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Seeman MV. Women with Schizophrenia Have Difficulty Maintaining Healthy Diets for Themselves and Their Children: A Narrative Review. Behav Sci (Basel) 2023; 13:967. [PMID: 38131823 PMCID: PMC10740554 DOI: 10.3390/bs13120967] [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: 10/12/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Severe psychiatric disorders such as schizophrenia are inevitably linked to unemployment, meagre per capita income, and residence in disadvantaged, poorly resourced neighbourhoods. This means difficult access to healthy food and is particularly problematic for pregnant women and mothers with children to feed. The necessity of taking antipsychotic drugs is an additional barrier to healthy eating because these drugs are associated with serious cognitive, psychological, behavioural, and metabolic sequelae. Being ill with psychosis makes it extremely difficult to maintain a healthy diet; nutritional deficiencies result, as do medical complications. The results of present literature review confirm the gravity of the problem and suggest a number of potentially useful clinical interventions.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 3G4, Canada
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Fares R, Haddad C, Sacre H, Hallit S, Haddad G, Salameh P, Calvet B. Neurological soft signs and cognition among inpatients with schizophrenia. Cogn Neuropsychiatry 2023; 28:406-423. [PMID: 37823861 DOI: 10.1080/13546805.2023.2269647] [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] [Received: 05/08/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
Introduction: Evidence has shown that neurological soft signs are strongly associated with neurocognitive dysfunction. Therefore, the primary objective of this study was to assess the association between NSS and cognitive impairments in a sample of inpatients with schizophrenia. The secondary objective was to explore the association between NSS total scores and functioning.Methods: The study enrolled 95 inpatients diagnosed with schizophrenia disorders and 45 healthy controls. The neurological evaluation scale (NES) was used to assess neurological soft sign while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive functioning in patients with schizophrenia.Results: Patients with schizophrenia had significantly higher mean scores on the NES total test and subtests than the control group. Higher cognition was significantly associated with lower NES total and subtest scores. Higher functional independence was significantly associated with a lower NES total score (Beta = -.25), lower motor coordination subtest score (Beta = -.04), and lower others subtest (Beta = -.12). When taking the functional independence scale as the dependent variable, a higher NES total score was significantly associated with lower functioning (Beta = -0.03).Conclusion: NSS were associated to neurocognitive impairments in almost every domain among patients with schizophrenia. Further prospective research is still needed to confirm this role.
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Affiliation(s)
- Rabih Fares
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Chadia Haddad
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Georges Haddad
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Benjamin Calvet
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Pôle Universitaire de Psychiatrie de l'Adulte, de l'Agée et d'Addictologie, centre hospitalier Esquirol, Limoges, France
- Centre mémoire de ressources et de recherche du Limousin, centre hospitalier Esquirol, Limoges, France
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3
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Speers LJ, Sissons DJ, Cleland L, Bilkey DK. Hippocampal phase precession is preserved under ketamine, but the range of precession across a theta cycle is reduced. J Psychopharmacol 2023; 37:809-821. [PMID: 37515458 PMCID: PMC10399102 DOI: 10.1177/02698811231187339] [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] [Indexed: 07/30/2023]
Abstract
BACKGROUND Hippocampal phase precession, which depends on the precise spike timing of place cells relative to local theta oscillations, has been proposed to underlie sequential memory. N-methyl-D-asparate (NMDA) receptor antagonists such as ketamine disrupt memory and also reproduce several schizophrenia-like symptoms, including spatial memory impairments and disorganized cognition. It is possible that these impairments result from disruptions to phase precession. AIMS/METHODS We used an ABA design to test whether an acute, subanesthetic dose (7.5 mg/kg) of ketamine disrupted phase precession in CA1 of male rats as they navigated around a rectangular track for a food reward. RESULTS/OUTCOMES Ketamine did not affect the ability of CA1 place cells to precess despite changes to place cell firing rates, local field potential properties and locomotor speed. However, ketamine reduced the range of phase precession that occurred across a theta cycle. CONCLUSION Phase precession is largely robust to acute NMDA receptor antagonism by ketamine, but the reduced range of precession could have important implications for learning and memory.
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Affiliation(s)
| | - Daena J Sissons
- Psychology Department, Otago University Dunedin, New Zealand
- Psychology Department, University of Canterbury, Christchurch, New Zealand
| | - Lana Cleland
- Psychology Department, Otago University Dunedin, New Zealand
- Department Psychological Medicine, Otago University, Christchurch, New Zealand
- Department Population Health, Otago University, Christchurch, New Zealand
| | - David K Bilkey
- Psychology Department, Otago University Dunedin, New Zealand
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Abstract
BACKGROUND Deficits in goal-directed behavior (i.e. behavior conducted to achieve a specific goal or outcome) are core to schizophrenia, difficult to treat, and associated with poor functional outcomes. Factors such as negative symptoms, effort-cost decision-making, cognition, and functional skills have all been associated with goal-directed behavior in schizophrenia as indexed by clinical interviews or laboratory-based tasks. However, little work has examined whether these factors relate to the real-world pursuit of goal-directed activities in this population. METHODS This study aimed to fill this gap by using Ecological Momentary Assessment (four survey prompts per day for 1 week) to test hypotheses about symptom, effort allocation, cognitive, and functional measures associated with planned and completed goal-directed behavior in the daily lives of 63 individuals with schizophrenia. RESULTS Individuals with schizophrenia completed more goal-directed activities than they planned [t(62) = -4.01, p < 0.001]. Motivation and pleasure (i.e. experiential) negative symptoms, controlling for depressive symptoms, negatively related to planned goal-directed behavior [odds ratio (OR) 0.92, p = 0.005]. Increased effort expenditure for high probability rewards (planned: OR 1.01, p = 0.034, completed: OR 1.01, p = 0.034) along with performance on a daily functional skills task (planned: OR 1.04, p = 0.002, completed: OR 1.03, p = 0.047) negatively related to both planned and completed goal-directed activity. CONCLUSIONS Our results present correlates of real-world goal-directed behavior that largely align with impaired ability to make future estimations in schizophrenia. This insight could help identify targeted treatments for the elusive motivated behavior deficits in this population.
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Affiliation(s)
- Jaisal T Merchant
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael J Strube
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Nielsen KT, Andersen U, Wæhrens EE, von Bülow C. Quality of ADL task performance in persons with schizophrenia: Looking beyond independence. Scand J Occup Ther 2023:1-10. [PMID: 36635973 DOI: 10.1080/11038128.2023.2165541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Persons with schizophrenia may experience decreased ability to perform activities of daily living (ADL) indicated by need for assistance in everyday life. Others are independent, but their quality of ADL task performance in terms of effort and efficiency may still be impacted. AIMS/OBJECTIVES The overall purpose of this study was to explore the quality of ADL task performance in subgroups with schizophrenia (independent/needing assistance). MATERIALS AND METHODS Participants were in- and outpatients at a Psychiatric Hospital diagnosed with schizophrenia (n = 83). Their quality of ADL task performance was evaluated using the Assessment of Motor and Process Skills (AMPS). Evaluations were conducted at the hospital. Two subgroups (A: independent and B: needing assistance) were created based on AMPS ADL ability measures. RESULTS The majority in both subgroups had AMPS ADL ability measures within the risk zones. Further, the majority in subgroup A had ADL ability measures within age expectations but below mean for well persons of the same age. Both ineffective motor and process skills were identified in both subgroups. CONCLUSIONS/SIGNIFICANCE Occupational therapy is indicated for persons with schizophrenia, both for independent persons and for persons needing assistance. This is to prevent decline in or to enhance ADL ability.
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Affiliation(s)
- Kristina Tomra Nielsen
- The Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark.,Occupation-Centered Occupational Therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Andersen
- Occupation-Centered Occupational Therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,The Department of Occupational Therapy, Copenhagen University College, Copenhagen, Denmark
| | - Eva Ejlersen Wæhrens
- Occupation-Centered Occupational Therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Occupational Science, User Perspectives and Community-Based Research, University of Southern Denmark, Odense, Denmark
| | - Cecilie von Bülow
- Occupation-Centered Occupational Therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Commey IT, Ninnoni JPK, Ampofo EA. Coping with personal care and stigma: experiences of persons living with schizophrenia. BMC Nurs 2022; 21:107. [PMID: 35524213 PMCID: PMC9077932 DOI: 10.1186/s12912-022-00891-5] [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: 01/28/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022] Open
Abstract
Living with a chronic mental condition such as schizophrenia impacts significantly on the individual’s social functioning and activities of daily living. However, there is little data on the experiences of people living with schizophrenia, especially in Ghana regarding personal care and stigma. This study explored qualitatively the experiences of people living with schizophrenia in Southern Ghana. Nine people with schizophrenia were purposively recruited for this study. Data were collected using semi-structured interviews and analysed thematically following a descriptive phenomenological data analysis framework. The study revealed that people with schizophrenia are capable of performing some activities of daily living, such as maintenance of personal and environmental hygiene and medication management. However, some participants narrated their experiences of stigma and thus, resorted to certain strategies such as spirituality, medication adherence and mental fortitude to cope with schizophrenia. In conclusion, it was evident that people with schizophrenia, in their lucid intervals, can undertake various activities of daily living, including personal care, however, living with schizophrenia impacts on psychological well-being enormously, and thus, education, counselling, and client adherence to the treatment may improve quality of life.
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Affiliation(s)
- Isaac Tetteh Commey
- Department of Mental Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, PMB, Cape Coast, Ghana.
| | - Jerry Paul K Ninnoni
- Department of Mental Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
| | - Evelyn Asamoah Ampofo
- Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
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Differences in daily life executive functioning between people with autism and people with schizophrenia. J Autism Dev Disord 2022:10.1007/s10803-022-05547-6. [PMID: 35441913 DOI: 10.1007/s10803-022-05547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
This is a comparative analysis of everyday executive functioning between individuals with Autism Spectrum Disorder (ASD), Schizophrenia Spectrum Disorders (SSD) and controls using Dysexecutive Questionnaire-Spanish (DEX-Sp), to identify patterns of difficulties. Also we assessed the relationship between EF and adaptive behavior as measured by the Vineland Adaptive Behavioral Scale-II. Common areas of everyday executive functions were established as problematic in individuals with ASD and SSD related to Disinhibition and Apathy, while Disorganization and Impulsivity was gravely affected in ASD group only. The degree of Dysexecutive Syndrome was predictive of adaptive behavior in ASD group only. These suggest that DEX-Sp could be a useful tool in differentiating areas of strength and weaknesses in clinical groups such as ASD and SDD.
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Effects of occupational balance and client-centered occupational management in a patient with schizophrenia. Asian J Psychiatr 2022; 69:102984. [PMID: 34973635 DOI: 10.1016/j.ajp.2021.102984] [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: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Occupational balance is an essential element for social participation and quality of life. However, it is difficult for patients with schizophrenia to participate in occupation and achieve occupational balance in daily life due to physical and mental symptoms. OBJECTIVE This study investigated the form of time use and occupational balance in a schizophrenic patient, and examined the effect of client-centered occupation-based case management. METHODS The research was conducted at a private center visited using one-on-one weekly client interactions for 10 weeks from September 1, 2020, and time use was analyzed using the Occupational Questionnaire (OQ) and the 2019 Life Time Survey Table of the National Statistical Office. In addition, data on work performance and satisfaction were collected using Canadian Occupational Performance Measure (COPM), and client-centered occupation-based interventions were conducted. RESULTS As a result of identifying the balance of work of clients, 38.46% of rest and sleep during the day, 30.77% of IADL, 17.94% of Work, 10.26% of BADL, and 2.57% of leisure. Through occupation-based case management for child care and work, which are the main goals of the client, the COPM score increased on average by 2 or more points per item, showing a positive effect. CONCLUSION In order to resolve the occupation imbalance of schizophrenic patients, it is necessary to closely understand the type of time use and actively intervene in client-centered occupation-based interventions. DATA AVAILABILITY STATEMENT Data pertinent to this report will be made available upon reasonable request to the author.
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Huang LJ, Hu FC, Wu C, Yang YH, Lee SC, Huang HC, Yu CY, Lai KY. Are the measurement structures of the Traditional Chinese Dispositional Flow Scale-2 equivalent between schizophrenic patients and healthy subjects? J Formos Med Assoc 2022; 121:1981-1992. [DOI: 10.1016/j.jfma.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022] Open
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10
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Axelsson SFA, Horst NK, Horiguchi N, Roberts AC, Robbins TW. Flexible versus Fixed Spatial Self-Ordered Response Sequencing: Effects of Inactivation and Neurochemical Modulation of Ventrolateral Prefrontal Cortex. J Neurosci 2021; 41:7246-7258. [PMID: 34261701 PMCID: PMC8387118 DOI: 10.1523/jneurosci.0227-21.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/16/2021] [Accepted: 05/30/2021] [Indexed: 11/21/2022] Open
Abstract
Previously, studies using human neuroimaging and excitotoxic lesions in non-human primate have demonstrated an important role of ventrolateral prefrontal cortex (vlPFC) in higher order cognitive functions such as cognitive flexibility and the planning of behavioral sequences. In the present experiments, we tested effects on performance of temporary inactivation (using GABA receptor agonists) and dopamine (DA) D2 and 5-HT2A-receptor (R) blockade of vlPFC via local intracerebral infusions in the marmoset. We trained common marmosets to perform spatial self-ordered sequencing tasks in which one cohort of animals performed two and three response sequences on a continuously varying spatial array of response options on a touch-sensitive screen. Inactivation of vlPFC produced a marked disruption of accuracy of sequencing which also exhibited significant error perseveration. There were somewhat contrasting effects of D2 and 5-HT2A-R blockade, with the former producing error perseveration on incorrect trials, though not significantly impairing accuracy overall, and the latter significantly impairing accuracy but not error perseveration. A second cohort of marmosets were directly compared on performance of fixed versus variable spatial arrays. Inactivation of vlPFC again impaired self-ordered sequencing, but only with varying, and not fixed spatial arrays, the latter leading to the consistent use of fewer, preferred sequences. These findings add to evidence that vlPFC is implicated in goal-directed behavior that requires higher-order response heuristics that can be applied flexibly over different (variable), as compared with fixed stimulus exemplars. They also show that dopaminergic and serotonergic chemomodulation has distinctive effects on such performance.SIGNIFICANCE STATEMENT This investigation employing local intracerebral infusions to inactivate the lateral prefrontal cortex (PFC) of the New World marmoset reveals the important role of this region in self-ordered response sequencing in variable but not fixed spatial arrays. These novel findings emphasize the higher order functions of this region, contributing to cognitive flexibility and planning of goal directed behavior. The investigation also reports for the first time somewhat contrasting neuromodulatory deficits produced by infusions of dopamine (DA) D2 and 5-HT2A receptor (R) antagonists into the same region, of possible significance for understanding cognitive deficits produced by anti-psychotic drugs.
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Affiliation(s)
- S F A Axelsson
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - N K Horst
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Naotaka Horiguchi
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - A C Roberts
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - T W Robbins
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom
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Holdnack JA, Brennan PF. Usability and Effectiveness of Immersive Virtual Grocery Shopping for Assessing Cognitive Fatigue in Healthy Controls: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e28073. [PMID: 34346898 PMCID: PMC8374668 DOI: 10.2196/28073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cognitive fatigue (CF) is a human response to stimulation and stress and is a common comorbidity in many medical conditions that can result in serious consequences; however, studying CF under controlled conditions is difficult. Immersive virtual reality provides an experimental environment that enables the precise measurement of the response of an individual to complex stimuli in a controlled environment. OBJECTIVE We aim to examine the development of an immersive virtual shopping experience to measure subjective and objective indicators of CF induced by instrumental activities of daily living. METHODS We will recruit 84 healthy participants (aged 18-75 years) for a 2-phase study. Phase 1 is a user experience study for testing the software functionality, user interface, and realism of the virtual shopping environment. Phase 2 uses a 3-arm randomized controlled trial to determine the effect that the immersive environment has on fatigue. Participants will be randomized into 1 of 3 conditions exploring fatigue response during a typical human activity (grocery shopping). The level of cognitive and emotional challenges will change during each activity. The primary outcome of phase 1 is the experience of user interface difficulties. The primary outcome of phase 2 is self-reported CF. The core secondary phase 2 outcomes include subjective cognitive load, change in task performance behavior, and eye tracking. Phase 2 uses within-subject repeated measures analysis of variance to compare pre- and postfatigue measures under 3 conditions (control, cognitive challenge, and emotional challenge). RESULTS This study was approved by the scientific review committee of the National Institute of Nursing Research and was identified as an exempt study by the institutional review board of the National Institutes of Health. Data collection will begin in spring 2021. CONCLUSIONS Immersive virtual reality may be a useful research platform for simulating the induction of CF associated with the cognitive and emotional challenges of instrumental activities of daily living. TRIAL REGISTRATION ClinicalTrials.gov NCT04883359; http://clinicaltrials.gov/ct2/show/NCT04883359. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/28073.
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Affiliation(s)
- James A Holdnack
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Patricia Flatley Brennan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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Tyburski E, Mak M, Sokołowski A, Starkowska A, Karabanowicz E, Kerestey M, Lebiecka Z, Preś J, Sagan L, Samochowiec J, Jansari AS. Executive Dysfunctions in Schizophrenia: A Critical Review of Traditional, Ecological, and Virtual Reality Assessments. J Clin Med 2021; 10:jcm10132782. [PMID: 34202881 PMCID: PMC8267962 DOI: 10.3390/jcm10132782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 01/19/2023] Open
Abstract
In recent years, interest has grown in measuring executive function in schizophrenia with ecological and virtual reality (VR) tools. However, there is a lack of critical analysis comparing those tools with traditional ones. This paper aims to characterize executive dysfunction in schizophrenia by comparing ecological and virtual reality assessments with traditional tools, and to describe the neurobiological and psychopathological correlates. The analysis revealed that ecological and VR tests have higher levels of verisimilitude and similar levels of veridicality compared to traditional tools. Both negative symptoms and disorganization correlate significantly with executive dysfunction as measured by traditional tools, but their relationships with measures based on ecological and VR methods are still unclear. Although there is much research on brain correlates of executive impairments in schizophrenia with traditional tools, it is uncertain if these results will be confirmed with the use of ecological and VR tools. In the diagnosis of executive dysfunction, it is important to use a variety of neuropsychological methods—especially those with confirmed ecological validity—to properly recognize the underlying characteristics of the observed deficits and to implement effective forms of therapy.
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Affiliation(s)
- Ernest Tyburski
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 61-719 Poznań, Poland
- Correspondence: ; Tel.: +48-61-271-12-22
| | - Monika Mak
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (M.M.); (Z.L.); (J.P.)
| | - Andrzej Sokołowski
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143, USA;
| | - Anna Starkowska
- Faculty of Psychology in Wrocław, SWPS University of Social Sciences and Humanities, 53-238 Wrocław, Poland;
| | - Ewa Karabanowicz
- Institute of Psychology, University of Szczecin, 71-017 Szczecin, Poland; (E.K.); (M.K.)
| | - Magdalena Kerestey
- Institute of Psychology, University of Szczecin, 71-017 Szczecin, Poland; (E.K.); (M.K.)
| | - Zofia Lebiecka
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (M.M.); (Z.L.); (J.P.)
| | - Joanna Preś
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (M.M.); (Z.L.); (J.P.)
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland;
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland;
| | - Ashok S. Jansari
- Department of Psychology, Goldsmiths, University of London, New Cross, London SE14 6NW, UK;
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Kim SY, Kim AR. Effectiveness of community-based interventions for patients with schizophrenia spectrum disorders: a study protocol for a systematic review. Syst Rev 2021; 10:106. [PMID: 33845902 PMCID: PMC8042964 DOI: 10.1186/s13643-021-01662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/05/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Schizophrenia requires a community-based intervention approach combined with standard treatment to prevent relapses. A literature review is required to understand the effectiveness of community-based interventions and to enhance quality in countries where they have not been fully established. This is a protocol for a systematic review of the effectiveness of community-based interventions for patients with schizophrenia spectrum disorders. METHODS We will search (from inception to January 2021) PubMed/MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, and Research Information Sharing Service/Korean databases. Randomized controlled trials on community-based interventions for patients with schizophrenia spectrum disorders will be eligible. The comparison groups will include patients with schizophrenia spectrum disorders who are only receiving the usual care and those who also receive community-based interventions. The schizophrenia spectrum disorders referred to in this study are defined according to the DSM-5: delusional disorders, schizophrenic disorders, and schizoaffective disorder will be included. Relapse/re-hospitalization rates (primary outcome) and quality of life (secondary outcome) will be identified for each group. Two reviewers will independently screen study titles, abstract data, and full-text articles and perform the data extraction process. Potential conflicts will be resolved through discussion. The study risk of bias will be appraised using the Cochrane Risk of Bias 2.0 tool. Results will be descriptively synthesized and will be structured according to patients' characteristics, intervention type and exposure, and outcome type. If feasible and appropriate, outcome data will be used to perform random effects meta-analyses. Discrete variables will be calculated via odds ratio, and continuous variables will be calculated via standardized mean difference using RevMan 5.3 software. DISCUSSION We will provide a summary of the available evidence on the effectiveness of community-based interventions and specific guidelines to improve their outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO ( CRD42019145660 ).
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Affiliation(s)
- Soo-Yeon Kim
- Department of Nursing, Daegu Haany University, Hanuidae-ro, Gyeongsan-si, Gyeongsangbuk-do 38609 Republic of Korea
| | - Ah. Rim Kim
- Department of Nursing, Far East University, Chungchungbuk-do, South Korea
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14
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Strassnig MT, Harvey PD, Miller ML, Depp CA, Granholm E. Real world sedentary behavior and activity levels in patients with schizophrenia and controls: An ecological momentary assessment study. Ment Health Phys Act 2021; 20:10.1016/j.mhpa.2020.100364. [PMID: 34221125 PMCID: PMC8247127 DOI: 10.1016/j.mhpa.2020.100364] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with schizophrenia often experience poor health, leading to shortened lifespans. The health of people with schizophrenia may be further exacerbated by increased sedentary behavior, which independently predicts health risk in the general population. However, the prevalence and patterns of objectively measured sedentary behavior in schizophrenia have not been studied extensively on a momentary basis. METHODS Activity of 100 patients with schizophrenia was compared to that of healthy controls (HC; n=71) using ecological momentary assessment (EMA). EMA provides real-time, real-world monitoring of behavior. We sampled behavior seven times per day for seven days, quantifying active versus inactive behaviors and four different movement patterns (recumbent, seated, standing, and moving). Due to different employment rates between samples, we focused on surveys completed at home. RESULTS Four of the five most commonly reported activities for participants with schizophrenia involved sitting or lying down. When considering activity during the last hour, participants with schizophrenia were more likely to be sitting or pacing and less likely to be standing than HC. If participants with schizophrenia only did one thing in the last hour, it was more likely to involve sitting and less likely to involve standing compared to HC. DISCUSSION People with schizophrenia were significantly more likely to be seated and less likely to be standing or active during the past hour than HC, despite high frequencies of seated behaviors in the HC as well. The adverse health consequences of sitting for extended periods may be especially relevant for people with schizophrenia and likely contribute to premature mortality in this population.
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Affiliation(s)
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL
- Bruce W. Carter VA Medical Center, Miami, FL
| | | | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA
- San Diego VA Medical Center La Jolla, CA
| | - Eric Granholm
- UCSD Health Sciences Center, La Jolla, CA
- San Diego VA Medical Center La Jolla, CA
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15
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Context-dependency in the Cognitive Bias Task and Resting-state Functional Connectivity of the Dorsolateral Prefrontal Cortex. J Int Neuropsychol Soc 2020; 26:749-762. [PMID: 32342829 DOI: 10.1017/s1355617720000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Goldberg, the author of the "novelty-routinization" framework, suggested a new pair of cognitive styles for agent-centered decision-making (DM), context-dependency/independency (CD/CI), quantified by the Cognitive Bias Task (CBT) and supposedly reflecting functional brain hemispheric specialization. To date, there are only three lesion and activation neuroimaging studies on the CBT with the largest sample of 12 participants. The present study is the first to analyze whole-brain functional connectivity (FC) of the dorsolateral prefrontal cortex (DLPFC), involved in contextual agent-centered DM. METHOD We compared whole-brain resting-state FC of the DLPFC between CD (n = 24) and CI (n = 22) healthy participants. Additionally, we investigated associations between CD/CI and different aspects of executive functions. RESULTS CD participants had stronger positive FC of the DLPFC with motor and visual regions; FC of the left DLPFC was more extensive. CI participants had stronger positive FC of the left DLPFC with right prefrontal and parietal-occipital areas and of the left and right DLPFC with ipsilateral cerebellar hemispheres. No sex differences were found. CD/CI had nonlinear associations with working memory. CONCLUSIONS The findings suggest that CD and CI are associated with different patterns of DLPFC FC. While CD is associated with FC between DLPFC and areas presumably involved in storing representations of current situation, CI is more likely to be associated with FC between DLPFC and right-lateralized associative regions, probably involved in the inhibition of the CD response and switching from processing of incoming perceptual information to creation of original response strategies.
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The Optimal Length of Hospitalization for Functional Recovery of Schizophrenia Patients, a Real-World Study in Chinese People. Psychiatr Q 2019; 90:661-670. [PMID: 31327081 DOI: 10.1007/s11126-019-09658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study investigated the relationship between the activities of daily living and the length of hospitalization to determine the optimal length of hospitalization for patients with schizophrenia. We collected information from all schizophrenia patients discharged in Peking University Huilongguan Clinical Medical School from January 1, 2015 to December 31, 2015. A total of 1967 patients were enrolled in this study. The Chinese version of the modified Barthel index (MBI-C) was used to assess patients' actual performance on activities of daily living. We used the paired samples t-test to compare MBI-C scores at admission and discharge and performed correlation analysis to find the trend of MBI-C change with length of hospitalization. The average length of hospitalization was 73.3 ± 42.2 days. There were significant differences between the MBI-C scores at the time of discharge from hospital compared with those at the time of admission to the hospital (93.4 ± 11.2 vs. 88.7 ± 11.8; P < 0.001). Taking the length of hospitalization as the grouping boundary value, the correlation analysis of the subgroup found that below a minimum of 20 days, the improvement in the MBI-C scores increased with the increase of length of hospitalization, and above a maximum of 50 days, the improvement in the MBI-C scores decreased with the increase of length of hospitalization. The optimal length of hospitalization for patients with schizophrenia may lie between 20 and 50 days, with regard to the recovery of daily living function.
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Harvey PD, Strassnig MT. Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry 2019; 18:165-167. [PMID: 31059625 PMCID: PMC6502430 DOI: 10.1002/wps.20647] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Research Service, Miami VA Healthcare System, Miami, FL, USA
| | - Martin T. Strassnig
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Palm Beach County Mental Health Services, Delray Beach, FL, USA
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18
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Hellinger N, Lipskaya-Velikovsky L, Weizman A, Ratzon NZ. Comparing executive functioning and clinical and sociodemographic characteristics of people with schizophrenia who hold a driver's license to those who do not. The Canadian Journal of Occupational Therapy 2019; 86:70-80. [PMID: 30991831 DOI: 10.1177/0008417419831399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Community engagement requires driving. However, there is paucity of research focusing on the potential to drive for people with schizophrenia. PURPOSE. This study aimed to characterize people with schizophrenia by comparing clinical signs, executive functions (EF), and sociodemographic aspects of those holding a driver's license to those without one. METHOD. This cross-sectional study used convenience sampling to select 60 ambulatory individuals to participate: 31 with a driver's license and 29 without one. They completed the Wisconsin Card Sorting Test (WCST) for evaluation of EF and the Positive and Negative Syndrome Scale (PANSS) for symptoms severity evaluation. Data were analyzed using multivariate analyses of covariance and logistic regression models. FINDINGS. Participants with a license had less severe negative symptoms and general psychopathology and better EF and sociodemographic aspects compared to those without a license. Logistic regression revealed significant odds ratios (OR) in general psychopathology (PANSS; OR = 0.963, p = .011) and in the WCST (OR = 0.504, p = .027). IMPLICATIONS. This study offers occupational therapists a data-driven perspective on evaluating potential fitness to drive to enable participation in daily life and well-being of people with schizophrenia.
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Berrouiguet S, Ramírez D, Barrigón ML, Moreno-Muñoz P, Carmona Camacho R, Baca-García E, Artés-Rodríguez A. Combining Continuous Smartphone Native Sensors Data Capture and Unsupervised Data Mining Techniques for Behavioral Changes Detection: A Case Series of the Evidence-Based Behavior (eB2) Study. JMIR Mhealth Uhealth 2018; 6:e197. [PMID: 30530465 PMCID: PMC6305880 DOI: 10.2196/mhealth.9472] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/18/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The emergence of smartphones, wearable sensor technologies, and smart homes allows the nonintrusive collection of activity data. Thus, health-related events, such as activities of daily living (ADLs; eg, mobility patterns, feeding, sleeping, ...) can be captured without patients' active participation. We designed a system to detect changes in the mobility patterns based on the smartphone's native sensors and advanced machine learning and signal processing techniques. OBJECTIVE The principal objective of this work is to assess the feasibility of detecting mobility pattern changes in a sample of outpatients with depression using the smartphone's sensors. The proposed method processed the data acquired by the smartphone using an unsupervised detection technique. METHODS In this study, 38 outpatients from the Hospital Fundación Jiménez Díaz Psychiatry Department (Madrid, Spain) participated. The Evidence-Based Behavior (eB2) app was downloaded by patients on the day of recruitment and configured with the assistance of a physician. The app captured the following data: inertial sensors, physical activity, phone calls and message logs, app usage, nearby Bluetooth and Wi-Fi connections, and location. We applied a change-point detection technique to location data on a sample of 9 outpatients recruited between April 6, 2017 and December 14, 2017. The change-point detection was based only on location information, but the eB2 platform allowed for an easy integration of additional data. The app remained running in the background on patients' smartphone during the study participation. RESULTS The principal outcome measure was the identification of mobility pattern changes based on an unsupervised detection technique applied to the smartphone's native sensors data. Here, results from 5 patients' records are presented as a case series. The eB2 system detected specific mobility pattern changes according to the patients' activity, which may be used as indicators of behavioral and clinical state changes. CONCLUSIONS The proposed technique could automatically detect changes in the mobility patterns of outpatients who took part in this study. Assuming these mobility pattern changes correlated with behavioral changes, we have developed a technique that may identify possible relapses or clinical changes. Nevertheless, it is important to point out that the detected changes are not always related to relapses and that some clinical changes cannot be detected by the proposed method.
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Affiliation(s)
- Sofian Berrouiguet
- Department of Psychiatry and Emergency, Brest Medical University Hospital, Brest, France.,IMT Atlantique, Lab-STICC, F-29238, Brest, France.,SPURBO EA 7479, Université de Bretagne Occidentale (UBO), Brest, France.,CHRU Cavale Blanche University Hospital of Brest, Brest, France
| | - David Ramírez
- Universidad Carlos III de Madrid, Leganés, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
| | - María Luisa Barrigón
- Department of Psychiatry, Fundación Jiménez Díaz Hospital, Madrid, Spain.,Department of Psychiatry, Autónoma University, Madrid, Spain
| | - Pablo Moreno-Muñoz
- Universidad Carlos III de Madrid, Leganés, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | - Enrique Baca-García
- Department of Psychiatry, Fundación Jiménez Díaz Hospital, Madrid, Spain.,Department of Psychiatry, Autónoma University, Madrid, Spain.,Centro de Investigación en Salud Mental, Carlos III Institute of Health, Madrid, Spain
| | - Antonio Artés-Rodríguez
- Universidad Carlos III de Madrid, Leganés, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain.,Centro de Investigación en Salud Mental, Carlos III Institute of Health, Madrid, Spain
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20
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Laloyaux J, Van der Linden M, Nuechterlein KH, Thonon B, Larøi F. A direct examination of the cognitive underpinnings of multitasking abilities: A first study examining schizophrenia. Psychiatry Res 2018; 268:288-296. [PMID: 30081201 DOI: 10.1016/j.psychres.2018.06.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/14/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Abstract
Many real world activities are complex and require multitasking abilities. However, the nature of these abilities remains poorly understood, and in particular in schizophrenia. The aim of the present study was to provide a better understanding of such abilities with the help of a newly developed computerized tool, the Computerized Meeting Preparation Task (CMPT). Fifty-seven individuals with schizophrenia and 39 healthy controls completed the CMPT and an extensive cognitive battery. Patients were also evaluated with a series of clinical measures. During the CMPT, participants are asked to prepare a room for a meeting while, at the same time, dealing with interruptions, solving problems, and remembering prospective memory instructions. The CMPT was found to significantly differentiate patients and healthy controls for several variables. Results also showed that multitasking abilities were related to a large array of cognitive functions and, in particular, to those associated to executive functioning. These relations were not explained by the presence of a general cognitive impairment. Finally, a double dissociation between multitasking abilities and performance on standard cognitive tests was observed. Altogether, these results underline the importance of evaluating multitasking abilities in schizophrenia as it allows detecting cognitive difficulties that cannot be identified by standard cognitive tests.
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Affiliation(s)
- Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium.
| | - Martial Van der Linden
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium; Cognitive Psychopathology and Neuropsychology Unit, University of Geneva, Geneva, Switzerland
| | - Keith H Nuechterlein
- Departments of Psychiatry and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Bénédicte Thonon
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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Khalkhali M, Golshahi M, Hasandokht T, Kafie M, Zare R. Cognitive Functioning in Schizophrenia, Methamphetamine-induced Psychotic Disorder, and Healthy People: A Comparative Study. Adv Biomed Res 2018; 7:123. [PMID: 30211136 PMCID: PMC6124221 DOI: 10.4103/abr.abr_14_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Methamphetamine-induced psychotic disorder (MIP) cannot be easily differentiated from other psychotic disorders. Some studies have reported that patients with MIP and schizophrenia have differences in their cognitive functioning. We hypothesized that their performance would be different on neuropsychological tests which assess executive functions and visual memory. Materials and Methods: In a cross-sectional study, 30 patients with MIP, 31 patients with schizophrenia, and 31 healthy controls were assessed by Rey–Osterrieth complex figure (ROCF) test and visual search and attention test (VSAT). One-way analysis of variance was performed to compare the mean scores of tests. Tukey's HSD test was used for post hoc analysis. Results: Three groups had significant differences according to ROCF test (F = 15.76, P < 0.0001), VSAT (F = 39.78, P < 0.0001), left VSAT (F = 37.96, P < 0.0001), right VSAT (F = 40.40, P < 0.0001), and the time of the test administration (F = 3.26, P = 0.04). The post hoc analysis showed that the mean score of ROCF test and VSAT (total, right, and left) was significantly higher in the control group than in the other two groups. The time of administering the test in the control group was significantly shorter than in the MIP group (P < 0.03) and nonsignificantly shorter than in the schizophrenia group (P = 0.54). The mean score of right side VSAT was significantly higher in the MIP group than in the schizophrenia group. Conclusion: ROCF could not differentiate MIP from schizophrenia. The better performance of patients with MIP on right side VSAT that is reported in this and in the previous study needs to be reevaluated in more controlled studies.
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Affiliation(s)
- Mohammadrasoul Khalkhali
- Department of Psychiatry, Shafa Psychiatry Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobeh Golshahi
- Department of Psychiatry, Shafa Psychiatry Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Moosa Kafie
- Department of Psychology, University of Guilan, Rasht, Iran
| | - Roghaye Zare
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
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22
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Sjåstad H, Baumeister RF. The Future and the Will: Planning requires self-control, and ego depletion leads to planning aversion. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2018. [DOI: 10.1016/j.jesp.2018.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Lambert C, Da Silva S, Ceniti AK, Rizvi SJ, Foussias G, Kennedy SH. Anhedonia in depression and schizophrenia: A transdiagnostic challenge. CNS Neurosci Ther 2018; 24:615-623. [PMID: 29687627 DOI: 10.1111/cns.12854] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anhedonia, as a dysregulation of the reward circuit, is present in both Major Depressive Disorder (MDD) and schizophrenia (SZ). AIMS To elucidate the clinical and neurobiological differences between schizophrenia (SZ) and depression (MDD) in regard to anhedonia, while reconciling the challenges and benefits of assessing anhedonia as a transdiagnostic feature under the Research Domain Criteria (RDoC) framework. METHODS In this review, we summarize data from publications examining anhedonia or its underlying reward deficits in SZ and MDD. A literature search was conducted in OVID Medline, PsycINFO and EMBASE databases between 2000 and 2017. RESULTS While certain subgroups share commonalities, there are also important differences. SZ may be characterized by a disorganization, rather than a deficiency, in reward processing and cognitive function, including inappropriate energy expenditure and focus on irrelevant cues. In contrast, MDD has been characterized by deficits in anticipatory pleasure, development of reward associations, and integration of information from past experience. Understanding the roles of neurotransmitters and aberrant brain circuitry is necessary to appreciate differences in reward function in SZ and MDD. CONCLUSION Anhedonia as a clinical presentation of reward circuit dysregulation is an important and relatively undertreated symptom of both SZ and MDD. In order to improve patient outcomes and quality of life, it is important to consider how anhedonia fits into both diagnoses.
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Affiliation(s)
- Clare Lambert
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland
| | - Susana Da Silva
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Amanda K Ceniti
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sakina J Rizvi
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Mental Health and Addiction Service, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Mental Health and Addiction Service, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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24
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Berrouiguet S, Perez-Rodriguez MM, Larsen M, Baca-García E, Courtet P, Oquendo M. From eHealth to iHealth: Transition to Participatory and Personalized Medicine in Mental Health. J Med Internet Res 2018; 20:e2. [PMID: 29298748 PMCID: PMC5772066 DOI: 10.2196/jmir.7412] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/08/2017] [Accepted: 09/13/2017] [Indexed: 11/13/2022] Open
Abstract
Clinical assessment in psychiatry is commonly based on findings from brief, regularly scheduled in-person appointments. Although critically important, this approach reduces assessment to cross-sectional observations that miss essential information about disease course. The mental health provider makes all medical decisions based on this limited information. Thanks to recent technological advances such as mobile phones and other personal devices, electronic health (eHealth) data collection strategies now can provide access to real-time patient self-report data during the interval between visits. Since mobile phones are generally kept on at all times and carried everywhere, they are an ideal platform for the broad implementation of ecological momentary assessment technology. Integration of these tools into medical practice has heralded the eHealth era. Intelligent health (iHealth) further builds on and expands eHealth by adding novel built-in data analysis approaches based on (1) incorporation of new technologies into clinical practice to enhance real-time self-monitoring, (2) extension of assessment to the patient's environment including caregivers, and (3) data processing using data mining to support medical decision making and personalized medicine. This will shift mental health care from a reactive to a proactive and personalized discipline.
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Affiliation(s)
- Sofian Berrouiguet
- Lab-STICC, IMT Atlantique, Université Bretagne Loire, Brest, France.,Laboratoire Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale SPURBO, Equipe d'accueil 7479, Brest, France
| | | | - Mark Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Enrique Baca-García
- Department of Psychiatry, Fundación Jimenez Diaz Hospital, Autónoma University, Centro de Investigacion en Red Salud Mental, Madrid, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Maria Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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25
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Efficacy of a Micro-Prompting Technology in Reducing Support Needed by People With Severe Acquired Brain Injury in Activities of Daily Living: A Randomized Control Trial. J Head Trauma Rehabil 2017; 33:E33-E41. [PMID: 29194177 DOI: 10.1097/htr.0000000000000358] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an automated interactive prompting technology in supporting the morning routine of persons with acquired brain injury. The morning routine included maintaining personal hygiene and dressing. SETTING An inpatient neurorehabilitation hospital. PARTICIPANTS Persons with acquired brain injury who required prompting when following their morning routine (n = 24), but were not limited by physical disability or dysphasia, took part in the study. Participants (67% with traumatic brain injury) had impairment on indices of memory and executive function. DESIGN A randomized control trial evaluated the effect of an automated interactive micro-prompting device on the number of prompts by trained staff required for successful completion of the morning routine. MAIN MEASURES Study-specific checklists assessed sequence performance, errors, and verbal prompts required over baseline, rehabilitation as usual, intervention, and return to baseline conditions. RESULTS The intervention significantly reduced the support required to complete the task compared with usual rehabilitation. CONCLUSIONS Micro-prompting technology is an effective assistive technology for cognition, which reduces support needs in people with significant cognitive impairments.
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Molins C, Carceller-Sindreu M, Navarro H, Carmona C, Piñeiro M, Martínez E, Álvarez E, Portella MJ. Plasma ratio of clozapine to N-desmethylclozapine can predict cognitive performance in treatment-resistant psychotic patients. Psychiatry Res 2017; 258:153-157. [PMID: 29024893 DOI: 10.1016/j.psychres.2017.10.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/11/2017] [Accepted: 10/02/2017] [Indexed: 01/22/2023]
Abstract
Cognitive symptoms play a central role in schizophrenia and are strongly associated with social functioning. Treatment with clozapine presents controversial results regarding its effects on cognition. The opposite effects of clozapine and n-desmethylclozapine (NDMC) on cholinergic system have been suggested to underlie these inconclusive findings. The aim of this study is to determine whether clozapine/NDMC ratio can predict cognitive performance in patients with treatment-resistant psychosis. Nineteen clinically stable patients with schizophrenia or schizoaffective disorder treated with clozapine monotherapy completed demographic and clinical interviews. For the purpose of the study, patients were assessed with a neuropsychological battery and on the same day a blood sampling was obtained from each patient to measure plasma levels of clozapine and NDMC. Our results showed that clozapine/NDMC ratio, but not clozapine or NDMC plasma levels separately, was a predictive factor of cognitive performance, specifically of executive functioning. Our results showed that lower clozapine/NDMC ratios are associated with better executive functioning in clinically stable patients. These findings could be interpreted by the different pharmacodynamic properties on cholinergic, dopaminergic and serotonergic systems of NDMC compared to clozapine.
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Affiliation(s)
- Conrad Molins
- Hospital de la Santa Creu i Sant Pau, Department of Psychiatry, Barcelona, Spain
| | - Mar Carceller-Sindreu
- Sant Pau Institute of Biomedical Research IIB-Sant Pau, Department of Psychiatry, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Helena Navarro
- Hospital de la Santa Creu i Sant Pau, Department of Psychiatry, Barcelona, Spain
| | - Cristina Carmona
- Hospital de la Santa Creu i Sant Pau, Department of Psychiatry, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Marina Piñeiro
- Hospital de la Santa Creu i Sant Pau, Department of Psychiatry, Barcelona, Spain
| | - Estrella Martínez
- Hospital de la Santa Creu i Sant Pau, Department of Psychiatry, Barcelona, Spain
| | - Enric Álvarez
- Hospital de la Santa Creu i Sant Pau, Department of Psychiatry, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria J Portella
- Sant Pau Institute of Biomedical Research IIB-Sant Pau, Department of Psychiatry, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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27
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Tyburski E, Pełka-Wysiecka J, Mak M, Samochowiec A, Bieńkowski P, Samochowiec J. Neuropsychological Profile of Specific Executive Dysfunctions in Patients with Deficit and Non-deficit Schizophrenia. Front Psychol 2017; 8:1459. [PMID: 28912737 PMCID: PMC5582382 DOI: 10.3389/fpsyg.2017.01459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives: Although it has been shown that there are more profound deficits present in deficit schizophrenia (DS) patients than in non-deficit schizophrenia (NDS) patients, there still remain some matters requiring further investigation. In this context, we formulated three research aims: (1) to compare executive functions between the investigated groups, (2) to determine the relationship between particular aspects of executive functions within the groups, and (3) to draw up a neuropsychological profile for executive functions. Methods: The study involved 148 schizophrenia patients divided into two groups on the basis of the Schedule for the Deficit Syndrome: DS (n = 70) and NDS (n = 78). Patients were matched for sex, age, years of education, and overall cognitive functioning. For assessing executive functions we used the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), the Phonemic Verbal Fluency Test (VFT P), the Stroop Color and Word Test (SCWT), and the Go/No Go task (GNG). Results: Deficit schizophrenia patients scored lower on the WCST and TMT (relative flexibility) than did the NDS patients. There were no inter-group differences in the VFT P, SCWT (relative inhibition), or GNG. There were significant correlations between WCST and TMT scores in both groups. The general neuropsychological profiles were similar in both groups. Conclusion: Deficit schizophrenia patients exhibited slightly greater interference with concept formation and non-verbal cognitive flexibility. Therefore, such problems may be specific to this particular type of schizophrenia. These results may be useful for the development of neuropsychological diagnostic methods for patients with schizophrenia.
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Affiliation(s)
- Ernest Tyburski
- Department of Clinical Psychology, Institute of Psychology, University of SzczecinSzczecin, Poland
| | | | - Monika Mak
- Independent Clinical Psychology Unit, Department of Psychiatry, Pomeranian Medical UniversitySzczecin, Poland
| | - Agnieszka Samochowiec
- Department of Clinical Psychology, Institute of Psychology, University of SzczecinSzczecin, Poland
| | | | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical UniversitySzczecin, Poland
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Lewis MW, Babbage DR, Leathem JM. Systematic behavioural observation of executive performance after brain injury. Brain Inj 2017; 31:639-648. [DOI: 10.1080/02699052.2017.1283535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mark W. Lewis
- School of Psychology, Massey University, Wellington, New Zealand
| | - Duncan R. Babbage
- Centre for eHealth, Auckland University of Technology, Auckland, New Zealand
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Janet M. Leathem
- School of Psychology, Massey University, Wellington, New Zealand
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29
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Weinberger R, Yi J, Calkins M, Guri Y, McDonald-McGinn DM, Emanuel BS, Zackai EH, Ruparel K, Carmel M, Michaelovsky E, Weizman A, Gur RC, Gur RE, Gothelf D. Neurocognitive profile in psychotic versus nonpsychotic individuals with 22q11.2 deletion syndrome. Eur Neuropsychopharmacol 2016; 26:1610-8. [PMID: 27524298 DOI: 10.1016/j.euroneuro.2016.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/12/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Abstract
The 22q11.2 deletion syndrome (22q11DS) is associated with increased rates of psychotic disorders and cognitive deficits, but large scale studies are needed to elucidate their interaction. The objective of this two-center study was to identify the neurocognitive phenotype of individuals with 22q11DS and psychotic disorders. We hypothesized that psychotic 22q11DS individuals compared to nonpsychotic deleted individuals would have more severe neurocognitive deficits, especially in executive function and social cognition. These deficits would be present when compared to IQ- matched individuals with Williams Syndrome (WS). Three groups were ascertained from the Tel Aviv and Philadelphia centers: 22q11DS individuals with a psychotic disorder (n=31), nonpsychotic 22q11DS (n=86) and typically-developing controls (TD, n=828). In Tel Aviv a group of individuals with WS (n=18) matched in IQ to the 22q11DS psychotic group was also included. The Penn Computerized Neurocognitive Battery (CNB) was used to assess a wide-range of cognitive functions and all patients underwent structured psychiatric evaluations. 22q11DS individuals performed poorly on all CNB domains compared to TD. Participants with 22q11DS and psychosis, compared to nonpsychotic 22q11DS, had more severe deficits in global neurocognitive performance (GNP), executive function, social cognition and episodic memory domains. The primary deficits were also significant when comparing the Tel Aviv 22q11DS psychotic group to IQ-matched individuals with WS. In conclusion, 22q11DS individuals with a psychotic disorder have specific neurocognitive deficits that are reliably identified cross nationality using the CNB. These cognitive dysfunctions should be further studied as potential endophenotypes of psychosis in 22q11DS and as targets for intervention.
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Affiliation(s)
| | - James Yi
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Monica Calkins
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Yael Guri
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Donna M McDonald-McGinn
- Division of Human Genetics, The Children׳s Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Beverly S Emanuel
- Division of Human Genetics, The Children׳s Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Elaine H Zackai
- Division of Human Genetics, The Children׳s Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Miri Carmel
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Elena Michaelovsky
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel
| | - Ruben C Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Israel; The Child Psychiatry Unit, Edmond and Lily Sapfra Children׳s Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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30
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Culbreth AJ, Westbrook A, Xu Z, Barch DM, Waltz JA. Intact Ventral Striatal Prediction Error Signaling in Medicated Schizophrenia Patients. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:474-483. [PMID: 28239676 DOI: 10.1016/j.bpsc.2016.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Midbrain dopaminergic neurons code a computational quantity, reward prediction error (RPE), which has been causally related to learning. Recently, this insight has been leveraged to link phenomenological and biological levels of understanding in psychiatric disorders, such as schizophrenia. However, results have been mixed, possibly due to small sample sizes. Here we present results from two studies with relatively large Ns to assess VS RPE in schizophrenia. METHODS In the current study we analyzed data from two independent studies, involving a total of 87 chronic medicated schizophrenia patients and 61 controls. Subjects completed a probabilistic reinforcement-learning task in conjunction with fMRI scanning. We fit each participant's choice behavior to a Q-learning model and derived trial-wise RPEs. We then modeled BOLD signal data with parametric regressor functions using these values to determine whether patient and control groups differed in prediction-error-related BOLD signal modulations. RESULTS Both groups demonstrated robust VS RPE BOLD activations. Interestingly, these BOLD activation patterns did not differ between groups in either study. This was true when we included all participants in the analysis, as well as when we excluded participants whose data was not sufficiently fit by the models. CONCLUSIONS These data demonstrate the utility of computational methods in isolating/testing underlying mechanisms of interest in psychiatric disorders. Importantly, similar VS RPE signal encoding across groups suggests that this mechanism does not drive task deficits in these patients. Deficits may instead stem from aberrant prefrontal/parietal circuits associated with maintenance and selection of goal-relevant information.
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Affiliation(s)
- Adam J Culbreth
- Department of Psychological and Brain Sciences, Washington University in Saint Louis
| | - Andrew Westbrook
- Department of Psychological and Brain Sciences, Washington University in Saint Louis
| | - Ziye Xu
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in Saint Louis; Department of Psychiatry & Radiology, Washington University in Saint Louis
| | - James A Waltz
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center
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31
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Culbreth AJ, Westbrook A, Daw ND, Botvinick M, Barch DM. Reduced model-based decision-making in schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:777-787. [PMID: 27175984 PMCID: PMC4980177 DOI: 10.1037/abn0000164] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Individuals with schizophrenia have a diminished ability to use reward history to adaptively guide behavior. However, tasks traditionally used to assess such deficits often rely on multiple cognitive and neural processes, leaving etiology unresolved. In the current study, we adopted recent computational formalisms of reinforcement learning to distinguish between model-based and model-free decision-making in hopes of specifying mechanisms associated with reinforcement-learning dysfunction in schizophrenia. Under this framework, decision-making is model-free to the extent that it relies solely on prior reward history, and model-based if it relies on prospective information such as motivational state, future consequences, and the likelihood of obtaining various outcomes. Model-based and model-free decision-making was assessed in 33 schizophrenia patients and 30 controls using a 2-stage 2-alternative forced choice task previously demonstrated to discern individual differences in reliance on the 2 forms of reinforcement-learning. We show that, compared with controls, schizophrenia patients demonstrate decreased reliance on model-based decision-making. Further, parameter estimates of model-based behavior correlate positively with IQ and working memory measures, suggesting that model-based deficits seen in schizophrenia may be partially explained by higher-order cognitive deficits. These findings demonstrate specific reinforcement-learning and decision-making deficits and thereby provide valuable insights for understanding disordered behavior in schizophrenia. (PsycINFO Database Record
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Affiliation(s)
- Adam J. Culbreth
- Department of Psychological and Brain Sciences, Washington University in Saint Louis
| | - Andrew Westbrook
- Department of Psychological and Brain Sciences, Washington University in Saint Louis
| | - Nathaniel D. Daw
- Princeton Neuroscience Institute and Department of Psychology, Princeton University
| | - Matthew Botvinick
- Princeton Neuroscience Institute and Department of Psychology, Princeton University
| | - Deanna M. Barch
- Department of Psychological and Brain Sciences, Washington University in Saint Louis
- Department of Psychiatry & Radiology, Washington University in Saint Louis
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32
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Clinical utility of the Multiple Errands Test in schizophrenia: A preliminary assessment. Psychiatry Res 2016; 240:390-397. [PMID: 27138836 DOI: 10.1016/j.psychres.2016.04.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 01/25/2023]
Abstract
Schizophrenia (SZ) is a chronic, severe disease, which results in misperception of reality, major social withdrawal, and cognitive disturbances. One type of cognitive disturbance, known as executive dysfunction, is widely considered as a primary determinant of functional outcome. However, classic neuropsychological measures of executive functioning (EF) poorly represent patients' functional outcome, and thus seem inappropriate for evaluating the real-world functional impact of diseases such as SZ. We hypothesized that the Multiple Errands Test (MET), an ecological assessment of executive function would show greater ability to measure everyday adaptive functioning SZ, compared to conventional EF assessment methods. 100 clinically stable SZ patients were administered the MET, Wisconsin Card Sorting Test - 64 and a paper version of MET. Correlation analyses were performed between each EF measure and functional outcome, as measured by the Social Autonomy Scale (SAS). After adjusting for age, education, IQ and illness duration, SAS was significantly predicted by MET global score. No other EF measure correlated with SAS. Results from this study suggest that MET offers a valuable prediction of daily life functional outcome in this large sample of SZ patients. Therefore, it could be used as a complementary measure to improve the identification of executive dysfunctions prior to psychosocial interventions.
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Katz N, Tadmor I, Felzen B, Hartman-Maeir A. Validity of the Executive Function Performance Test in Individuals with Schizophrenia. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920702700202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine the reliability and validity of the Executive Function Performance Test (EFPT) in a schizophrenic population. Participants were 30 individuals with the acute phase of schizophrenia and 31 with the chronic stage. Internal consistency using Cronbach's alpha was high (α = .88). Two-way multiple analysis of covariance revealed that the acute group scored significantly higher than the chronic group on almost all tasks and components of the EFPT ( p = .045 to .000), supporting construct validity. Moderate to high Spearman correlation coefficients were found between the total EFPT score and the total Behavioral Assessment of the Dysexecutive Syndrome profile and standardized scores within each of the groups ( r =.433 to .764; p < .017 to .000), supporting criterion validity. The findings support the use of the EFPT for identifying executive functions in the context of everyday life and instrumental activities of daily living tasks. However, further studies are needed in different populations and cultures.
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34
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Arnould A, Rochat L, Dromer E, Azouvi P, Van der Linden M. Does multitasking mediate the relationships between episodic memory, attention, executive functions and apathetic manifestations in traumatic brain injury? J Neuropsychol 2016; 12:101-119. [DOI: 10.1111/jnp.12107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/12/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Annabelle Arnould
- Cognitive Psychopathology and Neuropsychology Unit; University of Geneva; Switzerland
- Department of Physical Medicine and Rehabilitation; AP-HP; Raymond Poincaré Hospital; Garches France
- EA 4047; HANDIReSP; University of Versailles-Saint-Quentin-en Yvelines; France
| | - Lucien Rochat
- Cognitive Psychopathology and Neuropsychology Unit; University of Geneva; Switzerland
- Swiss Centre for Affective Sciences; University of Geneva; Switzerland
| | - Emilie Dromer
- Department of Physical Medicine and Rehabilitation; AP-HP; Raymond Poincaré Hospital; Garches France
- EA 4047; HANDIReSP; University of Versailles-Saint-Quentin-en Yvelines; France
| | - Philippe Azouvi
- Department of Physical Medicine and Rehabilitation; AP-HP; Raymond Poincaré Hospital; Garches France
- EA 4047; HANDIReSP; University of Versailles-Saint-Quentin-en Yvelines; France
| | - Martial Van der Linden
- Cognitive Psychopathology and Neuropsychology Unit; University of Geneva; Switzerland
- Swiss Centre for Affective Sciences; University of Geneva; Switzerland
- Cognitive Psychopathology Unit; University of Liège; Belgium
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35
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Maeder J, Schneider M, Bostelmann M, Debbané M, Glaser B, Menghetti S, Schaer M, Eliez S. Developmental trajectories of executive functions in 22q11.2 deletion syndrome. J Neurodev Disord 2016; 8:10. [PMID: 27018204 PMCID: PMC4807556 DOI: 10.1186/s11689-016-9141-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/08/2016] [Indexed: 12/13/2022] Open
Abstract
Background 22q11.2 deletion syndrome (22q11.2DS) is a genetic disorder associated with a specific cognitive profile. Higher-order cognitive skills like executive functions (EF) are reported as a relative weakness in this population. The present study aimed to delineate the developmental trajectories of multiple EF domains in a longitudinal sample using a broader age range than previous studies. Given the high incidence of psychotic symptoms in 22q11.2DS, we also compared the development of EF in participants with/without comorbid psychotic symptoms. Given the importance of EF in daily life, the third aim of the study was to characterize the link between EF and adaptive functioning. Methods The sample consisted of 95 individuals with 22q11.2DS and 100 typically developing controls aged 6–26 years. A large proportion of the sample (55.38 %) had multiple time points available. Between-group differences in the developmental trajectories of three subdomains of EF (verbal fluency, working memory, and inhibition) were examined using mixed models regression analyses. Analyses were repeated comparing only the 22q11.2DS group based on the presence/absence of psychotic symptoms to investigate the influence of executive dysfunction on the emergence of psychotic symptoms. Hierarchical stepwise regression analyses were also conducted to investigate the predictive value of EF on adaptive functioning. Results We observed lower performance on EF domains, as well as atypical development of working memory and verbal fluency. Participants who presented with negative symptoms exhibited different developmental trajectories of inhibition and working memory. Adaptive functioning level was not significantly predicted by EF scores. Conclusions The present study highlighted domain-specific atypical trajectories of EF in individuals with 22q11.DS and explored the link with psychotic symptoms. However, no relation between EF and adaptive functioning was observed.
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Affiliation(s)
- Johanna Maeder
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Maude Schneider
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Mathilde Bostelmann
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Martin Debbané
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland ; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Bronwyn Glaser
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Sarah Menghetti
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Marie Schaer
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Stanford Cognitive and Systems Neuroscience Laboratory, Stanford University School of Medicine, California, USA
| | - Stephan Eliez
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
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Culbreth AJ, Gold JM, Cools R, Barch DM. Impaired Activation in Cognitive Control Regions Predicts Reversal Learning in Schizophrenia. Schizophr Bull 2016; 42:484-93. [PMID: 26049083 PMCID: PMC4753588 DOI: 10.1093/schbul/sbv075] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reinforcement learning deficits have been associated with schizophrenia (SZ). However, the pathophysiology that gives rise to these abnormalities remains unclear. To address this question, SZ patients (N = 58) and controls (CN; N = 36) completed a probabilistic reversal-learning paradigm during functional magnetic resonance imaging scanning. During the task, participants choose between 2 stimuli. Initially, 1 stimulus was frequently rewarded (80%); the other was infrequently rewarded (20%). The reward contingencies reversed periodically because the participant learned the more rewarded stimulus. The results indicated that SZ patients achieved fewer reversals than CN, and demonstrated decreased winstay-loseshift decision-making behavior. On loseshift compared to winstay trials, SZ patients showed reduced Blood Oxygen Level Dependent activation compared to CN in a network of brain regions widely associated with cognitive control, and striatal regions. Importantly, relationships between group membership and behavior were mediated by alterations in the activity of cognitive control regions, but not striatum. These findings indicate an important role for the cognitive control network in mediating the use and updating of value representations in SZ. Such results provide biological targets for further inquiry because researchers attempt to better characterize decision-making neural circuitry in SZ as a means to discover new pathways for interventions.
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Affiliation(s)
- Adam J Culbreth
- Department of Psychology, Washington University in St Louis, St Louis, MO;
| | - James M Gold
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center, Baltimore MD
| | - Roshan Cools
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Deanna M Barch
- Department of Psychology, Washington University in St Louis, St Louis, MO; Department of Psychiatry & Radiology, Washington University in St Louis, St Louis, MO
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Schneider M, Eliez S, Birr J, Menghetti S, Debbané M, Van der Linden M. Multitasking Abilities in Adolescents With 22q11.2 Deletion Syndrome: Results From an Experimental Ecological Paradigm. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 121:151-164. [PMID: 26914469 DOI: 10.1352/1944-7558-121.2.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is associated with cognitive and functional impairments and increased risk for schizophrenia. We characterized multitasking abilities of adolescents with 22q11.2DS using an experimental naturalistic setting and examined whether multitasking impairments were associated with real-world functioning and negative symptoms. Thirty-nine adolescents (19 with 22q11.2DS and 20 controls) underwent the Multitasking Evaluation for Adolescents. Real-world functioning and clinical symptoms were assessed in participants with 22q11.2DS. Adolescents with 22q11.2DS performed poorly in the multitasking evaluation. Our data also suggest that multitasking abilities are related to adaptive functioning in the practical domain and negative symptoms. This study shows that adolescents with 22q11.2DS are characterized by multitasking impairments, which may be relevant for several aspects of the clinical phenotype.
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Affiliation(s)
- Maude Schneider
- Maude Schneider, Office Médico-Pédagogique Research Unit, Department of Psychiatry, School of Medicine, and Cognitive Psychopathology, and Neuropsychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Stephan Eliez
- Stephan Eliez, Office Médico-Pédagogique Research Unit, Department of Psychiatry, and Department of Genetic Medicine and Development, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Julie Birr
- Julie Birr, Office Médico-Pédagogique Research Unit, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Sarah Menghetti
- Sarah Menghetti, Office Médico-Pédagogique Research Unit, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Martin Debbané, Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland; and
| | - Martial Van der Linden
- Martial Van der Linden, Cognitive Psychopathology and Neuropsychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
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Nilsson BM, Holm G, Ekselius L. Karolinska Scales of Personality, cognition and psychotic symptoms in patients with schizophrenia and healthy controls. Nord J Psychiatry 2016; 70:53-61. [PMID: 26086780 DOI: 10.3109/08039488.2015.1048720] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies on both personality dimensions and cognition in schizophrenia are scarce. The objective of the present study was to examine personality traits and the relation to cognitive function and psychotic symptoms in a sample of patients with schizophrenia and healthy controls. METHOD In total 23 patients with schizophrenia and 14 controls were assessed with the Karolinska Scales of Personality (KSP). A broad cognitive test programme was used, including the Wechsler Adult Intelligence Scales, the Finger-Tapping Test, the Trail Making Test, the Verbal Fluency Test, the Benton Visual Retention Test, the Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test . RESULTS Compared with controls, the patients exhibited prominent elevations on KSP scales measuring anxiety proneness and neuroticism (P = 0.000005-0.0001), on the Detachment scale (P < 0.00009) and lower value on the Socialization scale (P < 0.0002). The patients also scored higher on the Inhibition of Aggression, Suspicion, Guilt and Irritability scales (P = 0.002-0.03) while the remaining five scales did not differ between patients and controls. KSP anxiety-related scales correlated with the Positive and Negative Symptoms Scale (PANSS) general psychopathology subscale. Cognitive test results were uniformly lower in the patient group and correlated with PANSS negative symptoms subscale. There was no association between KSP scale scores and PANSS positive or negative symptoms. CONCLUSION The patients revealed a highly discriminative KSP test profile with elevated scores in neuroticism- and psychoticism-related scales as compared to controls. Results support previous findings utilizing other personality inventories in patients with schizophrenia. Cognitive test performance correlated inversely with negative symptoms.
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Affiliation(s)
- Björn Mikael Nilsson
- a Björn Mikael Nilsson, M.D., Ph.D., Department of Neuroscience , Psychiatry, Uppsala University , SE 75185 Uppsala , Sweden
| | - Gunnar Holm
- b Gunnar Holm, Department of Neuroscience , Psychiatry, Psychologist, Uppsala University , SE 75185 Uppsala , Sweden
| | - Lisa Ekselius
- c Lisa Ekselius, M.D., Ph.D., Professor, Department of Neuroscience , Psychiatry, Uppsala University , SE 75185 Uppsala , Sweden
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Chiu EC, Lee SC, Kuo CJ, Lung FW, Hsueh IP, Hsieh CL. Development of a Performance-Based Measure of Executive Functions in Patients with Schizophrenia. PLoS One 2015; 10:e0142790. [PMID: 26561862 PMCID: PMC4642955 DOI: 10.1371/journal.pone.0142790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 10/27/2015] [Indexed: 11/28/2022] Open
Abstract
A performance-based measure for assessing executive functions (EF) is useful to understand patients’ real life performance of EF. This study aimed to develop a performance-based measure of executive functions (PEF) based on the Lezak model and to examine psychometric properties (i.e., unidimensionality and reliability) of the PEF using Rasch analysis in patients with schizophrenia. We developed the PEF in three phases: (1) designing the preliminary version of PEF; (2) consultation with experts, cognitive interviews with patients, and pilot tests on patients to revise the preliminary PEF; (3) establishment of the final version of the PEF and examination of unidimensionality and Rasch reliability. Two hundred patients were assessed using the revised PEF. After deleting items which did not satisfy the Rasch model’s expectations, the final version of the PEF contained 1 practice item and 13 test items for assessing the four domains of EF (i.e., volition, planning, purposive action, and effective performance). For unidimensional and multidimensional Rasch analyses, the 4 domains showed good reliability (i.e., 0.77–0.85 and 0.87–0.90, respectively). Our results showed that the PEF had satisfactory unidimensionality and Rasch reliability. Therefore, clinicians and researchers could use the PEF to assess the four domains of EF in patients with schizophrenia.
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Affiliation(s)
- En-Chi Chiu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-Chun Lee
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail: (SCL); (IPH)
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - For-Wey Lung
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (SCL); (IPH)
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Converging models of schizophrenia--Network alterations of prefrontal cortex underlying cognitive impairments. Prog Neurobiol 2015; 134:178-201. [PMID: 26408506 DOI: 10.1016/j.pneurobio.2015.09.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 09/10/2015] [Accepted: 09/17/2015] [Indexed: 02/08/2023]
Abstract
The prefrontal cortex (PFC) and its connections with other brain areas are crucial for cognitive function. Cognitive impairments are one of the core symptoms associated with schizophrenia, and manifest even before the onset of the disorder. Altered neural networks involving PFC contribute to cognitive impairments in schizophrenia. Both genetic and environmental risk factors affect the development of the local circuitry within PFC as well as development of broader brain networks, and make the system vulnerable to further insults during adolescence, leading to the onset of the disorder in young adulthood. Since spared cognitive functions correlate with functional outcome and prognosis, a better understanding of the mechanisms underlying cognitive impairments will have important implications for novel therapeutics for schizophrenia focusing on cognitive functions. Multidisciplinary approaches, from basic neuroscience to clinical studies, are required to link molecules, circuitry, networks, and behavioral phenotypes. Close interactions among such fields by sharing a common language on connectomes, behavioral readouts, and other concepts are crucial for this goal.
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Aubin G, Béliveau MF, Klinger E. An exploration of the ecological validity of the Virtual Action Planning-Supermarket (VAP-S) with people with schizophrenia. Neuropsychol Rehabil 2015; 28:689-708. [PMID: 26317526 DOI: 10.1080/09602011.2015.1074083] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
People with schizophrenia often have functional limitations that affect their daily activities due to executive function deficits. One way to assess these deficits is through the use of virtual reality programmes that reproduce real-life instrumental activities of daily living (IADLs). One such programme is the Virtual Action Planning-Supermarket (VAP-S). This exploratory study aimed to examine the ecological validity of this programme, specifically, how task performance in both virtual and natural environments compares. Case studies were used and involved five participants with schizophrenia, who were familiar with grocery shopping. They were assessed during both the VAP-S shopping task and a real-life grocery shopping task using an observational assessment tool, the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis. The results show that when difficulties were present in the virtual task, difficulties were also observed in the real-life task. For some participants, greater difficulties were observed in the virtual task. These difficulties could be explained by the presence of perceptual deficits and problems remembering the required sequenced actions in the virtual task. In conclusion, performance on the VAP-S by these five participants was generally comparable to the performance in a natural environment.
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Affiliation(s)
- Ginette Aubin
- a Occupational Therapy Department, Université du Québec à Trois-Rivières , Trois-Rivières , Canada
| | - Marie-France Béliveau
- a Occupational Therapy Department, Université du Québec à Trois-Rivières , Trois-Rivières , Canada
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Construct Validity of the Chinese Version of the Activities of Daily Living Rating Scale III in Patients with Schizophrenia. PLoS One 2015; 10:e0130702. [PMID: 26121246 PMCID: PMC4488143 DOI: 10.1371/journal.pone.0130702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/23/2015] [Indexed: 12/05/2022] Open
Abstract
Background The Chinese version of the Activities of Daily Living Rating Scale III (ADLRS-III), which has 10 domains, is commonly used for assessing activities of daily living (ADL) in patients with schizophrenia. However, construct validity (i.e., unidimensionality) for each domain of the ADLRS-III is unknown, limiting the explanations of the test results. Purpose This main purpose of this study was to examine unidimensionality of each domain in the ADLRS-III. We also examined internal consistency and ceiling/floor effects in patients with schizophrenia. Methods From occupational therapy records, we obtained 304 self-report data of the ADLRS-III. Confirmatory factor analysis (CFA) was conducted to examine the 10 one-factor structures. If a domain showed an insufficient model fit, exploratory factor analysis (EFA) was performed to investigate the factor structure and choose one factor representing the original construct. Internal consistency was examined using Cronbach’s alpha (α). Ceiling and floor effects were determined by the percentage of patients with the maximum and minimum scores in each domain, respectively. Results CFA analyses showed that 4 domains (i.e., leisure, picture recognition, literacy ability, communication tools use) had sufficient model fits. These 4 domains had acceptable internal consistency (α = 0.79-0.87) and no ceiling/floor effects, except the leisure domain which had a ceiling effect. The other 6 domains showed insufficient model fits. The EFA results showed that these 6 domains were two-factor structures. Conclusion The results supported unidimensional constructs of the leisure, picture recognition, literacy ability, and communication tool uses domains. The sum scores of these 4 domains can be used to represent their respective domain-specific functions. Regarding the 6 domains with insufficient model fits, we have explained the two factors of each domain and chosen one factor to represent its original construct. Future users may use the items from the chosen factors to assess domain-specific functions in patients with schizophrenia.
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Abstract
Cognitive functioning, particularly executive functioning, is a strong predictor of functional outcomes in people with schizophrenia. Cognitive remediation has been shown to improve specific cognitive processes, but adjunctive interventions are required for meaningful gains in adaptive functioning, particularly in people with chronic illness. This study examined whether (and how) environmental adaptations, used without training, may circumvent cognitive difficulties and facilitate everyday task performance in individuals with chronic schizophrenia. Forty-two individuals with chronic schizophrenia/schizoaffective disorder were administered cognitive measures and two versions of the Naturalistic Action Test (NAT)-a standard version (ST-NAT), and a user-centered version (UC-NAT) that incorporated environmental adaptations designed to facilitate task performance. The NAT conditions were counterbalanced across participants. Analyses compared performance between the NAT versions and examined the cognitive correlates of each NAT condition. Individuals with schizophrenia made fewer errors on the UC-NAT as compared to the ST-NAT; this between-group difference was significant for all error types. Compared to the ST-NAT, the UC-NAT performance was not significantly associated with an executive function measure of planning. Environmental adaptations may be implemented without extensive training to improve everyday action in individuals with chronic schizophrenia. Environmental adaptations that reduce planning demands may be most effective in this population.
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Tanguay AN, Davidson PSR, Guerrero Nuñez KV, Ferland MB. Cooking breakfast after a brain injury. Front Behav Neurosci 2014; 8:272. [PMID: 25228863 PMCID: PMC4151095 DOI: 10.3389/fnbeh.2014.00272] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022] Open
Abstract
Acquired brain injury (ABI) often compromises the ability to carry out instrumental activities of daily living such as cooking. ABI patients' difficulties with executive functions and memory result in less independent and efficient meal preparation. Accurately assessing safety and proficiency in cooking is essential for successful community reintegration following ABI, but in vivo assessment of cooking by clinicians is time-consuming, costly, and difficult to standardize. Accordingly, we examined the usefulness of a computerized meal preparation task (the Breakfast Task; Craik and Bialystok, 2006) as an indicator of real life meal preparation skills. Twenty-two ABI patients and 22 age-matched controls completed the Breakfast Task. Patients also completed the Rehabilitation Activities of Daily Living Survey (RADLS; Salmon, 2003) and prepared actual meals that were rated by members of the clinical team. As expected, the ABI patients had significant difficulty on all aspects of the Breakfast Task (failing to have all their foods ready at the same time, over- and under-cooking foods, setting fewer places at the table, and so on) relative to controls. Surprisingly, however, patients' Breakfast Task performance was not correlated with their in vivo meal preparation. These results indicate caution when endeavoring to replace traditional evaluation methods with computerized tasks for the sake of expediency.
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Affiliation(s)
| | - Patrick S R Davidson
- School of Psychology, University of Ottawa Ottawa, ON, Canada ; Bruyère Research Institute, University of Ottawa Ottawa, ON, Canada ; Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation of Canada Ottawa, ON, Canada
| | | | - Mark B Ferland
- School of Psychology, University of Ottawa Ottawa, ON, Canada ; The Robin Easey Centre, Ottawa Hospital Rehabilitation Centre Ottawa, ON, Canada ; Ottawa Hospital Research Institute Ottawa, ON, Canada
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Aubin G, Lamoureux J, Gélinas I, Chapparo C, Stip E, Rainville C. Daily Task Performance and Information Processing among People with Schizophrenia and Healthy Controls: A Comparative Study. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14098207541117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Many individuals with schizophrenia have information processing difficulties. This study investigated the use of information processing skills during the performance of a daily task by participants with schizophrenia and compared it to that of participants without a psychiatric diagnosis. Studies comparing similar groups found differences in the number and types of errors. However, there is limited knowledge about the related problematic information processing skills. This information could help to better pinpoint the needs of this group of clients. Method: Participants were paired based on age and gender. Information processing skills were assessed with the Perceive, Recall, Plan, and Perform system of task analysis. Generalized linear mixed models were used to compare both groups. Results: Individuals with schizophrenia made more accuracy errors and had more difficulties when attending and gathering information and when planning was required during the task. They were also more cognitively impaired than the comparison group. Conclusion: The large number of accuracy errors may result from specific skills deficits that impact on other processing skills or from a general vulnerability affecting most processing skills. In future studies, the influence of employment and of the social environment of housing on task performance should be investigated.
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Affiliation(s)
- Ginette Aubin
- Assistant Professor, Université du Québec à Trois-Rivières, Occupational Therapy Department, Trois-Rivières, Quebec, Canada
| | - Julie Lamoureux
- Statistician, Centre de Recherche Interdisciplinaire en Réadaptation, Montreal, Quebec, Canada
| | - Isabelle Gélinas
- Associate Professor, School of Physical and Occupational Therapy, Montreal, Quebec, Canada
| | - Christine Chapparo
- Senior Lecturer, University of Sydney, Department of Occupational Therapy, Sydney, New South Wales, Australia
| | - Emmanuel Stip
- M.D., Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Constant Rainville
- Associate Researcher, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
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Commissions and omissions are dissociable aspects of everyday action impairment in schizophrenia. J Int Neuropsychol Soc 2014; 20:812-21. [PMID: 25076016 DOI: 10.1017/s1355617714000654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prior research using performance-based assessment of functional impairment has informed a novel neuropsychological model of everyday action impairment in dementia in which omission errors (i.e., failure to complete task steps) dissociate from commission errors (i.e., inaccurate performance of task steps) and have unique neuropsychological correlates. However, this model has not been tested in other populations. The present study examined whether this model extends to schizophrenia. Fifty-four individuals with schizophrenia or schizoaffective disorder were administered a neuropsychological protocol and the Naturalistic Action Test (NAT), a performance-based measure of everyday action. A principal component analysis (PCA) was performed to examine the construct(s) comprising everyday action impairment, and correlations between the resultant component(s) and neuropsychological tests were examined. Results showed that omissions and a subset of commissions were distinct components of everyday action. However, results did not support unique associations between these components and specific neuropsychological measures. These findings extend the omission-commission model to schizophrenia and may have important implications for efficient assessment and effective rehabilitation of functional impairment, such as the potential efficacy of targeted interventions for the rehabilitation of omission and commission deficits in everyday functioning. Larger studies with prospective designs are needed to replicate the present preliminary findings.
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Pillet B, Morvan Y, Todd A, Franck N, Duboc C, Grosz A, Launay C, Demily C, Gaillard R, Krebs MO, Amado I. Cognitive remediation therapy (CRT) benefits more to patients with schizophrenia with low initial memory performances. Disabil Rehabil 2014; 37:846-53. [PMID: 25109501 DOI: 10.3109/09638288.2014.946153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Cognitive deficits in schizophrenia mainly affect memory, attention and executive functions. Cognitive remediation is a technique derived from neuropsychology, which aims to improve or compensate for these deficits. Working memory, verbal learning, and executive functions are crucial factors for functional outcome. Our purpose was to assess the impact of the cognitive remediation therapy (CRT) program on cognitive difficulties in patients with schizophrenia, especially on working memory, verbal memory, and cognitive flexibility. METHODS We collected data from clinical and neuropsychological assessments in 24 patients suffering from schizophrenia (Diagnostic and Statistical Manual of mental Disorders-Fourth Edition, DSM-IV) who followed a 3-month (CRT) program. Verbal and visuo-spatial working memory, verbal memory, and cognitive flexibility were assessed before and after CRT. RESULTS The Wilcoxon test showed significant improvements on the backward digit span, on the visual working memory span, on verbal memory and on flexibility. Cognitive improvement was substantial when baseline performance was low, independently from clinical benefit. CONCLUSIONS CRT is effective on crucial cognitive domains and provides a huge benefit for patients having low baseline performance. Such cognitive amelioration appears highly promising for improving the outcome in cognitively impaired patients.
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Affiliation(s)
- Benoit Pillet
- Centre Référent en Remédiation et Réhabilitation Psychosociale (C3R-P) (SHU, Secteur 17), Inserm U894, Hôpital Sainte-Anne , Paris , France
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Ottemiller DD, Elliott CS, Giovannetti T. Creativity, Overinclusion, and Everyday Tasks. CREATIVITY RESEARCH JOURNAL 2014. [DOI: 10.1080/10400419.2014.929407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Laloyaux J, Van der Linden M, Levaux MN, Mourad H, Pirri A, Bertrand H, Domken MA, Adam S, Larøi F. Multitasking capacities in persons diagnosed with schizophrenia: a preliminary examination of their neurocognitive underpinnings and ability to predict real world functioning. Psychiatry Res 2014; 217:163-70. [PMID: 24731876 DOI: 10.1016/j.psychres.2014.03.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 01/11/2023]
Abstract
Difficulties in everyday life activities are core features of persons diagnosed with schizophrenia and in particular during multitasking activities. However, at present, patients׳ multitasking capacities have not been adequately examined in the literature due to the absence of suitable assessment strategies. We thus recently developed a computerized real-life activity task designed to take into account the complex and multitasking nature of certain everyday life activities where participants are required to prepare a room for a meeting. Twenty-one individuals diagnosed with schizophrenia and 20 matched healthy controls completed the computerized task. Patients were also evaluated with a cognitive battery, measures of symptomatology and real world functioning. To examine the ecological validity, 14 other patients were recruited and were given the computerized version and a real version of the meeting preparation task. Results showed that performance on the computerized task was significantly correlated with executive functioning, pointing to the major implication of these cognitive processes in multitasking situations. Performance on the computerized task also significantly predicted up to 50% of real world functioning. Moreover, the computerized task demonstrated good ecological validity. These findings suggest the importance of evaluating multitasking capacities in patients diagnosed with schizophrenia in order to predict real world functioning.
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Affiliation(s)
- Julien Laloyaux
- Department of Psychology, University of Liège, Bd. du Rectorat (B33), 4000 Liège, Belgium.
| | - Martial Van der Linden
- Department of Psychology, University of Liège, Bd. du Rectorat (B33), 4000 Liège, Belgium; Cognitive Psychopathology and Neuropsychology Unit, University of Geneva, Geneva, Switzerland
| | - Marie-Noëlle Levaux
- Department of Psychology, University of Liège, Bd. du Rectorat (B33), 4000 Liège, Belgium; Intercommunale de Soins Spécialisés de Liège (Mental Health Sector), Liège, Belgium
| | - Haitham Mourad
- Intercommunale de Soins Spécialisés de Liège (Mental Health Sector), Liège, Belgium
| | - Anthony Pirri
- Department of Psychology, University of Liège, Bd. du Rectorat (B33), 4000 Liège, Belgium
| | - Hervé Bertrand
- Intercommunale de Soins Spécialisés de Liège (Mental Health Sector), Liège, Belgium
| | - Marc-André Domken
- Intercommunale de Soins Spécialisés de Liège (Mental Health Sector), Liège, Belgium
| | - Stéphane Adam
- Department of Psychology, University of Liège, Bd. du Rectorat (B33), 4000 Liège, Belgium
| | - Frank Larøi
- Department of Psychology, University of Liège, Bd. du Rectorat (B33), 4000 Liège, Belgium
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Abstract
Despite 50 years of pharmacological and psychosocial interventions, schizophrenia remains one of the leading causes of disability. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. The end result is a considerably reduced lifespan that is marred by reduced levels of independence, with few novel treatment options available. Disability is a multidimensional construct that results from different, and often interacting, factors associated with specific types and levels of impairment. In schizophrenia, the most poignant and well characterized determinants of disability are symptoms, cognitive and related skills deficits, but there is limited understanding of other relevant factors that contribute to disability. Here we conceptualize how reduced physical performance interacts with aging, neurobiological, treatment-emergent, and cognitive and skills deficits to exacerbate ADL disability and worsen physical health. We argue that clearly defined physical performance components represent underappreciated variables that, as in mentally healthy people, offer accessible targets for exercise interventions to improve ADLs in schizophrenia, alone or in combination with improvements in cognition and health. And, finally, due to the accelerated aging pattern inherent in this disease – lifespans are reduced by 25 years on average – we present a training model based on proven training interventions successfully used in older persons. This model is designed to target the physical and psychological declines associated with decreased independence, coupled with the cardiovascular risk factors and components of the metabolic syndrome seen in schizophrenia due to their excess prevalence of obesity and low fitness levels.
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