024:sbae035. [PMID: 38525590 DOI: 10.1093/schbul/sbae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive health in schizophrenia spectrum psychosis has received substantial empirical attention in recent decades, coinciding with the development and implementation of interventions including cognitive remediation. Subjective experience in psychosis, including qualitative explorations of service user perspectives, has also proliferated; however, there is no available synthesis of service user representation in the psychosis cognitive health literature. This scoping review investigated prevalence and characteristics of qualitative research reporting service user perspectives across the extant research on cognitive health and related interventions in psychosis. STUDY DESIGN We conducted a literature search on qualitative methods in cognitive health and/or related interventions across PubMed, Web of Science, and PsycInfo databases. The review followed the PRISMA-ScR guidelines for scoping reviews and identified 23 papers. Data extraction included study design and sample characteristics, qualitative methodology, and reporting. STUDY RESULTS Of 23 articles, 18 reported on user experiences of interventions, most often in the context of feasibility/acceptability for otherwise quantitative trials. Five studies described service user experiences of cognitive health separately from interventions. Only 3 included any service user involvement or participatory methods. Twenty articles reported any demographic characteristics, and fewer than half (11) reported any racial or ethnic sample characteristics. There was substantial variability in qualitative methodology and reporting across studies. CONCLUSIONS Qualitative methodology is lacking in its representation and rigor across the cognitive health literature for schizophrenia spectrum psychosis. Additional inclusion of service user lived experience is critical for future research to better characterize cognitive health and inform interventions to promote recovery.
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Affiliation(s)
- Lauren Gonzales
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian, New York, NY, USA
| | - Nev Jones
- Department of Psychiatry, School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
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Lisoni J, Nibbio G, Baldacci G, Zucchetti A, Cicale A, Zardini D, Miotto P, Deste G, Barlati S, Vita A. Improving depressive symptoms in patients with schizophrenia using bilateral bipolar-nonbalanced prefrontal tDCS: Results from a double-blind sham-controlled trial. J Affect Disord 2024; 349:165-175. [PMID: 38199388 DOI: 10.1016/j.jad.2024.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Treating depressive symptoms in patients with schizophrenia is challenging. While transcranical Dicrect Current Stimulation (tDCS) improved other core symptoms of schizophrenia, conflicting results have been obtained on depressive symptoms. Thus, we aimed to expand current evidence on tDCS efficacy to improve depressive symptoms in patients with schizophrenia. METHODS A double-blind RCT was performed with patients randomized to 2 mA active-tDCS or sham-tDCS (15 daily sessions) with a bilateral bipolar-nonbalanced prefrontal placement (anode: left Dorsolateral prefrontal cortex; cathode: right orbitofrontal region). Clinical outcomes included variations of Calgary Depression Scale for Schizophrenia total score (CDSS) and of Depression-hopelessness and Guilty idea of reference-pathological guilt factors. Analysis of covariance was performed evaluating between-group changes over time. The presence/absence of probable clinically significant depression was determined when CDSS > 6. RESULTS As 50 outpatients were included (both groups, n = 25), significant improvements following active-tDCS were observed for CDSS total score (p = 0.001), Depression-hopelessness (p = 0.001) and Guilty idea of reference-pathological guilt (p = 0.03). Considering patients with CDSS>6 (n = 23), compared to sham, active-tDCS significantly improved CDSS total score (p < 0.001), Depression-hopelessness (p = 0.001) but Guilty idea of reference-pathological guilt only marginally improved (p = 0.051). Considering response rates of clinically significant depression, important reductions of CDSS score were observed (78 % of the sample scored ≤6; active-tDCS, n = 23; sham-tDCS, n = 16; p = 0.017). Early wakening item did not significantly change in any group. LIMITATIONS The study lacks a follow-up period and evaluation of tDCS effects on psychosocial functioning. CONCLUSIONS Bilateral bipolar-nonbalanced prefrontal tDCS is a successful protocol for the treatment of depressive symptoms in patients with schizophrenia.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Daniela Zardini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Paola Miotto
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
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Øie MB, Haugen I, Stubberud J, Øie MG. Effects of Goal Management Training on self-efficacy, self-esteem, and quality of life for persons with schizophrenia spectrum disorders. Front Psychol 2024; 15:1320986. [PMID: 38515967 PMCID: PMC10955763 DOI: 10.3389/fpsyg.2024.1320986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Persons with schizophrenia often show executive dysfunction assessed with both subjective (self-report) and objective (neuropsychological tests) measures. In a recent randomized controlled trial (RCT), subjective executive functioning in everyday life was improved following Goal Management Training (GMT). The aim of the current study is to investigate the potential of GMT to improve secondary well-being outcomes from that RCT, including self-esteem, self-efficacy, and quality of life in persons with schizophrenia spectrum disorders. Since well-being is frequently lower in persons with schizophrenia compared to healthy individuals, further knowledge about well-being as an outcome after cognitive remediation may have implications for clinical treatment. Sixty-five participants were randomly assigned to GMT (n = 31) or a waiting list control condition (n = 34). Assessments were conducted at baseline (T1), immediately after the intervention (T2-5 weeks), and at six-month follow-up (T3). Measures included the Rosenberg Self-Esteem Scale, the Perceived Quality of Life Scale, and the General Self-Efficacy Scale. Results were analyzed using a linear mixed model analysis for repeated measures. There were no significant effects of GMT on self-esteem or quality of life. Only the GMT group showed a significant increase in self-efficacy that was most evident at six months follow-up, F(1, 34) = 10.71, p = 0.002, d = 0.71. Improved self-efficacy was found to correlate significantly with a reduction in perceived executive dysfunction in an exploratory post hoc analysis. Our findings demonstrate the potential of GMT in improving self-efficacy in schizophrenia Clinical trial registration:https://clinicaltrials.gov, NCT03048695.
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Affiliation(s)
| | - Ingvild Haugen
- Research Division, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Division, Innlandet Hospital Trust, Brumunddal, Norway
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Wang L, Wang L, Chen J, Qiu C, Liu T, Wu Y, Li Y, Zou P, Guo S, Lu J. Five-week music therapy improves overall symptoms in schizophrenia by modulating theta and gamma oscillations. Front Psychiatry 2024; 15:1358726. [PMID: 38505791 PMCID: PMC10948521 DOI: 10.3389/fpsyt.2024.1358726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Some clinical studies have shown that music therapy as an adjunctive therapy can improve overall symptoms in patients with schizophrenia. However, the neural mechanisms of this improvement remain unclear due to insufficient neuroimaging evidence. Methods In this work, 17 patients with schizophrenia accepted a five-week music therapy (music group) that integrated listening, singing, and composing, and required patients to cooperate in a group to complete music therapy tasks. Meanwhile, 15 patients with schizophrenia received a five-week visual art intervention as the control group including handicraft and painting activities. We collected the Manchester Scale (MS) and Positive and Negative Symptom Scale (PANSS) scores and electroencephalography (EEG) data before and after intervention in two groups. Results Behavioral results showed that both interventions mentioned above can effectively help patients with schizophrenia relieve their overall symptoms, while a trend-level effect was observed in favor of music therapy. The EEG results indicated that music therapy can improve abnormal neural oscillations in schizophrenia which is reflected by a decrease in theta oscillation in the parietal lobe and an increase in gamma oscillation in the prefrontal lobe. In addition, correlation analysis showed that in the music group, both reductions in theta oscillations in the parietal lobe and increases in gamma oscillations in the prefrontal lobe were positively correlated with the improvement of overall symptoms. Discussion These findings help us to better understand the neural mechanisms by which music therapy improves overall symptoms in schizophrenia and provide more evidence for the application of music therapy in other psychiatric disorders.
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Affiliation(s)
- Lujie Wang
- Music and Digital Intelligence, Key Laboratory of Sichuan Province, Sichuan Conservatory of Music, Chengdu, China
- Department of Musicology, Sichuan Conservatory of Music, Chengdu, China
- Southwest Music Research Center, Key Research Base of Social Sciences in Sichuan Province, Sichuan Conservatory of Music, Chengdu, China
| | - Liju Wang
- Ministry of Education (MOE) Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiaxian Chen
- Ministry of Education (MOE) Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Chenxi Qiu
- Ministry of Education (MOE) Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Liu
- Department of Rehabilitation, Chengdu Dekang Hospital, Chengdu, China
| | - Yulin Wu
- Yueling Music Therapy Service Center, Chengdu, China
| | - Yan Li
- Ministry of Education (MOE) Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Pengyu Zou
- Ministry of Education (MOE) Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Sijia Guo
- Ministry of Education (MOE) Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Lu
- Ministry of Education (MOE) Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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Ishibashi T, Nobukawa S, Tobe M, Kikuchi M, Takahashi T. Alterations in the hub structure of whole-brain functional networks in patients with drug-naïve schizophrenia: Insights from electroencephalography-based research. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e164. [PMID: 38868477 PMCID: PMC11114440 DOI: 10.1002/pcn5.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 06/14/2024]
Abstract
Aim This study aimed to identify atypical hubs in the whole-brain networks of patients with schizophrenia (SZ) and examine the effects of antipsychotic medications, using electroencephalography (EEG) data. Methods We estimated the functional connectivity across all electrodes by applying the phase lag index to the EEG signals of 21 drug-naïve patients with SZ and 31 age-matched healthy controls. Betweenness centrality (BC), a measure of hub status, was calculated for each electrode and frequency band. Data from 14 patients were re-evaluated after initiating treatment with antipsychotic medications. Results BC values decreased significantly at the Fz site in the beta band, decreased significantly at Pz in the gamma band, and increased significantly at O1 in the gamma band among patients with SZ. These changes persisted after antipsychotic treatment and were unrelated to clinical symptoms. Conclusion The abnormal hub topology we observed, especially in the high-frequency band, may reflect the pathophysiology of SZ, and this study highlights the utility of BC analysis of EEG data for detecting alterations in the whole-brain networks of patients with SZ.
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Affiliation(s)
| | - Sou Nobukawa
- Department of Computer ScienceChiba Institute of TechnologyChibaJapan
- Graduate School of Information and Computer ScienceChiba Institute of TechnologyChibaJapan
- Research Center for Mathematical EngineeringChiba Institute of TechnologyChibaJapan
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Mayuna Tobe
- Graduate School of Information and Computer ScienceChiba Institute of TechnologyChibaJapan
| | - Mitsuru Kikuchi
- Department of Psychiatry & Behavioral ScienceKanazawa UniversityIshikawaJapan
- Research Center for Child Mental DevelopmentKanazawa UniversityIshikawaJapan
| | - Tetsuya Takahashi
- Department of NeuropsychiatryUniversity of FukuiFukuiJapan
- Research Center for Child Mental DevelopmentKanazawa UniversityIshikawaJapan
- Uozu Shinkei SanatoriumUozuJapan
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Vita A, Kakli M, Barlati S, Nibbio G, Dossou P, Degila SL, Villa S, Deste G. Implementation of cognitive rehabilitation interventions for schizophrenia in low-income countries: An experience from Togo and Benin. Int J Soc Psychiatry 2024; 70:408-409. [PMID: 37329184 DOI: 10.1177/00207640231181526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Mawuko Kakli
- Association Saint Camille de Lellis, Afagnan, Togo
- Diocese of Aného, Togo
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | | | - Simona Villa
- Congregation 'Suore Misericordine' mission in Fatebenefratelli Hospital of Afagnan, Togo
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Wood-Ross C, Milanovic M, Vanrooy T, Bromley S, Bowie CR. Disseminating action-based cognitive remediation to an early psychosis network: Clinician perspectives on feasibility and implementation barriers. Early Interv Psychiatry 2024; 18:190-197. [PMID: 37439297 DOI: 10.1111/eip.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/22/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
AIM Action-based cognitive remediation (ABCR) is a group cognitive remediation treatment that aims to improve neurocognitive impairments experienced in patients with severe mental illness. Developed in research settings, ABCR is not yet widely available in community settings. As such, this study examines the feasibility of implementing ABCR in community clinics in an early psychosis network. METHODS Eighty-five allied health professionals who work within an early psychosis intervention network were trained in the provision of ABCR. They were surveyed 6-months after training to gather information regarding their experience implementing ABCR within their clinical settings (e.g., barriers, perceived helpfulness of the treatment, modifications made to the manualized treatment). Access to ongoing training supports (e.g., treatment manual, asynchronous digital communication, conference calls) was also assessed. RESULTS Fifty-one clinicians responded to the survey. Staff time, manager support, and equipment were rated as organizational barriers. Geographic location, other responsibilities, and motivation were rated as patient barriers. Over half of the sample modified the overall dose of ABCR to offer fewer sessions and/or shorter duration of sessions than the manualized approach. Clinicians that reduced the dose of ABCR reported significantly higher barriers with manager support than staff who delivered ABCR as manualized but did not report worse patient outcomes. We found asynchronous learning opportunities (i.e., manual, online discussion forum) were perceived as the most accessible and helpful methods of ongoing training support. CONCLUSIONS The results provide preliminary information about barriers to implementing time-intensive cognitive treatments into clinical settings and may inform future training practices to increase successful implementation of cognitive remediation treatments.
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Affiliation(s)
- Chelsea Wood-Ross
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Melissa Milanovic
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tammy Vanrooy
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Sarah Bromley
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Tinch-Taylor R, Pickles A, Stringer D, Csipke E, Cella M, McCrone P, Reeder C, Birchwood M, Fowler D, Greenwood K, Johnson S, Perez J, Ritunnano R, Thompson A, Upthegrove R, Wilson J, Kenny A, Isok I, Joyce EM, Wykes T. Understanding the Mechanisms of Cognitive Remediation on Recovery in People With Early Psychosis: A Mediation and Moderation Analysis. Schizophr Bull 2024:sbae021. [PMID: 38428943 DOI: 10.1093/schbul/sbae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND To provide precision cognitive remediation therapy (CR) for schizophrenia, we need to understand whether the mechanism for improved functioning is via cognition improvements. This mechanism has not been rigorously tested for potential moderator effects. STUDY DESIGN We used data (n = 377) from a randomized controlled trial using CIRCuiTS, a therapist-supported CR, with participants from first-episode psychosis services. We applied structured equation modeling to test whether: (1) CR hours explain the goal attainment functional outcome (GAS) at posttreatment, (2) global cognitive improvement mediates GAS, and if (3) total symptoms moderate the CR hours to cognitive improvement pathway, and/or negative symptoms moderate the cognition to functioning pathway, testing moderator effects via the mediator or directly on CR hours to functioning path. STUDY RESULTS CR produced significant functioning benefit for each therapy hour (Coeff = 0.203, 95% CI 0.101-0.304, P < .001). The mediated path from CR hours to cognition and cognition to functioning was small and nonsignificant (Coeff = 0.014, 95% CI = -0.010, 0.037, P = .256). Total symptoms did not moderate the path to cognition (P = .211) or the direct path to outcome (P = .896). However, negative symptoms significantly moderated the effect of cognitive improvements on functioning (P = .015) with high negative symptoms reducing the functional gains of improved cognition. CONCLUSIONS Although cognitive improvements were correlated with functioning benefit, they did not fully explain the positive effect of increased therapy hours on functioning, suggesting additional CR factors also contribute to therapy benefit. Negative symptoms interfere with the translation of cognitive improvements into functional gains so need consideration.
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Affiliation(s)
- Rose Tinch-Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Stringer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emese Csipke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul McCrone
- School of Health Sciences, University of Greenwich, London, UK
| | - Clare Reeder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Sonia Johnson
- Faculty of Brain Sciences, University College London, London, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Rosa Ritunnano
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alex Kenny
- Patient Advisory Board, King's College London, London, UK
| | - Iris Isok
- Patient Advisory Board, King's College London, London, UK
| | - Eileen M Joyce
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Mantonakis L, Stefanatou P, Tsionis A, Konstantakopoulos G, Xenaki LA, Ntigrintaki AA, Ralli I, Dimitrakopoulos S, Kollias K, Stefanis NC. Cognitive Inflexibility Predicts Negative Symptoms Severity in Patients with First-Episode Psychosis: A 1-Year Follow-Up Study. Brain Sci 2024; 14:162. [PMID: 38391736 PMCID: PMC10886606 DOI: 10.3390/brainsci14020162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Negative symptoms and cognitive deficits play a major role in psychosis and significantly influence the functional outcomes of patients, particularly those with a first episode of psychosis (FEP). However, limited research has explored the predictive capacity of cognitive deficits during FEP for subsequent negative symptomatology. Drawing from the Athens FEP research study, we conducted a retrospective longitudinal study in 80 individuals with FEP. All patients were drug naive at admission. Cognitive tests were administered at 1-month and 1-year post-admission, while negative symptomatology was assessed at the same time points using PANSS by trained raters. We considered confounding factors such as age, gender, duration of untreated psychosis (DUP), treatment received, premorbid social adjustment, and premorbid IQ. Univariate regression analysis identified cognitive domains that correlated with negative symptomatology. These, along with the confounders, were incorporated into a multiple regression, with the 1-year PANSS negative scale serving as the dependent variable. Employing the backward elimination technique, we found a statistically significant inverse relationship between the categories completed in the Wisconsin card sorting test (WCST) and the 1-year PANNS negative scale (p = 0.01), beyond the associations with DUP and the 1-month PANSS negative scale. Our results suggest that cognitive flexibility, a key component of executive functions, predicts negative symptom severity one year after FEP.
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Affiliation(s)
- Leonidas Mantonakis
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Antonis Tsionis
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - George Konstantakopoulos
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Research Department of Clinical, Education and Health Psychology, University College London, London WC1E 7HB, UK
| | - Lida-Alkisti Xenaki
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Angeliki-Aikaterini Ntigrintaki
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Irene Ralli
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Stefanos Dimitrakopoulos
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Psychiatric Clinic, 414 Military Hospital of Athens, 15236 Palea Penteli, Greece
| | - Konstantinos Kollias
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikos C Stefanis
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Tandon R, Nasrallah H, Akbarian S, Carpenter WT, DeLisi LE, Gaebel W, Green MF, Gur RE, Heckers S, Kane JM, Malaspina D, Meyer-Lindenberg A, Murray R, Owen M, Smoller JW, Yassin W, Keshavan M. The schizophrenia syndrome, circa 2024: What we know and how that informs its nature. Schizophr Res 2024; 264:1-28. [PMID: 38086109 DOI: 10.1016/j.schres.2023.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
With new data about different aspects of schizophrenia being continually generated, it becomes necessary to periodically revisit exactly what we know. Along with a need to review what we currently know about schizophrenia, there is an equal imperative to evaluate the construct itself. With these objectives, we undertook an iterative, multi-phase process involving fifty international experts in the field, with each step building on learnings from the prior one. This review assembles currently established findings about schizophrenia (construct, etiology, pathophysiology, clinical expression, treatment) and posits what they reveal about its nature. Schizophrenia is a heritable, complex, multi-dimensional syndrome with varying degrees of psychotic, negative, cognitive, mood, and motor manifestations. The illness exhibits a remitting and relapsing course, with varying degrees of recovery among affected individuals with most experiencing significant social and functional impairment. Genetic risk factors likely include thousands of common genetic variants that each have a small impact on an individual's risk and a plethora of rare gene variants that have a larger individual impact on risk. Their biological effects are concentrated in the brain and many of the same variants also increase the risk of other psychiatric disorders such as bipolar disorder, autism, and other neurodevelopmental conditions. Environmental risk factors include but are not limited to urban residence in childhood, migration, older paternal age at birth, cannabis use, childhood trauma, antenatal maternal infection, and perinatal hypoxia. Structural, functional, and neurochemical brain alterations implicate multiple regions and functional circuits. Dopamine D-2 receptor antagonists and partial agonists improve psychotic symptoms and reduce risk of relapse. Certain psychological and psychosocial interventions are beneficial. Early intervention can reduce treatment delay and improve outcomes. Schizophrenia is increasingly considered to be a heterogeneous syndrome and not a singular disease entity. There is no necessary or sufficient etiology, pathology, set of clinical features, or treatment that fully circumscribes this syndrome. A single, common pathophysiological pathway appears unlikely. The boundaries of schizophrenia remain fuzzy, suggesting the absence of a categorical fit and need to reconceptualize it as a broader, multi-dimensional and/or spectrum construct.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI 49008, United States of America.
| | - Henry Nasrallah
- Department of Psychiatry, University of Cincinnati College of Medicine Cincinnati, OH 45267, United States of America
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA 02139, United States of America
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Dusseldorf, Heinrich-Heine University, Dusseldorf, Germany
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles, CA 90024, United States of America; Greater Los Angeles Veterans' Administration Healthcare System, United States of America
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States of America
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY 11004, United States of America
| | - Dolores Malaspina
- Department of Psychiatry, Neuroscience, Genetics, and Genomics, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannhein/Heidelberg University, Mannheim, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, UK
| | - Michael Owen
- Centre for Neuropsychiatric Genetics and Genomics, and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Psychiatric and Neurodevelopmental Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Walid Yassin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
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40
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Sohal VS. Neurobiology of schizophrenia. Curr Opin Neurobiol 2024; 84:102820. [PMID: 38091860 DOI: 10.1016/j.conb.2023.102820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/23/2023] [Accepted: 11/19/2023] [Indexed: 02/18/2024]
Affiliation(s)
- Vikaas S Sohal
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, Kavli Institute for Fundamental Neuroscience, Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, CA 94143-0444, USA.
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41
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Jespersen AE, Lumbye A, Vinberg M, Glenthøj L, Nordentoft M, Wæhrens EE, Knudsen GM, Makransky G, Miskowiak KW. Effect of immersive virtual reality-based cognitive remediation in patients with mood or psychosis spectrum disorders: study protocol for a randomized, controlled, double-blinded trial. Trials 2024; 25:82. [PMID: 38268043 PMCID: PMC10809611 DOI: 10.1186/s13063-024-07910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Cognitive impairments are prevalent across mood disorders and psychosis spectrum disorders, but there is a lack of real-life-like cognitive training programmes. Fully immersive virtual reality has the potential to ensure motivating and engaging cognitive training directly relevant to patients' daily lives. We will examine the effect of a 4-week, intensive virtual reality-based cognitive remediation programme involving daily life challenges on cognition and daily life functioning in patients with mood disorders or psychosis spectrum disorders and explore the neuronal underpinnings of potential treatment efficacy. METHODS The trial has a randomized, controlled, double-blinded, parallel-group design. We will include 66 symptomatically stable outpatients with mood disorders or psychosis spectrum disorders aged 18-55 years with objective and subjective cognitive impairment. Assessments encompassing a virtual reality test of daily life cognitive skills, neuropsychological testing, measures of daily life functioning, symptom ratings, questionnaires on subjective cognitive complaints, and quality of life are carried out at baseline, after the end of 4 weeks of treatment and at a 3-month follow-up after treatment completion. Functional magnetic resonance imaging scans are performed at baseline and at the end of treatment. The primary outcome is a broad cognitive composite score comprising five subtasks on a novel ecologically valid virtual reality test of daily life cognitive functions. Two complete data sets for 54 patients will provide a power of 80% to detect a clinically relevant between-group difference in the primary outcome. Behavioural data will be analysed using linear mixed models in SPSS, while MRI data will be analysed with the FMRIB Expert Analysis Tool (FEAT). Treatment-related changes in neural activity from baseline to end of treatment will be investigated for the dorsal prefrontal cortex and hippocampus as the regions of interest. DISCUSSION The results will provide insight into whether virtual reality-based cognitive remediation has beneficial effects on cognition and functioning in symptomatically stable patients with mood disorders or psychosis spectrum disorders, which can aid future treatment development. TRIAL REGISTRATION ClinicalTrials.gov NCT06038955. Registered on September 15, 2023.
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Affiliation(s)
- Andreas E Jespersen
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, DK-2000, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services, The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen, Denmark
| | - Louise Glenthøj
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Guido Makransky
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Virtual Learning Lab, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, DK-2000, Copenhagen, Denmark.
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
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Du N, Meng X, Li J, Shi L, Zhang X. Decline in Working Memory in Stable Schizophrenia May Be Related to Attentional Impairment: Mediating Effects of Negative Symptoms, a Cross-Sectional Study. Neuropsychiatr Dis Treat 2024; 20:149-158. [PMID: 38288268 PMCID: PMC10822768 DOI: 10.2147/ndt.s447965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
Background Schizophrenia (SCZ) is a severe mental illness, Cognitive deficits and negative symptoms (NS) are prevalent in individuals with SCZ and are crucial indicators of functional recovery. It is well known that cognitive symptoms and negative symptoms are interrelated and that negative symptoms can affect the ability to take cognitive tests. However, the specific relationship between attention, working memory (WM), and NS in stable SCZ remains unclear. This study aims to explore these associations and provide valuable insights for the subsequent treatment of SCZ. Methods We conducted a comprehensive assessment of 145 patients with stable SCZ using the Chinese Brief Neurocognitive Suite of Tests (C-BCT) and the Positive and Negative Symptom Scale (PANSS). Results Patients with abnormal cognition exhibited significantly higher PANSS total scores, cognitive symptom scores, and NS than those with normal cognition (P<0.05). Pearson's correlation analysis revealed significant positive correlations between digital breadth(DB) and continuous operation(CO) (r=0.389, P<0.001), as well as a significant negative correlation between DB and NS (r=-0.291, P<0.001). Moreover, CO showed a negative correlation with NS (r=-0.173, P<0.05). However, no significant correlations were found between the digital breadth-anterograde score and CO or NS (r=0.148, P>0.05; r=-0.068, P>0.05). Notably, NS were identified as a mediator in the relationship between attention and WM (effect size=0.024). Conclusion Our findings highlight significant associations between WM, attention, and NS in individuals with stable SCZ. Moreover, attention not only directly impacts WM but also indirectly influences it through NS. Addressing cognitive deficits and NS in the treatment of SCZ may lead to improved overall outcomes for affected individuals.
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Affiliation(s)
- Nan Du
- Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
- Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
| | - Xiaojing Meng
- Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
- Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
| | - Jingwei Li
- Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
| | - Li Shi
- Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
| | - Xulai Zhang
- Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
- Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
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Dark F, Galloway G, Gray M, Cella M, De Monte V, Gore-Jones V, Ritchie G. Reward Learning as a Potential Mechanism for Improvement in Schizophrenia Spectrum Disorders Following Cognitive Remediation: Protocol for a Clinical, Nonrandomized, Pre-Post Pilot Study. JMIR Res Protoc 2024; 13:e52505. [PMID: 38252470 PMCID: PMC10845020 DOI: 10.2196/52505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Cognitive impairment is common with schizophrenia spectrum disorders. Cognitive remediation (CR) is effective in improving global cognition, but not all individuals benefit from this type of intervention. A better understanding of the potential mechanism of action of CR is needed. One proposed mechanism is reward learning (RL), the cognitive processes responsible for adapting behavior following positive or negative feedback. It is proposed that the structure of CR enhances RL and motivation to engage in increasingly challenging tasks, and this is a potential mechanism by which CR improves cognitive functioning in schizophrenia. OBJECTIVE Our primary objective is to examine reward processing in individuals with schizophrenia before and after completing CR and to compare this with a group of matched clinical controls. We will assess whether RL mediates the relationship between CR and improved cognitive function and reduced negative symptoms. Potential differences in social RL and nonsocial RL in individuals with schizophrenia will also be investigated and compared with a healthy matched control group. METHODS We propose a clinical, nonrandomized, pre-post pilot study comparing the impact of CR on RL and neurocognitive outcomes. The study will use a combination of objective and subjective measures to assess neurocognitive, psychiatric symptoms, and neurophysiological domains. A total of 40 individuals with schizophrenia spectrum disorders (aged 18-35 years) will receive 12 weeks of CR therapy (n=20) or treatment as usual (n=20). Reward processing will be evaluated using a reinforcement learning task with 2 conditions (social reward vs nonsocial reward) at baseline and the 12-week follow-up. Functional magnetic resonance imaging responses will be measured during this task. To validate the reinforcement learning task, RL will also be assessed in 20 healthy controls, matched for age, sex, and premorbid functioning. Mixed-factorial ANOVAs will be conducted to evaluate treatment group differences. For the functional magnetic resonance imaging analysis, computational modeling will allow the estimation of learning parameters at each point in time, during each task condition, for each participant. We will use a variational Bayesian framework to measure how learning occurred during the experimental task and the subprocesses that underlie this learning. Second-level group analyses will examine how learning in patients differs from that observed in control participants and how CR alters learning efficiency and the underlying neural activity. RESULTS As of September 2023, this study has enrolled 15 participants in the CR group, 1 participant in the treatment-as-usual group, and 11 participants in the healthy control group. Recruitment is expected to be completed by September 2024. Data analysis is expected to be completed and published in early 2025. CONCLUSIONS The results of this study will contribute to the knowledge of CR and RL processes in severe mental illness and the understanding of the systems that impact negative symptoms and cognitive impairments within this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52505.
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Affiliation(s)
- Frances Dark
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Graham Galloway
- Translational Research Institute, Woolloongabba, Australia
- Herston Imaging Research Facility, The University of Queensland, Brisbane, Australia
| | - Marcus Gray
- Translational Research Institute, Woolloongabba, Australia
| | | | - Veronica De Monte
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
| | | | - Gabrielle Ritchie
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Adamowicz DH, Wu TC, Daly R, Irwin MR, Jeste DV, Tu XM, Eyler LT, Lee EE. Executive functioning trajectories and their prospective association with inflammatory biomarkers in schizophrenia and non-psychiatric comparison participants. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110866. [PMID: 37742747 PMCID: PMC10829566 DOI: 10.1016/j.pnpbp.2023.110866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive change in people with schizophrenia (PwS) is challenging to assess, but important to understand. Previous studies with limited age ranges and follow-up were subject to practice effects. Controlling for practice effects in a well-established cohort, we examined executive functioning trajectories and their association with inflammatory biomarkers, hypothesizing that PwS will have worsening executive functioning over time compared to non-psychiatric comparison participants (NCs), predicted by higher baseline inflammation with a stronger relationship in PwS than NCs. STUDY DESIGN Executive functioning was assessed in 350 participants (n = 186 PwS, 164 NCs) at 12-16-month intervals (0 to 7 follow-up visits). Inflammatory biomarkers at baseline included high sensitivity C-Reactive Protein (hs-CRP), Interferon-gamma, Tumor Necrosis Factor (TNF)-alpha, and Interleukin(IL)-6, -8, and - 10. Executive functioning trajectories across diagnostic groups were estimated using a linear mixed-effects model controlling for age, sex, race/ethnicity, and education level, with additional models to assess prediction by baseline inflammation. STUDY RESULTS Over 4.4 years average follow-up, improvements in executive functioning were attenuated in PwS and older participants. Controlling for practice effects negated improvements, revealing declines among highly educated participants regardless of diagnosis. Higher baseline hs-CRP predicted worse executive functioning only among NCs, while TNF-alpha was predictive of change in all participants only after controlling for practice effects. Only the main effect of hs-CRP on executive function was significant after adjusting for multiple comparisons. None of the other inflammatory biomarkers predicted executive functioning or trajectories of performance among study participants. CONCLUSIONS Systemic inflammation as reflected by baseline inflammatory biomarker levels did not predict longitudinal declines in executive functioning. Additional studies examining the temporal dynamics of inflammation and cognition in PwS will help further clarify their relationship and associated mechanisms.
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Affiliation(s)
- David H Adamowicz
- Mass General Brigham, Department of Psychiatry, Division of Geriatric Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.
| | - Tsung-Chin Wu
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.
| | - Rebecca Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA.
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience, University of California, Los Angeles, CA, USA.
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA
| | - Xin M Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA.
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
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Walter N, Wenzel J, Haas SS, Squarcina L, Bonivento C, Ruef A, Dwyer D, Lichtenstein T, Bastrük Ö, Stainton A, Antonucci LA, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Lencer R, Meisenzahl E, Salokangas RKR, Pantelis C, Bertolino A, Koutsouleris N, Kambeitz J, Kambeitz-Ilankovic L. A multivariate cognitive approach to predict social functioning in recent onset psychosis in response to computerized cognitive training. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110864. [PMID: 37717645 DOI: 10.1016/j.pnpbp.2023.110864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
Clinical and neuroimaging data has been increasingly used in recent years to disentangle heterogeneity of treatment response to cognitive training (CT) and predict which individuals may achieve the highest benefits. CT has small to medium effects on improving cognitive and social functioning in recent onset psychosis (ROP) patients, who show the most profound cognitive and social functioning deficits among psychiatric patients. We employed multivariate pattern analysis (MVPA) to investigate the potential of cognitive data to predict social functioning improvement in response to 10 h of CT in patients with ROP. A support vector machine (SVM) classifier was trained on the naturalistic data of the Personalized Prognostic Tools for Early Psychosis Management (PRONIA) study sample to predict functioning in an independent sample of 70 ROP patients using baseline cognitive data. PRONIA is a part of a FP7 EU grant program that involved 7 sites across 5 European countries, designed and conducted with the main aim of identifying (bio)markers associated with an enhanced risk of developing psychosis in order to improve early detection and prognosis. Social functioning was predicted with a balanced accuracy (BAC) of 66.4% (Sensitivity 78.8%; Specificity 54.1%; PPV 60.5%; NPV 74.1%; AUC 0.64; P = 0.01). The most frequently selected cognitive features (mean feature weights > ± 0.2) included the (1) correct number of symbol matchings within the Digit Symbol Substitution Test, (2) the number of distracting stimuli leading to an error within 300 and 200 trials in the Continuous Performance Test and (3) the dynamics of verbal fluency between 15 and 30 s within the Verbal Fluency Test, phonetic part. Next, the SVM classifier generated on the PRONIA sample was applied to the intervention sample, that obtained 54 ROP patients who were randomly assigned to a social cognitive training (SCT) or treatment as usual (TAU) group and dichotomized into good (GF-S ≥ 7) and poor (GF-S < 7) functioning patients based on their level of Global Functioning-Social (GF-S) score at follow-up (FU). By applying the initial PRONIA classifier, using out-of-sample cross-validation (OOCV) to the sample of ROP patients who have undergone the CT intervention, a BAC of 59.3% (Sensitivity 70.4%; Specificity 48.1%; PPV 57.6%; NPV 61.9%; AUC 0.63) was achieved at T0 and a BAC of 64.8% (Sensitivity 66.7%; Specificity 63.0%; PPV 64.3%; NPV 65.4%; AUC 0.66) at FU. After SCT intervention, a significant improvement in predicted social functioning values was observed in the SCT compared to TAU group (P ≤0.05; ES[Cohens' d] = 0.18). Due to a small sample size and modest variance of social functioning of the intervention sample it was not feasible to predict individual response to SCT in the current study. Our findings suggest that the use of baseline cognitive data could provide a robust individual estimate of future social functioning, while prediction of individual response to SCT using cognitive data that can be generated in the routine patient care remains to be addressed in large-scale cognitive training trials.
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Affiliation(s)
- Nina Walter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | | | | | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Öznur Bastrük
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Alexandra Stainton
- Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda A Antonucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen Youth Health, Melbourne, Australia; School of Psychology, University of Birmingham, United Kingdom; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, United Kingdom; Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Rebekka Lencer
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & NorthWestern Mental Health, Melbourne, Australia
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany; Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany.
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Deste G, Kakli M, Barlati S, Nibbio G, Dossou P, Degila SL, Ceraso A, Lisoni J, Calzavara-Pinton I, Villa S, Vita A. Application of cognitive remediation in the world: new experiences from two schizophrenia rehabilitation centers in Togo and Benin. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02603-z. [PMID: 38184811 DOI: 10.1007/s00127-023-02603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE People with schizophrenia in Sub-Saharan Africa often live in very difficult conditions, suffer important social isolation and usually do not receive any kind of treatment. In this context, some non-governmental initiatives have come to light, providing accommodation, food, primary healthcare, medications and, in some cases, education and rehabilitation. The aims of this study were to assess feasibility, effects, and acceptability of a Cognitive Remediation Therapy (CRT) intervention in the particular context of psychiatric rehabilitation in Togo and Benin. METHODS Patients diagnosed with schizophrenia accessing the "Saint Camille" association rehabilitation centers in Togo and Benin during the enrollment period were allocated consecutively with a 1:1 proportion to receive a manualized CRT intervention (46 one-hour sessions over 14 weeks) or continuing Treatment As Usual (TAU). The assessment included validated measures of cognitive performance and real-world functioning and was performed at baseline and at the conclusion of treatment. RESULTS All subjects that were invited into the study agreed to participate and completed the intervention, for a total of 36 participants. CRT produced greater improvements than TAU in processing speed, working memory, verbal memory, cognitive flexibility, and executive functions measures, with moderate to large effect sizes, in particular in processing speed and working memory domains. CONCLUSIONS CRT represents a feasible and effective psychosocial intervention that can be implemented even in contexts with very limited resources, and could represent an important instrument to promote the rehabilitation process of people living with schizophrenia in low-income countries.
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Affiliation(s)
- Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mawuko Kakli
- Association Saint Camille de Lellis, Lomé, Togo
- Diocese of Aného, Aného, Togo
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | | | | | - Anna Ceraso
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Irene Calzavara-Pinton
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Simona Villa
- Congregation "Suore Misericordine" mission in Fatebenefratelli Hospital of Afagnan, Afanyagan, Togo
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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John AP, Mya T, Haywood D. Cognitive deficits among people with schizophrenia and prediabetes or diabetes. Acta Psychiatr Scand 2024; 149:65-76. [PMID: 37950362 DOI: 10.1111/acps.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Both type 2 diabetes mellitus (T2DM) and schizophrenia are known to be associated with cognitive deficits. The impact of the comorbidities of T2DM or prediabetes (PD) on cognition among people with schizophrenia has been poorly researched. We evaluated the cognitive functioning of patients with schizophrenia and PD or T2DM and compared them to patients with schizophrenia with normal blood sugar. METHODS We retrospectively collated data on cognition, fasting blood glucose (FBG), lipids and other selected demographic and clinical variables of 171 patients with schizophrenia and 16 patients with schizoaffective disorder who were admitted to an inpatient rehabilitation facility in Western Australia from 2011 to 2018. The Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive functioning. Parametric and non-parametric analyses were used to examine the study's aims. RESULTS Sixty-six percent of the patients had normal blood sugar, 25% had PD and 9% had T2DM. The BACS composite score revealed an increasing gradient of cognitive deficits, ranging from mild to severe, between the normal, PD and T2DM groups, respectively. The T2DM group had a significantly lower composite score compared with the PD (p = 0.026) and normal groups (p < 0.001). On the BACS subtests, the scores of T2DM and PD patients were similar except for the token motor task, in which the T2DM group had significantly lower scores (p < 0.001). The T2DM group also had lower scores on the subtests of BACS, except memory tests, compared with those with normal blood sugar. There was no significant difference in the composite and subtest cognitive scores between the PD and normal groups. CONCLUSIONS Our study revealed more pronounced cognitive deficits among patients with schizophrenia and dysglycaemia, particularly those with T2DM, compared with those with schizophrenia with normal blood sugar.
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Affiliation(s)
| | - Thynn Mya
- University of Western Australia, Perth, Australia
| | - Darren Haywood
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Mental Health, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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Berendsen S, Berendse S, van der Torren J, Vermeulen J, de Haan L. Cognitive behavioural therapy for the treatment of schizophrenia spectrum disorders: an umbrella review of meta-analyses of randomised controlled trials. EClinicalMedicine 2024; 67:102392. [PMID: 38274116 PMCID: PMC10809079 DOI: 10.1016/j.eclinm.2023.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
Background Cognitive behavioural therapy (CBT) forms the standard psychotherapy for schizophrenia spectrum disorders (SSD). We aimed to summarize and evaluate the evidence on the effectiveness of CBT for SSD. Methods In this umbrella review, we searched PubMed, Embase, Cochrane Database, and PsychInfo, for meta-analyses of randomised controlled trials (RCTs) of CBT in SSD published between database inception up to Aug 18, 2023. Inclusion criteria were RCTs investigating individually provided CBT in a population of patients with SSD, compared to either standard care, treatment as usually, or any other psychosocial therapies. No restrictions concerning follow-up or language were applied. We used the "assessment of multiple systematic reviews" (AMSTAR-2) appraisal checklist for the evaluation of methodological quality of meta-analysis. We extracted summary metrics from eligible studies in duplicate. The strength of evidence was classified by the sample size, p-value, excess significance bias, prediction intervals, significance of largest study, and heterogeneity. The strength of evidence was ranked according to established criteria as: convincing, highly suggestive, suggestive, weak, or not significant. Primary outcomes were general psychopathology, positive and negative symptoms. This study is registered in PROSPERO, CRD42022334671. Findings We found 26 eligible meta-analyses, of which 16 meta-analyses provided sufficient data. Using the AMSTAR-2, we found limitations in details concerning the selection of study design, quality of the search and reporting of funding in included meta-analyses. A minority of 42.9% of the comparisons showed a significant result in favor of CBT; 57.1% were non-significant with no convincing or highly suggestive evidence. Suggestive evidence was found in favor of CBT for general psychopathology (6.2%, N = 34 RCTs, effect size (ES) = -0.33 (-0.47; -0.19), I2 = 67.93), delusions (16.7%, N = 27, ES = 0.36 (0.22; 0.51), I2 = 50.47), and hallucinations (33.3%, N = 28, ES = 0.32 (0.19; 0.46), I2 = 45.14) at the end of treatment (EoT). Weak (N = 34 RCTs, ES = -0.13 (-0.24; -0.02), I2 = 51.28), or non-significant evidence (N = 28 RCTs, ES = 0.12 (-0.03; 0.27) I2 = 64.63) was found for negative symptoms at EoT. At longer follow-up, evidence became weak or non-significant. Interpretation Findings suggest that the effectiveness of CBT on general and positive symptoms in SSD at EoT was small to medium, while we found inconsistent evidence for a sustainable effect. CBT has no convincing impact on other relevant outcomes. Guidelines may use these results to specify their recommendations. Funding None.
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Affiliation(s)
- Steven Berendsen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
- Dimence Mental Health Care, Deventer, the Netherlands
| | - Silke Berendse
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Jeanne van der Torren
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
- Arkin Mental Health Care, Amsterdam, the Netherlands
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Frawley E, Heary C, Berry C, Cella M, Fowler D, Wykes T, Donohoe G. Participant perspectives on cognitive remediation and social recovery in early psychosis (CReSt-R): An acceptability study. Early Interv Psychiatry 2024; 18:34-41. [PMID: 37186460 DOI: 10.1111/eip.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/12/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
AIM Psychosis spectrum disorders continue to rank highly among causes of disability. This has resulted in efforts to expand the range of treatment targets beyond symptom remission to include other recovery markers, including social and occupational function and quality of life. Although the efficacy of psychosocial interventions in early psychosis has been widely reported, the acceptability of these interventions is less well-known. This study explores the participant perspective on a novel, psychosocial intervention combining cognitive remediation and social recovery therapy. METHODS We employed a qualitative research design, based on semi-structured interviews and reflexive thematic analysis. Six participants with early psychosis were recruited from the intervention arm of a randomized pilot study, three women and three men, aged between 22 and 27 years. RESULTS Four themes were developed through the analytical process, namely, (1) a solid therapeutic foundation, (2) multi-directional flow of knowledge, (3) a tailored toolset, and (4) an individual pathway to recovery. Participants also provided pragmatic feedback about how to improve the delivery of the therapy assessments and intervention. Both the themes and pragmatic feedback are described. CONCLUSIONS People with early psychosis described the intervention as acceptable, engaging, helpful and person-centred, suggesting its potential role in a multicomponent therapy model of early intervention in psychosis services. Participants in this study also highlight the importance of an individualized approach to therapy, the vital role of the therapeutic relationship and the ecological validity and value of adopting an assertive outreach delivery, providing therapy outside a conventional clinic setting.
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Affiliation(s)
- Emma Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, University of Galway, Galway, Ireland
| | - Clio Berry
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
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Pieters L, Blanken T, van Lunteren K, van Harten P, Deenik J. A Network Model of Health-Related Changes after a Lifestyle-Enhancing Treatment in Patients with Severe Mental Illness: the MULTI Study VI. Int J Clin Health Psychol 2024; 24:100436. [PMID: 38226003 PMCID: PMC10788809 DOI: 10.1016/j.ijchp.2024.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
Background/Objective The effects of lifestyle interventions on physical and mental health in people with severe mental illness (SMI) are promising, but its underlying mechanisms remain unsolved. This study aims to examine changes in health-related outcomes after a lifestyle intervention, distinguishing between direct and indirect effects. Method We applied network intervention analysis on data from the 18-month cohort Multidisciplinary Lifestyle enhancing Treatment for Inpatients with SMI (MULTI) study in 106 subjects (62% male, mean age=54.7 (SD=10.8)) that evaluated changes in actigraphy-measured physical activity, metabolic health, psychopathology, psychosocial functioning, quality of life and medication use after MULTI (n=65) compared to treatment as usual (n=41). Results MULTI is directly connected to decreased negative symptoms and psychotropic medication dosage, and improved physical activity and psychosocial functioning, suggesting a unique and direct association between MULTI and the different outcome domains. Secondly, we identified associations between outcomes within the same domain (e.g., metabolic health) and between the domains (e.g., metabolic health and social functioning), suggesting potential indirect effects of MULTI. Conclusions This novel network approach shows that MULTI has direct and indirect associations with various health-related outcomes. These insights contribute to the development of effective treatment strategies in people with severe mental illness.
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Affiliation(s)
- Lydia Pieters
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tessa Blanken
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kirsten van Lunteren
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
| | - Peter van Harten
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jeroen Deenik
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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