1
|
Remote cognitive assessment in severe mental illness: a scoping review. SCHIZOPHRENIA 2022; 8:14. [PMID: 35249112 PMCID: PMC8897553 DOI: 10.1038/s41537-022-00219-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022]
Abstract
Many individuals living with severe mental illness, such as schizophrenia, present cognitive deficits and reasoning biases negatively impacting clinical and functional trajectories. Remote cognitive assessment presents many opportunities for advancing research and treatment but has yet to be widely used in psychiatric populations. We conducted a scoping review of remote cognitive assessment in severe mental illness to provide an overview of available measures and guide best practices. Overall, 34 studies (n = 20,813 clinical participants) were reviewed and remote measures, psychometrics, facilitators, barriers, and future directions were synthesized using a logic model. We identified 82 measures assessing cognition in severe mental illness across 11 cognitive domains and four device platforms. Remote measures were generally comparable to traditional versions, though psychometric properties were infrequently reported. Facilitators included standardized procedures and wider recruitment, whereas barriers included imprecise measure adaptations, technology inaccessibility, low patient engagement, and poor digital literacy. Our review identified several remote cognitive measures in psychiatry across all cognitive domains. However, there is a need for more rigorous validation of these measures and consideration of potentially influential factors, such as sex and gender. We provide recommendations for conducting remote cognitive assessment in psychiatry and fostering high-quality research using digital technologies.
Collapse
|
2
|
Gawęda Ł, Moritz S. The role of expectancies and emotional load in false auditory perceptions among patients with schizophrenia spectrum disorders. Eur Arch Psychiatry Clin Neurosci 2021; 271:713-722. [PMID: 31493150 PMCID: PMC8119254 DOI: 10.1007/s00406-019-01065-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Abstract
Cognitive models suggest that top-down and emotional processes increase false perceptions in schizophrenia spectrum disorders (SSD). However, little is still known about the interaction of these processes in false auditory perceptions. The present study aimed at investigating the specific as well as joint impacts of expectancies and emotional load on false auditory perceptions in SSD. Thirty-three patients with SSD and 33 matched healthy controls were assessed with a false perception task. Participants were asked to detect a target stimulus (a word) in a white noise background (the word was present in 60% of the cases and absent in 40%). Conditions varied in terms of the level of expectancy (1. no cue prior to the stimulus, 2. semantic priming, 3. semantic priming accompanied by a video of a man's mouth spelling out the word). The words used were neutral or emotionally negative. Symptom severity was assessed with the Positive and Negative Syndrome Scale. Higher expectancy significantly increased the likelihood of false auditory perceptions only among the patients with SSD (the group x expectancy condition interaction was significant), which was unrelated to general cognitive performance. Emotional load had no impact on false auditory perceptions in either group. Patients made more false auditory perceptions with high confidence than controls did. False auditory perceptions were significantly correlated with the severity of positive symptoms and disorganization, but not with other dimensions. Perception in SSD seems to be susceptible to top-down processes, increasing the likelihood of high-confidence false auditory perceptions.
Collapse
Affiliation(s)
- Łukasz Gawęda
- Psychopathology and Early Intervention Lab II, Department of Psychiatry, The Medical University of Warsaw, Ul. Kondratowicza 8, 03-242, Warsaw, Poland.
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Sauvé G, Lavigne KM, Pochiet G, Brodeur MB, Lepage M. Efficacy of psychological interventions targeting cognitive biases in schizophrenia: A systematic review and meta-analysis. Clin Psychol Rev 2020; 78:101854. [DOI: 10.1016/j.cpr.2020.101854] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/14/2022]
|
4
|
‘Twisting the lion's tail’: Manipulationist tests of causation for psychological mechanisms in the occurrence of delusions and hallucinations. Clin Psychol Rev 2019; 68:25-37. [DOI: 10.1016/j.cpr.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
|
5
|
McLean BF, Mattiske JK, Balzan RP. Towards a reliable repeated-measures beads task for assessing the jumping to conclusions bias. Psychiatry Res 2018; 265:200-207. [PMID: 29730540 DOI: 10.1016/j.psychres.2018.04.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
The jumping to conclusions bias (JTC), in which some people gather less information than others before making a decision, has been linked to delusions in psychosis. JTC is usually identified via the beads task, in which a sequence of beads (the "target" sequence) is used to measure the amount of evidence participants require before making a decision. Yet, despite its common use, the reliability of the task has never been properly investigated. We investigated its reliability, and tested an alternate version which used distractor sequences to obfuscate the target sequence. Healthy participants (N = 212) were randomised into two groups. One group completed ten trials using the target sequence, while the other completed ten trials of the target sequence and three distractor sequences. Our data indicated the standard task may not be reliable over repeated measures, but that by including distractor sequences, the task becomes more believable, repeatable, and reliable. Additionally, excluding first-trial data (a "silent" practice trial) also improves repeatability. These improvements to the task are relevant to single trial studies, and will be especially useful to repeated-measures longitudinal, experimental, and treatment studies. Such repeated-measures studies are important for investigating the causal link between JTC and delusions.
Collapse
Affiliation(s)
- Benjamin F McLean
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia.
| | - Julie K Mattiske
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.
| | - Ryan P Balzan
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| |
Collapse
|
6
|
Moritz S, Göritz AS, McLean B, Westermann S, Brodbeck J. Do depressive symptoms predict paranoia or vice versa? J Behav Ther Exp Psychiatry 2017; 56:113-121. [PMID: 27817827 DOI: 10.1016/j.jbtep.2016.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/30/2016] [Accepted: 10/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Affective versus nonaffective psychoses are today no longer regarded as mutually exclusive disorders. Theorists have recently highlighted the role of affective symptoms in the formation of paranoid beliefs, particularly negative beliefs about the self, interpersonal sensitivity, sleep disturbances, and worrying, which exist along a continuum in the general population. For the present study, we tested the bidirectional causal relationships between paranoia and affect. METHOD A large population sample (N = 2,357) was examined at three time-points (baseline, six months, two years) as to the severity of subclinical paranoid beliefs (Paranoia Checklist, PCL) and depressive symptoms (Patient Health Questionnaire-9, PHQ-9). Worrying and avoidance were measured with items from the Maladaptive and Adaptive Coping Style Questionnaire (MAX). RESULTS Depression and paranoid symptoms were strongly cross-sectionally related (r = 0.69) and showed high stability (r > 0.72). Depressive symptoms at T2 predicted paranoid symptoms at T3 (beta = 0.16; no significant relationship from T1 to T2), whereas paranoid symptoms predicted depressive symptoms from T1 to T2 (beta = 0.09; no significant relationship from T2 to T3). LIMITATIONS Results should be replicated in a sample of paranoid patients, as risk factors for subclinical versus manifest paranoia may differ. Some constructs were measured with single items derived from a new scale. CONCLUSIONS The predictive association of depression to subsequent paranoia was small and confined to the long interval from T2 to T3. Treatments should target both paranoia and depression - irrespective of their causal relationship - particularly as patients with psychosis consider treatment of their emotional problems a priority.
Collapse
Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany
| | - Benjamin McLean
- School of Psychology, Flinders University, South Australia, Australia
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Jeannette Brodbeck
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| |
Collapse
|
7
|
Contreras F, Albacete A, Tebé C, Benejam B, Caño A, Menchón JM. Patients with schizophrenia activate behavioural intentions facilitated by counterfactual reasoning. PLoS One 2017; 12:e0178860. [PMID: 28586400 PMCID: PMC5460856 DOI: 10.1371/journal.pone.0178860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/19/2017] [Indexed: 11/18/2022] Open
Abstract
METHOD The main variables assessed were: answer to complete a target task (wrong or correctly), and percentage gain in the reaction time (RT) to complete a target task correctly depending on whether the prime was a counterfactual or a neutral-control cue. These variables were assessed in 37 patients with schizophrenia and 37 healthy controls. Potential associations with clinical status and socio-demographic characteristics were also explored. RESULTS When a counterfactual prime was presented, the probability of giving an incorrect answer was lower for the entire sample than when a neutral prime was presented (OR 0.58; CI 95% 0.42 to 0.79), but the schizophrenia patients showed a higher probability than the controls of giving an incorrect answer (OR 3.89; CI 95% 2.0 to 7.6). Both the schizophrenia patients and the controls showed a similar percentage gain in RT to a correct answer of 8%. CONCLUSIONS Challenging the results of previous research, our findings suggest a normal activation of behavioural intentions facilitated by CFT in schizophrenia. Nevertheless, the patients showed more difficulty than the controls with the task, adding support to the concept of CFT as a potential new target for consideration in future therapeutic approaches for this illness.
Collapse
Affiliation(s)
- Fernando Contreras
- Department of Psychiatry, Bellvitge University Hospital- IDIBELL, L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, L'Hospitalet de Llobregat, Spain
- Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Auria Albacete
- Department of Psychiatry, Bellvitge University Hospital- IDIBELL, L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, L'Hospitalet de Llobregat, Spain
- Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Cristian Tebé
- Statistical Advisory Service, Bellvitge Biomedical Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
- Faculty of Medicine and Health Sciences, University Rovira i Virgili, Tarragona, Spain
| | - Bessy Benejam
- Department of Psychiatry, Bellvitge University Hospital- IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Agnes Caño
- Department of Psychology, University of Girona, Girona, Spain
| | - José Manuel Menchón
- Department of Psychiatry, Bellvitge University Hospital- IDIBELL, L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, L'Hospitalet de Llobregat, Spain
- Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| |
Collapse
|
8
|
Moritz S, Balzan RP, Bohn F, Veckenstedt R, Kolbeck K, Bierbrodt J, Dietrichkeit M. Subjective versus objective cognition: Evidence for poor metacognitive monitoring in schizophrenia. Schizophr Res 2016; 178:74-79. [PMID: 27591821 DOI: 10.1016/j.schres.2016.08.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with schizophrenia display a number of cognitive biases, particularly a tendency to jump to conclusions, which are implicated in the pathogenesis of the disorder. The present study contrasted the degree of objective reasoning biases with subjective cognitive insight. We expected that patients with schizophrenia would display greater objective than subjective impairment suggestive of poor metacognitive awareness. METHODS Patients with schizophrenia (n=140) and healthy controls (n=60) underwent a test battery encompassing a cognitive bias paradigm (beads task) as well as neurocognitive tests (story recall, trail-making tests). In addition, they were administered the Beck Cognitive Insight Scale (BCIS), a subjective measure of (meta)cognitive awareness. RESULTS Corroborating prior research on decision making, draws to decisions were significantly delayed in controls relative to patients, whereas the core jumping to conclusion parameter (i.e., decision after one or two pieces of information) bordered significance. Patients with schizophrenia showed a lowered decision threshold and impaired neurocognition relative to nonclinical controls. Despite poor cognitive performance and prior psychotic episodes, patients with schizophrenia showed similar scores on the self-confidence subscale of the BCIS and reported even higher levels of self-reflectiveness relative to healthy controls. DISCUSSION The study demonstrates that patients with schizophrenia show severe cognitive biases and neurocognitive deficits but display only partial awareness herein. Raising cognitive insight in a non-insulting fashion and elevating patients' corrigibility as well as willingness to consider others' feedback and advice may help to narrow this gap and improve psychiatric symptomatology.
Collapse
Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ryan P Balzan
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Francesca Bohn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Kolbeck
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Bierbrodt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mona Dietrichkeit
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Effects of online intervention for depression on mood and positive symptoms in schizophrenia. Schizophr Res 2016; 175:216-222. [PMID: 27210726 DOI: 10.1016/j.schres.2016.04.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/12/2016] [Accepted: 04/19/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is common in schizophrenia. Whereas the improvement of mood and self-esteem represents a subjective treatment priority for many patients, depression is rarely a primary target for clinical intervention. The present trial examined whether an online intervention for depression can ameliorate depressive symptoms in schizophrenia. METHODS A total of 58 individuals with schizophrenia were invited to participate in an online survey which encompassed the Center for Epidemiologic Studies-Depression Scale (CES-D, primary outcome), the Patient-Health-Questionnaire-9 (PHQ-9) and the Paranoia Checklist. Subsequently, telephone interviews were conducted to verify diagnostic status and assess symptoms (Positive and Negative Syndrome Scale, PANSS). Participants were randomized either to the experimental condition (online depression intervention) or to a waitlist control condition. Three months after inclusion, a reassessment was carried out (self-report and telephone interview blind for group condition). The trial was registered (registration: DRKS00007888). RESULTS Participants in the treatment group showed a significant decline of depressive symptoms at a medium-to-large effect size, as assessed with the CES-D and the PANSS depression item, in comparison to the waitlist control group (completer (CC) and intention-to-treat analyses (ITT)). For the PHQ-9 (CC and ITT) and the PANSS distress subscale (CC only) significance was bordered at a medium effect size. Completion at the post-assessment after three months was 84%. DISCUSSION Depression in schizophrenia is both underdiagnosed and undertreated. To reduce the large treatment gap in the disorder, low threshold strategies are urgently needed. Online treatment and bibliotherapy may represent valuable tools to address patients' needs beyond the treatment of the core positive syndrome.
Collapse
|
10
|
Schlier B, Moritz S, Lincoln TM. Measuring fluctuations in paranoia: Validity and psychometric properties of brief state versions of the Paranoia Checklist. Psychiatry Res 2016; 241:323-32. [PMID: 27227702 DOI: 10.1016/j.psychres.2016.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/22/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022]
Abstract
Research increasingly assesses momentary changes in paranoia in order to elucidate causal mechanisms. Observed or manipulated changes in postulated causal factors should result in fluctuations in state paranoid ideation. Previous studies often employed a state-adapted Paranoia Checklist (Freeman et al., 2005) to measure state paranoia. This study examined whether the Paranoia Checklist or subsets of its items are appropriate for this purpose. Thirteen studies (N=860) were subjected to meta-analyses of each Paranoia Checklist item. We selected items based on (1) whether they showed pre-to-post change in the expected direction and (2) whether this effect was larger in experimental vs. control conditions. All resulting item selections were cross-validated on a hold-out sample (n=1893). Finally, we explored how much variation in paranoia was captured by the state-adapted version in a brief ambulatory assessment study (N=32). A thirteen item State Paranoia Checklist as well as a five item and a three item Brief State Paranoia Checklist were extracted. Cross validation revealed better model fit and increased sensitivity to change. Multilevel analysis indicated 25-30% of the variance in the Brief State Paranoia Checklists to be due to intra-individual daily fluctuations in paranoia. Our analyses produced reliable and valid revised scales. Increases in change sensitivity indicate that future assessment of state paranoia in experimental and ambulatory assessment studies can be optimized by using the revised scales.
Collapse
Affiliation(s)
- Björn Schlier
- Institute of Psychology, University of Hamburg, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany
| | | |
Collapse
|