Effects of environmental noise on cognitive (dys)functions in schizophrenia: A pilot within-subjects experimental study

The mediodorsal thalamus in executive control

Executive control, the ability to organize thoughts and action plans in real time, is a defining feature of higher cognition. Classical theories have emphasized cortical contributions to this process, but recent studies have reinvigorated interest in the role of the thalamus. Although it is well established that local thalamic damage diminishes cognitive capacity, such observations have been difficult to inform functional models. Recent progress in experimental techniques is beginning to enrich our understanding of the anatomical, physiological, and computational substrates underlying thalamic engagement in executive control. In this review, we discuss this progress and particularly focus on the mediodorsal thalamus, which regulates the activity within and across frontal cortical areas. We end with a synthesis that highlights frontal thalamocortical interactions in cognitive computations and discusses its functional implications in normal and pathological conditions.

The noise in our brain: A systematic review and meta-analysis of neuroimaging and signal-detection studies on source monitoring in psychosis

OBJECTIVES

Noisy thoughts or perceptions are characteristics of psychosis (PSY) and, they are deeply related to source monitoring (SM) - the ability to discriminate the origin of internal/external experiences.

METHODS

This MOOSE, PRISMA-compliant meta-analysis compared SM performances in PSY compared to healthy controls (HC) focusing on signal-to-noise discrimination in order to: i) test whether neuroimaging procedures (fMRI/EEG) might be a group-specific source of noise for SM; ii) compare error- and accuracy-based indexes; iii) to meta-analyze signal-detection measures (i.e., discrimination index and response bias); iv) to determine the best index capturing SM deficits in psychosis. We conducted a 3-level meta-analysis for each aim to estimate pooled effect-sizes (Cohen's d). SM type, source discrimination and stimulus modality were used as meta-regressors. Heterogeneity (I2), publication bias (Egger's test) and multiple comparisons (Bonferroni correction) were considered.

RESULTS

Sixteen neuroimaging, 44 error/accuracy-based behavioral and 7 signal-detection trials were included (2297 PSY, age range = 18.78-52.6; 1745 HC, age range = 21.1-53.3). The noise generated by neuroimaging procedures slightly influenced error, but not accuracy. Accuracy-based (d = -0.83), but not error-based, indexes showed significant and large SM impairments in PSY compared to HC. Overall SM performance differences between PSY and HC were larger in discrimination index (d = -0.65) and accuracy (d = -0.61), followed by response bias (d = -0.59, ns) and error-based (d = 0.35) indexes.

CONCLUSION

Although both accuracy and discrimination indexes differentiate patients with PSY from HC, discrimination index is more reliable and may better capture the bi-directional nature of the internal/external source confusion.

Walking through the city soundscape: an audio-visual analysis of sensory experience for people with psychosis

This article discusses how an aspect of urban environments - sound and noise - is experienced by people walking in the city; it particularly focuses on atypical populations such as people diagnosed with psychosis, who are reported to be particularly sensitive to noisy environments. Through an analysis of video-recordings of naturalistic activities in an urban context and of video-elicitations based on these recordings, the study details the way participants orient to sound and noise in naturalistic settings, and how sound and noise are reported and reexperienced during interviews. By bringing together urban context, psychosis and social interaction, this study shows that, thanks to video recordings and conversation analysis, it is possible to analyse in detail the multimodal organization of action (talk, gesture, gaze, walking bodies) and of the sensory experience(s) of aural factors, as well as the way this organization is affected by the ecology of the situation.

Association of environmental and socioeconomic indicators with serious mental illness diagnoses identified from general practitioner practice data in England: A spatial Bayesian modelling study

BACKGROUND

The evidence is sparse regarding the associations between serious mental illnesses (SMIs) prevalence and environmental factors in adulthood as well as the geographic distribution and variability of these associations. In this study, we evaluated the association between availability and proximity of green and blue space with SMI prevalence in England as a whole and in its major conurbations (Greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle).

METHODS AND FINDINGS

We carried out a retrospective analysis of routinely collected adult population (≥18 years) data at General Practitioner Practice (GPP) level. We used data from the Quality and Outcomes Framework (QOF) on the prevalence of a diagnosis of SMI (schizophrenia, bipolar affective disorder and other psychoses, and other patients on lithium therapy) at the level of GPP over the financial year April 2014 to March 2018. The number of GPPs included ranged between 7,492 (April 2017 to March 2018) to 7,997 (April 2014 to March 2015) and the number of patients ranged from 56,413,719 (April 2014 to March 2015) to 58,270,354 (April 2017 to March 2018). Data at GPP level were converted to the geographic hierarchy unit Lower Layer Super Output Area (LSOA) level for analysis. LSOAs are a geographic unit for reporting small area statistics and have an average population of around 1,500 people. We employed a Bayesian spatial regression model to explore the association of SMI prevalence in England and its major conurbations (greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle) with environmental characteristics (green and blue space, flood risk areas, and air and noise pollution) and socioeconomic characteristics (age, ethnicity, and index of multiple deprivation (IMD)). We incorporated spatial random effects in our modelling to account for variation at multiple scales. Across England, the environmental characteristics associated with higher SMI prevalence at LSOA level were distance to public green space with a lake (prevalence ratio [95% credible interval]): 1.002 [1.001 to 1.003]), annual mean concentration of PM2.5 (1.014 [1.01 to 1.019]), and closeness to roads with noise levels above 75 dB (0.993 [0.992 to 0.995]). Higher SMI prevalence was also associated with a higher percentage of people above 24 years old (1.002 [1.002 to 1.003]), a higher percentage of ethnic minorities (1.002 [1.001 to 1.002]), and more deprived areas. Mean SMI prevalence at LSOA level in major conurbations mirrored the national associations with a few exceptions. In Birmingham, higher average SMI prevalence at LSOA level was positively associated with proximity to an urban green space with a lake (0.992 [0.99 to 0.998]). In Liverpool and Manchester, lower SMI prevalence was positively associated with road traffic noise ≥75 dB (1.012 [1.003 to 1.022]). In Birmingham, Liverpool, and Manchester, there was a positive association of SMI prevalence with distance to flood zone 3 (land within flood zone 3 has ≥1% chance of flooding annually from rivers or ≥0.5% chance of flooding annually from the sea, when flood defences are ignored): Birmingham: 1.012 [1.000 to 1.023]; Liverpool and Manchester: 1.016 [1.006 to 1.026]. In contrast, in Leeds, there was a negative association between SMI prevalence and distance to flood zone 3 (0.959 [0.944 to 0.975]). A limitation of this study was because we used a cross-sectional approach, we are unable to make causal inferences about our findings or investigate the temporal relationship between outcome and risk factors. Another limitation was that individuals who are exclusively treated under specialist mental health care and not seen in primary care at all were not included in this analysis.

CONCLUSIONS

Our study provides further evidence on the significance of socioeconomic associations in patterns of SMI but emphasises the additional importance of considering environmental characteristics alongside socioeconomic variables in understanding these patterns. In this study, we did not observe a significant association between green space and SMI prevalence, but we did identify an apparent association between green spaces with a lake and SMI prevalence. Deprivation, higher concentrations of air pollution, and higher proportion of ethnic minorities were associated with higher SMI prevalence, supporting a social-ecological approach to public health prevention. It also provides evidence of the significance of spatial analysis in revealing the importance of place and context in influencing area-based patterns of SMI.

Environmental pollution and mental health: a narrative review of literature

Pollutant agents are exponentially increasing in modern society since industrialization processes and technology are being developed worldwide. Impact of pollution on public health is well known but little has been described on the association between environmental pollutants and mental health. A literature search on PubMed and EMBASE has been conducted and 134 articles published on the issue of pollution and mental health have been included, cited, reviewed, and summarized. Emerging evidences have been collected on association between major environmental pollutants (air pollutants, heavy metals, ionizing radiation [IR], organophosphate pesticides, light pollution, noise pollution, environmental catastrophes) and various mental health disorders including anxiety, mood, and psychotic syndromes. Underlying pathogenesis includes direct and indirect effects of these agents on brain, respectively, due to their biological effect on human Central Nervous System or related to some levels of stress generated by the exposure to the pollutant agents over the time. Most of emerging evidences are still nonconclusive. Further studies should clarify how industrial production, the exploitation of certain resources, the proximity to waste and energy residues, noise, and the change in lifestyles are connected with psychological distress and mental health problems for the affected populations.

Using behavioral rhythms and multi-task learning to predict fine-grained symptoms of schizophrenia

Schizophrenia is a severe and complex psychiatric disorder with heterogeneous and dynamic multi-dimensional symptoms. Behavioral rhythms, such as sleep rhythm, are usually disrupted in people with schizophrenia. As such, behavioral rhythm sensing with smartphones and machine learning can help better understand and predict their symptoms. Our goal is to predict fine-grained symptom changes with interpretable models. We computed rhythm-based features from 61 participants with 6,132 days of data and used multi-task learning to predict their ecological momentary assessment scores for 10 different symptom items. By taking into account both the similarities and differences between different participants and symptoms, our multi-task learning models perform statistically significantly better than the models trained with single-task learning for predicting patients' individual symptom trajectories, such as feeling depressed, social, and calm and hearing voices. We also found different subtypes for each of the symptoms by applying unsupervised clustering to the feature weights in the models. Taken together, compared to the features used in the previous studies, our rhythm features not only improved models' prediction accuracy but also provided better interpretability for how patients' behavioral rhythms and the rhythms of their environments influence their symptom conditions. This will enable both the patients and clinicians to monitor how these factors affect a patient's condition and how to mitigate the influence of these factors. As such, we envision that our solution allows early detection and early intervention before a patient's condition starts deteriorating without requiring extra effort from patients and clinicians.

Combined Effect of Noise and Smoking on the Cognitive Performance of Automotive Industry Workers

Introduction:

Noise is an environmental stressor and can cause or exacerbate mental disorders, and affect the individual performance in certain conditions. This study aimed to evaluate the combined effects of noise and smoking on the cognitive performance of the workers in the automotive industry.

Methods:

This research is a descriptive-analytical study with a cross-sectional design conducted on 300 workers randomly assigned into two groups of noise-exposed and nonexposed. They were examined using computerized tests, including the Tower of London test (TOL), Continuous Performance test (CPT), and Stroop test. The sound pressure levels were measured based on an 8-hour equal-loudness contour in each group according to ISO 9612 standard, using the Testo CEL-815 sound level meter.

Results:

The study of combined effects of noise and smoking on 12 CPT indicators using the 2-way Analysis of Variance (ANOVA) indicate that noise and smoking factors had a significant impact on the mean number of errors and correct responses in the third 50-stimuli stage, the mean number of errors and correct responses in the second 50-stimuli stage with P<0.001, P<0.001, P=0.012 and P<0.001 for smoking respectively, but only noise affected the other 7 indicators (P<0.001).

Conclusion:

Smoking and noise have negative impacts on concentration, attention, and cognitive processing speed, which can lead to an individual’s mistakes and delayed decision making at the workplace.

Urban remediation: a new recovery-oriented strategy to manage urban stress after first-episode psychosis

PURPOSE

Urban living is a major risk factor for psychosis. Considering worldwide increasing rates of urbanization, new approaches are needed to enhance patients' wellbeing in cities. Recent data suggest that once psychosis has emerged, patients struggle to adapt to urban milieu and that they lose access to city centers, which contributes to isolation and reduced social contacts. While it is acknowledged that there are promising initiatives to improve mental health in cities, concrete therapeutic strategies to help patients with psychosis to better handle urban stress are lacking. We believe that we should no longer wait to develop and test new therapeutic approaches.

METHOD

In this review, we first focus on the role of urban planning, policies, and design, and second on possible novel therapeutic strategies at the individual level. We review how patients with psychosis may experience stress in the urban environment. We then review and describe a set of possible strategies, which could be proposed to patients with the first-episode psychosis.

RESULTS

We propose to group these strategies under the umbrella term of 'urban remediation' and discuss how this novel approach could help patients to recover from their first psychotic episode.

CONCLUSION

The concepts developed in this paper are speculative and a lot of work remains to be done before it can be usefully proposed to patients. However, considering the high prevalence of social withdrawal and its detrimental impact on the recovery process, we strongly believe that researchers should invest this new domain to help patients regain access to city centers.

Interaction of Background Noise and Auditory Hallucinations on Phonemic Mismatch Negativity (MMN) and P3a Processing in Schizophrenia

Auditory hallucinations (AHs) are among the cardinal symptoms of schizophrenia (SZ). During the presence of AHs aberrant activity of auditory cortices have been observed, including hyperactivation during AHs alone and hypoactivation when AHs are accompanied by a concurrent external auditory competitor. Mismatch negativity (MMN) and P3a are common ERPs of interest within the study of SZ as they are robustly reduced in the chronic phase of the illness. The present study aimed to explore whether background noise altered the auditory MMN and P3a in those with SZ and treatment-resistant AHs.

METHODS

MMN and P3a were assessed in 12 hallucinating patients (HPs), 11 non-hallucinating patients (NPs) and 9 healthy controls (HCs) within an auditory oddball paradigm. Standard (P = 0.85) and deviant (P = 0.15) stimuli were presented during three noise conditions: silence (SL), traffic noise (TN), and wide-band white noise (WN).

RESULTS

HPs showed significantly greater deficits in MMN amplitude relative to NPs in all background noise conditions, though predominantly at central electrodes. Conversely, both NPs and HPs exhibited significant deficits in P3a amplitude relative to HCs under the SL condition only.

SIGNIFICANCE

These findings suggest that the presence of AHs may specifically impair the MMN, while the P3a appears to be more generally impaired in SZ. That MMN amplitudes are specifically reduced for HPs during background noise conditions suggests HPs may have a harder time detecting changes in phonemic sounds during situations with external traffic or "real-world" noise compared to NPs.

The impact of social and sensory stress on cognitive biases and delusions in schizophrenia

INTRODUCTION

Stress aggravates delusional symptoms, but the exact underlying mechanisms are still not fully understood. One of the routes may be via exacerbation of information processing distortions frequently observed in psychosis. The aim of the present study was thus to investigate the impact of social and sensory stress on specific cognitive processes along with different dimensions of delusional thinking.

METHODS

Nineteen individuals affected by schizophrenia and 15 healthy controls were assessed under 3 experimental conditions (social stress, neutral, noise stress), with counter-balanced presentation of stress conditions across participants of both groups. Under each condition participants performed parallel versions of experimental tasks and had to report their level of paranoid thinking and subjective distress.

RESULTS

Irrespective of condition, patients showed significant impairments in metacognitive accuracy compared with controls. When social stress was applied first, mentalising accuracy decreased significantly in the subsequent condition among patients only. Following exposure to either social or sensory stress, patients reported significantly higher conviction in their paranoid ideas in the subsequent condition.

CONCLUSIONS

Only limited evidence was found for the negative impact of stress on cognitive processes in schizophrenia patients. However, this may not be true for those with more severe information processing abnormalities and/or delusions.

Assessment of Cognition in Schizophrenia Using Trail Making Test: A Meta-Analysis

OBJECTIVE

The present meta-analysis aimed to analyze the cognitive performance of schizophrenia patients measured by Trail Making Tests (TMT) and the contribution of socio-demographic factors to cognitive impairments.

METHODS

PubMed and PsycARTICLES databases were searched for the studies published between January 1985 and November 2017. Data were drawn from 19 studies encompassing 1095 patients and 324 controls. The effect size and heterogeneity were assessed with Comprehensive Meta-Analysis version 2 using random-effect model.

RESULTS

Overall, the results showed that the schizophrenia patients performed significantly (p<0.001) worse than healthy controls in both TMT-A and B. However, concurrent substance abuse, clinical status (inpatient or outpatient), duration of education and duration of illness were not associated with cognitive impairment among the schizophrenia patients.

CONCLUSION

The present meta-analysis confirmed the cognitive processing speed and flexibility of schizophrenia patients were impaired. However, their duration of education, duration of illness and clinical status (inpatient or outpatient) were not the risk factors.

Development and preliminary validation of a brief behavioral measure of psychotic propensity

Extensive research demonstrates that the dimensional assessment of psychotic manifestations is a primary strength of the Rorschach inkblot task, which provides an in vivo sample of problem-solving behavior and normative standards concerning the logic and coherence of thought processes and the typicality of perceptual representations. This article presents foundational research for the Thought and Perception Assessment System (TPAS), a Rorschach-based system designed to assess solely for disordered thinking and perceptual aberrations using either the standard 10-card set of inkblots or alternative 3-, 4-, and 5-card short forms. Using data from three patient samples (ns = 61, 93, and 133) and one nonpatient sample (n = 118), we document the equivalence of mean scores across the full and short-form card sets. We also document satisfactory interrater reliability and validity for the full and short forms, as well as strong part-whole reliability coefficients between the short forms and the full form. Consistent with psychometric theory and the principle of aggregation, each type of coefficient decreased as a function of decreasing the number of cards. We discuss implications and future applications in research and clinical assessment.