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Espinosa V, Naides N, López-Carrilero R, Vila-Badia R, Colomer-Salvans A, Barajas A, Barrigón ML, Birulés I, Butjosa A, Díaz-Cutraro L, Del Cacho N, Frigola-Capell E, González-Higueras F, Grasa E, Gutiérrez-Zotes A, Lorente-Rovira E, Moreno-Kustner B, Pélaez T, Pousa E, Ruiz-Delgado I, Serra-Arumí C, Verdaguer-Rodríguez M, Usall J, Ochoa S. The influence of gender in cognitive insight and cognitive bias in people with first-episode psychosis: an uncontrolled exploratory analysis. Arch Womens Ment Health 2024; 27:669-678. [PMID: 38353751 DOI: 10.1007/s00737-024-01425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/11/2024] [Indexed: 09/17/2024]
Abstract
PURPOSE Previous studies have investigated the role of gender in clinical symptoms, social functioning, and neuropsychological performance in people with first-episode psychosis (FEP). However, the evidence of gender differences for metacognition in subjects with FEP is still limited and controversial. The aim of the present study was to explore gender differences in cognitive insight and cognitive biases in this population. METHODS Cross-sectional study was carried out in a sample of 104 patients with FEP (35 females and 69 males) recruited from mental health services. Symptoms were assessed with the Positive and Negative Syndrome Scale, cognitive insight with the Beck Cognitive Insight Scale, and cognitive bias by the Cognitive Biases Questionnaire for Psychosis. The assessment also included clinical and sociodemographic characteristics. RESULTS After controlling for potential confounders (level of education, marital status, and duration of psychotic illness) analysis of covariance revealed that males presented greater self-reflectiveness (p = 0.004) when compared to females. However, no significant differences were found in self-certainty and composite index of the cognitive insight scale, as in the cognitive biases assessed. CONCLUSIONS Gender was an independent influence factor for self-reflectiveness, being better for males. Self-reflectiveness, if shown to be relatively lacking in women, could contribute to the design of more gender-sensitive and effective psychotherapeutic treatments, as being able to self-reflect predicts to better treatment response in psychosis.
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Affiliation(s)
- Victoria Espinosa
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Naomi Naides
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Raquel López-Carrilero
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Regina Vila-Badia
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Alícia Colomer-Salvans
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de La Salut, Serra Hunter Fellow, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Barcelona, Spain
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain
| | - María Luisa Barrigón
- Departament of Psychiatry, University Hospital Virgen del Rocio, Seville, Spain
- Psychiatry Service, Area de Gestión Sanitaria Sur Granada, Motril, Granada, Spain
| | - Irene Birulés
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Facultat de Psicologia Departament de Cognició, Desenvolupament i Psicologia de l'Educació, Facultat de Psicologia, Universitat de Barcelona, Barcelona, Spain
| | - Anna Butjosa
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Luciana Díaz-Cutraro
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Núria Del Cacho
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Eva Frigola-Capell
- Mental Health and Addiction Research Group, Fundació Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
- Institut d'Assistencia Sanitària, Girona, Spain
| | | | - Eva Grasa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, Reus, Spain
| | - Esther Lorente-Rovira
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Psychiatry Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Trinidad Pélaez
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Clara Serra-Arumí
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Marina Verdaguer-Rodríguez
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - Judith Usall
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Ochoa
- Research and Development Unit of Parc Sanitari Sant Joan de Déu, Edifici Sant Rafael, Primera Planta C/Dr. Pujades, 42, Sant Boi de Llobregat, Barcelona, Spain.
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain.
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Lim MJH, Loffman SJ, Gaus K, Slawik SV, Iyyalol R, Lee JWY, Hepple EK, Martin-Iverson MT. Bi-directional and multi-modal effects of dexamphetamine on spatial binding windows in healthy individuals. Hum Psychopharmacol 2024:e2909. [PMID: 38995719 DOI: 10.1002/hup.2909] [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: 02/19/2024] [Revised: 05/20/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES Stimuli that are separated by a short window of space or time, known as spatial and temporal binding windows (SBW/TBWs), may be perceived as separate. Widened TBWs are evidenced in schizophrenia, although it is unclear if the SBW is similarly affected. The current study aimed to assess if dexamphetamine (DEX) may increase SBWs in a multimodal visuo-tactile illusion, potentially validating usefulness as an experimental model for multimodal visuo-tactile hallucinations in schizophrenia, and to examine a possible association between altered binding windows (BWs) and working memory (WM) suggested by previous research. METHODS A placebo-controlled, double-blinded, and counter-balanced crossover design was employed. Permuted block randomisation was used for drug order. Healthy participants received DEX (0.45 mg/kg, PO, b.i.d.) or placebo (glucose powder) in capsules. The Rubber Hand Illusion (RHI) and Wechsler Adult Intelligence Scale Spatial Span was employed to determine whether DEX would alter SBWs and WM, respectively. Schizotypy was assessed with a variety of psychological scales. RESULTS Most participants did not experience the RHI even under normal circumstances. Bi-directional and multimodal effects of DEX on individual SBWs and schizotypy were observed, but not on WM. CONCLUSIONS Bidirectional multimodal effects of DEX on the RHI and SBWs were observed in individuals, although not associated with alterations in WM.
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Affiliation(s)
- Mark J H Lim
- Pharmacology, School of Biomedical Sciences, the University of Western Australia, Crawley, Western Australia, Australia
| | - Sean J Loffman
- Pharmacology, School of Biomedical Sciences, the University of Western Australia, Crawley, Western Australia, Australia
| | - Katharina Gaus
- Department of Psychology, University of Wuppertal, Düsseldorf, Germany
| | - Sophie V Slawik
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Rajan Iyyalol
- Psychiatry, School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Graylands Hospital, The University of Western Australia (M708), Crawley, Western Australia, Australia
| | - Joseph W Y Lee
- Psychiatry, School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Emily K Hepple
- Psychiatry, School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Mathew T Martin-Iverson
- Pharmacology, School of Biomedical Sciences, the University of Western Australia, Crawley, Western Australia, Australia
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Pillny M, Hallford DJ, Böge K. The Nature of Mental Imagery and Its Relationship With Amotivational Psychopathology in People With Schizophrenia Spectrum Disorders. Behav Ther 2024; 55:885-897. [PMID: 38937057 DOI: 10.1016/j.beth.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/14/2023] [Accepted: 01/09/2024] [Indexed: 06/29/2024]
Abstract
Many people with schizophrenia spectrum disorders (SSDs) experience profound amotivation, which is strongly related to anticipatory anhedonia. Yet, the neuropsychological fundamentals of anticipatory anhedonia and amotivation are barely understood, resulting in a lack of effective treatments for these patients. Aberrancies in positive mental imagery may interfere with the anticipation of pleasure and could thus explain anticipatory anhedonia and amotivation. However, the nature of mental imagery and its relationship with amotivational psychopathology in SSD is largely unknown. In this preregistered study, we therefore examined mental imagery characteristics and their relation to anticipatory anhedonia, amotivation, and daily life activity in SSD. TheN = 86 participants included individuals with SSD (n = 43) and demographically matched healthy controls (n = 43). Mental imagery, anticipatory pleasure, amotivation, and activity engagement were assessed with structured interviews and self-report questionnaires. Ecological momentary assessment was used to measure state anticipatory pleasure and activity engagement in daily life (n = 81). Compared to the control group, the SSD group showed comparable quantity, but less vividness of mental imagery. Reduced vividness of mental imagery in SSD was significantly associated with higher anticipatory anhedonia, amotivation, and low activity engagement in cross-sectional and prospective analyses. Reduced mental imagery vividness may cause a lack of internal incentive to seek pleasurable experiences and could explain amotivation. Interventions aiming to improve mental imagery vividness and related anticipatory pleasure responses in SSD may be effective in targeting amotivation.
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Sáringer S, Fehér Á, Sáry G, Kaposvári P. Perceptual Expectations Are Reflected by Early Alpha Power Reduction. J Cogn Neurosci 2024; 36:1282-1296. [PMID: 38652100 DOI: 10.1162/jocn_a_02169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The predictability of a stimulus can be characterized by its transitional probability. Perceptual expectations derived from the transitional probability of the stimulus were found to modulate the early alpha oscillations in the sensory regions of the brain when neural responses to expected versus unexpected stimuli were compared. The objective of our study was to find out the extent to which this low-frequency oscillation reflects stimulus predictability. We aimed to detect the alpha-power difference with smaller differences in transitional probabilities by comparing expected stimuli with neutral ones. We studied the effect of expectation on perception by applying an unsupervised visual statistical learning paradigm with expected and neutral stimuli embedded in an image sequence while recording EEG. Time-frequency analysis showed that expected stimuli elicit lower alpha power in the window of 8-12 Hz and 0-400 msec after stimulus presentation, appearing in the centroparietal region. Comparing previous findings of expectancy-based alpha-band modulation with our results suggests that early alpha oscillation shows an inverse relationship with stimulus predictability. Although current data are insufficient to determine the origin of the alpha power reduction, this could be a potential sign of expectation suppression in cortical oscillatory activity.
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Kammerer MK, Nowak U, Lincoln TM, Krkovic K. Revisiting Cognitive Deficits in Outpatients with Psychotic Disorders: A Transdiagnostic Comparison of Cognitive Performance While Accounting for Putative Confounding Factors. Brain Sci 2024; 14:446. [PMID: 38790425 PMCID: PMC11119287 DOI: 10.3390/brainsci14050446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
Recent research suggests that cognitive deficits in individuals with psychotic disorders could be overestimated because poor cognitive test performance is partly attributable to non-cognitive factors. To further test this, we included non-hospitalized individuals with psychotic disorders (PSY, n = 38), individuals with attenuated psychotic symptoms (n = 40), individuals with obsessive-compulsive disorders (n = 39), and healthy controls (n = 38). Relevant cognitive domains were assessed using the MATRICS Consensus Cognitive Battery. Putative confounding non-cognitive factors-heart rate, self-reported stress, negative affect, performance-related beliefs, and actigraphy-derived sleep-were assessed before cognitive testing. A multivariate analysis of covariance was calculated to examine group differences in cognitive performance while controlling for non-cognitive factors. PSY showed decreased test performance in graphomotor speed, attention, and verbal tasks compared to the other groups, whereas non-verbal/visual-spatial tasks were unimpaired. After accounting for non-cognitive factors, group differences diminished in verbal learning, whereas differences in the other domains remained significant. Against our hypotheses, the present findings indicate that some cognitive deficits in PSY cannot be attributed to momentary confounding factors.
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Affiliation(s)
- Mathias Konstantin Kammerer
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany; (M.K.K.); (U.N.); (T.M.L.)
| | - Ulrike Nowak
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany; (M.K.K.); (U.N.); (T.M.L.)
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany; (M.K.K.); (U.N.); (T.M.L.)
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy for Children and Youth, Department of Psychology, Faculty of Human Sciences, University of Potsdam, 14476 Potsdam, Germany
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Liang L, Heinrichs RW, Liddle PF, Jeon P, Théberge J, Palaniyappan L. Cortical impoverishment in a stable subgroup of schizophrenia: Validation across various stages of psychosis. Schizophr Res 2024; 264:567-577. [PMID: 35644706 DOI: 10.1016/j.schres.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cortical thinning is a well-known feature in schizophrenia. The considerable variation in the spatial distribution of thickness changes has been used to parse heterogeneity. A 'cortical impoverishment' subgroup with a generalized reduction in thickness has been reported. However, it is unclear if this subgroup is recoverable irrespective of illness stage, and if it relates to the glutamate hypothesis of schizophrenia. METHODS We applied hierarchical cluster analysis to cortical thickness data from magnetic resonance imaging scans of three datasets in different stages of psychosis (n = 288; 160 patients; 128 healthy controls) and studied the cognitive and symptom profiles of the observed subgroups. In one of the samples, we also studied the subgroup differences in 7-Tesla magnetic resonance spectroscopy glutamate concentration in the dorsal anterior cingulate cortex. RESULTS Our consensus-based clustering procedure consistently produced 2 subgroups of participants. Patients accounted for 75%-100% of participants in one subgroup that was characterized by significantly lower cortical thickness. Both subgroups were equally symptomatic in clinically unstable stages, but cortical impoverishment indicated a higher symptom burden in a clinically stable sample and higher glutamate levels in the first-episode sample. There were no subgroup differences in cognitive and functional outcome profiles or antipsychotic exposure across all stages. CONCLUSIONS Cortical thinning does not vary with functioning or cognitive impairment, but it is more prevalent among patients, especially those with glutamate excess in early stages and higher residual symptom burden at later stages, providing an important mechanistic clue to one of the several possible pathways to the illness.
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Affiliation(s)
- Liangbing Liang
- Graduate Program in Neuroscience, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada
| | | | - Peter F Liddle
- Institute of Mental Health, Division of Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Peter Jeon
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jean Théberge
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Lena Palaniyappan
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Harris M, Blanco E, Howie H, Rempfer M. The Discrepancy between Subjective and Objective Evaluations of Cognitive and Functional Ability among People with Schizophrenia: A Systematic Review. Behav Sci (Basel) 2023; 14:30. [PMID: 38247682 PMCID: PMC10812940 DOI: 10.3390/bs14010030] [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: 12/02/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND An important aspect of recovery in schizophrenia relates to one's subjective, lived experience. Self-report is a subjective measurement method with yet-uncertain utility in the assessment of functioning among individuals diagnosed with schizophrenia-spectrum disorder. No review to date has comprehensively synthesized existing research to evaluate the degree of correspondence, or lack thereof, between subjective and objective assessments of cognitive and everyday functioning, nor how extant data can inform the use of self-reported information in treatment and research. METHODS A systematic review was completed to provide a broad perspective of the literature on this topic. Relevant manuscripts were identified via a search strategy using key terms in PubMed and PsycINFO and a review of manuscript bibliographies. Twenty-six studies met the inclusion criteria. RESULTS These studies show minimal to modest associations between subjective assessments of cognition and everyday functioning and objective assessments of these domains, including informant reports and neuropsychological and behavioral measures. Individuals with schizophrenia appear to overestimate their functioning when compared to objective measures. Depression and greater cognitive ability tend to predict greater correspondence between subjective and objective assessments of cognition and everyday functioning. DISCUSSION This review discusses how we might understand the low correspondence between subjective and objective measures of functioning and provides recommendations for using and eliciting self-reported information in the pursuit of recovery-centered practices.
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Affiliation(s)
- Molly Harris
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO 64110-2499, USA
| | - Emily Blanco
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO 64110-2499, USA
| | - Hunter Howie
- Department of Psychology, University of Kansas, Lawrence, KS 66045, USA (M.R.)
| | - Melisa Rempfer
- Department of Psychology, University of Kansas, Lawrence, KS 66045, USA (M.R.)
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Douglas K, Bell C, Tanveer S, Eggleston K, Porter R, Boden J. UNITE Project: understanding neurocognitive impairment after trauma exposure-study protocol of an observational study in Christchurch, New Zealand. BMJ Open 2023; 13:e072195. [PMID: 37550025 PMCID: PMC10407410 DOI: 10.1136/bmjopen-2023-072195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Our previous research has demonstrated significant cognitive effects of earthquake exposure 2-3 years following the Canterbury earthquake sequence of 2011. Such impairment has major implications for a population trying to recover, and to rebuild, a devastated city. This study aims to examine psychological, cognitive and biological factors that may contribute to subjective cognitive difficulties in a large group of individuals exposed to the Canterbury earthquake sequence. METHODS AND ANALYSIS Two-hundred earthquake-exposed participants from an existing large cohort study (Christchurch Health and Development Study, CHDS) will be recruited. Inclusion is based on results of online screening of the CHDS cohort, using the Cognitive Failures Questionnaire. Individuals scoring the highest (n=100) and lowest (n=100), representing the highest and lowest levels of subjective cognitive impairment, are selected. Exclusions are: psychotic/bipolar disorders, serious substance/alcohol dependence, chronic medical conditions, pregnancy and previous serious head injury. Participants will undergo a half-day assessment including clinician-rated interviews, self-report measures, objective and subjective cognitive assessments, blood sample collection and physical measurements. The primary analysis will compare cognitive, psychological and biological measures in 'high' and 'low' subjective cognitive impairment groups. The study will have power (p<0.05, α=0.8) to show a difference between groups of 0.4 SD on any variable. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. The online screening component of the study received ethical approval on 1 April 2021 (16/STH/188, PAF 7), and the main study (subsequent to screening) received approval on 16 August 2021 (Northern A 21/NTA/68). All participants provide written informed consent. Findings will be disseminated initially to the CHDS cohort members, the wider Canterbury community, and then by publication in scientific journals and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05090046).
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Affiliation(s)
- Katie Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Caroline Bell
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Sandila Tanveer
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Specialist Mental Health Services, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Specialist Mental Health Services, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Joseph Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Moritz S, Xie J, Penney D, Bihl L, Hlubek N, Elmers J, Beblo T, Hottenrott B. The magnitude of neurocognitive impairment is overestimated in depression: the role of motivation, debilitating momentary influences, and the overreliance on mean differences. Psychol Med 2023; 53:2820-2830. [PMID: 35022092 PMCID: PMC10235659 DOI: 10.1017/s0033291721004785] [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: 06/02/2021] [Revised: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Meta-analyses agree that depression is characterized by neurocognitive dysfunctions relative to nonclinical controls. These deficits allegedly stem from impairments in functionally corresponding brain areas. Increasingly, studies suggest that some performance deficits are in part caused by negative task-taking attitudes such as poor motivation or the presence of distracting symptoms. A pilot study confirmed that these factors mediate neurocognitive deficits in depression. The validity of these results is however questionable given they were based solely on self-report measures. The present study addresses this caveat by having examiners assess influences during a neurocognitive examination, which were concurrently tested for their predictive value on performance. METHODS Thirty-three patients with depression and 36 healthy controls were assessed on a battery of neurocognitive tests. The examiner completed the Impact on Performance Scale, a questionnaire evaluating mediating influences that may impact performance. RESULTS On average, patients performed worse than controls at a large effect size. When the total score of the Impact on Performance Scale was accounted for by mediation analysis and analyses of covariance, group differences were reduced to a medium effect size. A total of 30% of patients showed impairments of at least one standard deviation below the mean. CONCLUSIONS This study confirms that neurocognitive impairment in depression is likely overestimated; future studies should consider fair test-taking conditions. We advise researchers to report percentages of patients showing performance deficits rather than relying solely on overall group differences. This prevents fostering the impression that the majority of patients exert deficits, when in fact deficits are only true for a subgroup.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jingyuan Xie
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Danielle Penney
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l’Île-de-Montréal, Douglas Mental Health University Institute, Montreal, Canada
| | - Lisa Bihl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niklas Hlubek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Elmers
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Oomen PP, Begemann MJH, Brand BA, de Haan L, Veling W, Koops S, van Os J, Smit F, Bakker PR, van Beveren N, Boonstra N, Gülöksüz S, Kikkert M, Lokkerbol J, Marcelis M, Rosema BS, de Beer F, Gangadin SS, Geraets CNW, van ‘t Hag E, Haveman Y, van der Heijden I, Voppel AE, Willemse E, van Amelsvoort T, Bak M, Batalla A, Been A, van den Bosch M, van den Brink T, Faber G, Grootens KP, de Jonge M, Knegtering R, Kurkamp J, Mahabir A, Pijnenborg GHM, Staring T, Veen N, Veerman S, Wiersma S, Graveland E, Hoornaar J, Sommer IEC. Longitudinal clinical and functional outcome in distinct cognitive subgroups of first-episode psychosis: a cluster analysis. Psychol Med 2023; 53:2317-2327. [PMID: 34664546 PMCID: PMC10123843 DOI: 10.1017/s0033291721004153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes. METHODS 204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up. RESULTS Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present. CONCLUSIONS Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.
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Affiliation(s)
- Priscilla P. Oomen
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke J. H. Begemann
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bodyl A. Brand
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Koops
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Filip Smit
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Centre of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - P. Roberto Bakker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Nico van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Nynke Boonstra
- NHL/Stenden, University of Applied Sciences, Leeuwarden, The Netherlands
- KieN VIP Mental Health Care Services, Leeuwarden, The Netherlands
| | - Sinan Gülöksüz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Martijn Kikkert
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Joran Lokkerbol
- Centre of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Bram-Sieben Rosema
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shiral S. Gangadin
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Chris N. W. Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna van ‘t Hag
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yudith Haveman
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van der Heijden
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Janssen-Cilag B.V., Breda, the Netherlands
| | - Alban E. Voppel
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elske Willemse
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Albert Batalla
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Agaath Been
- Dimence Institute for Mental Health, Deventer, Zwolle, The Netherlands
| | | | | | - Gunnar Faber
- Yulius, Mental Health Institute, Dordrecht, The Netherlands
| | - Koen P. Grootens
- Reinier van Arkel Institute for Mental Health Care, ‘s Hertogenbosch, The Netherlands
| | - Martin de Jonge
- Program for Psychosis & Severe Mental Illness, Pro Persona Mental Health, Wolfheze, The Netherlands
| | - Rikus Knegtering
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Jörg Kurkamp
- Center for Youth with Psychosis, Mediant ABC Twente, Enschede, The Netherlands
| | | | - Gerdina H. M. Pijnenborg
- Department of Psychotic Disorders, GGZ-Drenthe, Assen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty BSS, University of Groningen, Groningen, The Netherlands
| | - Tonnie Staring
- Department ABC Early Psychosis, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Natalie Veen
- GGZ Delfland, Delfland Institute for Mental Health Care, Delft, The Netherlands
| | - Selene Veerman
- Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The Netherlands
| | - Sybren Wiersma
- Early Intervention Psychosis Team, GGZ inGeest Specialized Mental Health Care, Hoofddorp, The Netherlands
| | | | - Joelle Hoornaar
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Low rate of performance validity failures among individuals with bipolar disorder. J Int Neuropsychol Soc 2023; 29:298-305. [PMID: 35403599 DOI: 10.1017/s1355617722000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Assessing performance validity is imperative in both clinical and research contexts as data interpretation presupposes adequate participation from examinees. Performance validity tests (PVTs) are utilized to identify instances in which results cannot be interpreted at face value. This study explored the hit rates for two frequently used PVTs in a research sample of individuals with and without histories of bipolar disorder (BD). METHOD As part of an ongoing longitudinal study of individuals with BD, we examined the performance of 736 individuals with BD and 255 individuals with no history of mental health disorder on the Test of Memory Malingering (TOMM) and the California Verbal Learning Test forced choice trial (CVLT-FC) at three time points. RESULTS Undiagnosed individuals demonstrated 100% pass rate on PVTs and individuals with BD passed over 98% of the time. A mixed effects model adjusting for relevant demographic variables revealed no significant difference in TOMM scores between the groups, a = .07, SE = .07, p = .31. On the CVLT-FC, no clinically significant differences were observed (ps < .001). CONCLUSIONS Perfect PVT scores were obtained by the majority of individuals, with no differences in failure rates between groups. The tests have approximately >98% specificity in BD and 100% specificity among non-diagnosed individuals. Further, nearly 90% of individuals with BD obtained perfect scores on both measures, a trend observed at each time point.
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12
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Ruiz-Delgado I, Moreno-Küstner B, García-Medina M, Barrigón ML, Gonzalez-Higueras F, López-Carrilero R, Barrios-Mellado I, Barajas A, Pousa E, Lorente-Rovira E, Grasa E, Cid J, Barrau-Sastre P, Moritz S, Ochoa S. Is Metacognitive Training effective for improving neurocognitive function in patients with a recent onset of psychosis? Psychiatry Res 2022; 318:114941. [PMID: 36375331 DOI: 10.1016/j.psychres.2022.114941] [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: 08/09/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
The aims are to assess improvements in memory, attention and executive function in first-episode psychosis after Metacognitive Training (MCT). A multicenter randomized clinical trial was performed with two arms: MCT and psychoeducational intervention. A total of 126 patients with a diagnosis of psychosis, less than 5 years from the onset of the disease, were included. Patients were assessed two or three moments (baseline, post-treatment, 6 months follow-up) depending on the test, with a battery of neurocognitive tests (TAVEC, TMTA-B, CPT, WCST, Stroop and premorbid IQ). General linear models for repeated measures were performed. A better improvement in the MCT was found by an interaction between group and time in CPT Hit index, TMTB, Stroop, recent memory and number of perseverations of the TAVEC. Considering three assessments, a better improvement was found in non-perseverative, perseverative and total errors of the WCST and TMTB. The MCT is an effective psychological intervention to improve several cognitive functions.
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Affiliation(s)
- Isabel Ruiz-Delgado
- UGC Salud Mental Hospital Regional de Málaga. Servicio Andaluz de Salud, Spain.
| | - Berta Moreno-Küstner
- PhD Department of Personality, Assessment and Psychological treatments. Faculty of Psychology,University of Málaga. Spain; Biomedical Research Institute of Malaga (IBIMA) Spain, GAP Research Group, Spain
| | | | - María Luisa Barrigón
- UGC Salud Mental Hospital Universitario Virgen del Rocio, Sevilla, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid Spain
| | | | - Raquel López-Carrilero
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat. Parc Sanitari Sant Joan de Déu, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid Spain
| | - Irene Barrios-Mellado
- UGC Salud Mental Hospital Universitario Virgen del Rocío. Servicio Andaluz de Salud, Spain
| | - Ana Barajas
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellatera, Cerdanyola del Vallès, Spain; Serra Húnter Programme, Government of Catalonia, Barcelona, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid Spain; Servei de Psiquiatría Hospital de la Santa Creu i Sant Pau
| | - Esther Lorente-Rovira
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid Spain; Hospital Clínico Universitario, Valencia, Spain
| | - Eva Grasa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid Spain; Servei de Psiquiatría Hospital de la Santa Creu i Sant Pau; Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Spain
| | - Jordi Cid
- Mental Health & Addiction Research Group, IdiBGi, Institut d'Assistencia Sanitària, Girona, Spain
| | - Paula Barrau-Sastre
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat. Parc Sanitari Sant Joan de Déu, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Universitat Barcelona, Barcelona, Spain
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Susana Ochoa
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat. Parc Sanitari Sant Joan de Déu, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid Spain.
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13
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Pena-Garijo J, Palop-Grau A, Masanet MJ, Lacruz M, Plaza R, Hernández-Merino A, Edo-Villamón S, Valllina O. Self-reported cognitive biases in psychosis: Validation of the Davos Assessment of Cognitive Biases Scale (DACOBS) in a Spanish sample of psychotic patients and healthy controls. J Psychiatr Res 2022; 155:526-533. [PMID: 36191521 DOI: 10.1016/j.jpsychires.2022.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/10/2022] [Accepted: 09/23/2022] [Indexed: 10/31/2022]
Abstract
Cognitive biases have been demonstrated to be important in developing and maintaining psychosis. However, self-report measures for everyday clinical practice have been developed only recently. We aimed to study one of these instruments for assessing cognitive biases: the Davos Assessment of Cognitive Biases Scale (DACOBS). In a Spanish sample of 84 patients diagnosed with schizophrenia-spectrum disorders and 152 healthy controls, we examined a) the factor structure using Confirmatory Factor Analysis (CFA) to test the original one-, three- and seven-factor solutions, b) the reliability (Cronbach's alpha), c) the discriminative power (Multivariate Analysis of Covariance - MANCOVA) and d) the relationships of cognitive biases with positive psychotic-like experiences (PPLEs) in healthy individuals and with psychotic symptoms in schizophrenia-spectrum patients. The CFA revealed that the seven-factor solution achieved the best fit. The DACOBS overall scale (Cronbach's alpha = .92) and subscales obtained good internal consistencies. MANCOVA, controlling for age and education, demonstrated that all subscales differentiated between healthy controls and psychotic patients (Wilks' Lambda = 0.87; F7, 226 = 4.70; p < .000; partial eta squared = 0.13). In addition, the DACOBS showed high correlations with PPLEs (controls) and moderate correlations with positive and general symptoms (patients), demonstrating its predictive validity. Concluding, the DACOBS proved to be a psychometrically suitable instrument for assessing cognitive biases in psychosis and adequately differentiated between patients and healthy individuals within the Spanish population. Norm scores are provided.
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Affiliation(s)
| | | | | | - María Lacruz
- University Hospital Doctor Peset, Valencia, Spain
| | - Rut Plaza
- University Hospital Doctor Peset, Valencia, Spain
| | | | - Silvia Edo-Villamón
- Consorcio Hospitalario Provincial of Castellon, Castellon de La Plana, Spain
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14
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Raucher-Chéné D, Pochiet G, Lavigne KM, Heinrichs RW, Malla A, Joober R, Lepage M. Normal-range verbal memory in the first-episode of psychosis: Clinical and functional outcomes across 24 months and impact of estimated verbal memory decrement. Schizophr Res 2022; 246:75-84. [PMID: 35728419 DOI: 10.1016/j.schres.2022.06.007] [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: 02/03/2022] [Revised: 05/18/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022]
Abstract
Verbal memory (VM) dysfunction is prevalent in first-episode psychosis (FEP) and has major impacts on long-term functional and clinical outcomes. Nevertheless, a substantial proportion of FEP patients have VM performance in the norm, called normal-range (NR) VM, and only a few studies have explored its relation to outcomes. Moreover, probable decrements between estimated premorbid and current cognitive performance could confuse the relationship between VM and clinical or functional outcomes in FEP patients. These potential interactions have not yet been considered in FEP, thus, we examined 1) the longitudinal relationship between VM performance (NR vs. below NR (BNR)) in FEP and clinical and functional outcomes over 24 months following admission to treatment, and 2) compared the clinical and functional status of NR patients with and without cognitive decrement at baseline and 12 months. A total of 271 patients (BNR = 114, NR = 157; 81 out of 105 NR with decrement) completed measures of psychosocial functioning and clinical symptoms at baseline, month 12, and month 24. Generalized Estimating Equations and unpaired t-tests were used to address the first and second aim, respectively. NR demonstrated better functioning and fewer negative symptoms when compared to BNR. Interestingly, NR patients with decrement reported significantly more negative symptoms at baseline compared to their counterparts without decrement. These findings document that a large proportion (57.9 %) of FEP patients have NR VM that appear to be functionally advantageous but that NR VM is nuanced by the presence or absence of a potential decrement early in the developmental course of the disorder.
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Affiliation(s)
- Delphine Raucher-Chéné
- Douglas Mental Health University Institute, McGill University, Montreal, Canada; Academic Department of Psychiatry, University Hospital of Reims, EPSM Marne, Reims, France; Cognition, Health, and Society Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Gabrielle Pochiet
- Douglas Mental Health University Institute, McGill University, Montreal, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Canada
| | - Katie M Lavigne
- Douglas Mental Health University Institute, McGill University, Montreal, Canada; Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | | | - Ashok Malla
- Douglas Mental Health University Institute, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychoses (PEPP - Montreal), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychoses (PEPP - Montreal), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychoses (PEPP - Montreal), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
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15
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Décombe A, Brinkmann K, Merenciano M, Capdevielle D, Gendolla GHE, Raffard S. Cognitive effort in Schizophrenia: Dissimilar effects on cardiovascular activity and subjective effort. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Pillny M, Krkovic K, Buck L, Lincoln TM. From Memories of Past Experiences to Present Motivation? A Meta-analysis on the Association Between Episodic Memory and Negative Symptoms in People With Psychosis. Schizophr Bull 2022; 48:307-324. [PMID: 34635918 PMCID: PMC8886596 DOI: 10.1093/schbul/sbab120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Based on findings from cognitive science, it has been theorized that the reductions in motivation and goal-directed behavior in people with psychosis could stem from impaired episodic memory. In the current meta-analysis, we investigated this putative functional link between episodic memory deficits and negative symptoms. We hypothesized that episodic memory deficits in psychosis would be related to negative symptoms in general but would be more strongly related to amotivation than to reduced expressivity. We included 103 eligible studies (13,622 participants) in the analyses. Results revealed significant, moderate negative associations of episodic memory with negative symptoms in general (k = 103; r = -.23; z = -13.40; P ≤ .001; 95% CI [-.26; -.20]), with amotivation (k = 16; r = -.18; z = -6.6; P ≤ .001; 95% CI [-.23; -.13]) and with reduced expressivity (k = 15; r = -.18; z = -3.30; P ≤.001; 95% CI[-.29; -.07]). These associations were not moderated by sociodemographic characteristics, positive symptoms, depression, antipsychotic medication or type of negative symptom scale. Although these findings provide sound evidence for the association between episodic memory deficits and amotivation, the rather small magnitude and the unspecific pattern of this relationship also indicate that episodic memory deficits are unlikely to be the only factor relevant to amotivation. This implicates that future research should investigate episodic memory in conjunction with other factors that could account for the association of episodic memory deficits and amotivation in psychosis.
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Affiliation(s)
- Matthias Pillny
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Laura Buck
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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17
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Ferrer-Quintero M, Fernández D, López-Carrilero R, Birulés I, Barajas A, Lorente-Rovira E, Luengo A, Díaz-Cutraro L, Verdaguer M, García-Mieres H, Gutiérrez-Zotes A, Grasa E, Pousa E, Huerta-Ramos E, Pélaez T, Barrigón ML, Gómez-Benito J, González-Higueras F, Ruiz-Delgado I, Cid J, Moritz S, Sevilla-Llewellyn-Jones J, Ochoa S. Males and females with first episode psychosis present distinct profiles of social cognition and metacognition. Eur Arch Psychiatry Clin Neurosci 2022; 272:1169-1181. [PMID: 35802165 PMCID: PMC9508015 DOI: 10.1007/s00406-022-01438-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/23/2022] [Indexed: 12/01/2022]
Abstract
Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.
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Affiliation(s)
- M. Ferrer-Quintero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Departament de Psicologia Social I Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, Barcelona, Spain ,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - D. Fernández
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain ,Fundació Sant Joan de Déu, Esplugues de Llobregat Barcelona, Spain ,Serra Húnter Fellow. Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, 08028 Spain ,Institute of Mathematics of UPC - BarcelonaTech (IMTech), Universitat Politècnica de Catalunya, Barcelona, 08028 Spain
| | - R. López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain ,Fundació Sant Joan de Déu, Esplugues de Llobregat Barcelona, Spain
| | - I. Birulés
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Departament de Psicologia Social I Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, Barcelona, Spain
| | - A. Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de La Salut. Serra Hunter Fellow, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Barcelona, Spain ,Department of Research, Centre d’Higiene Mental Les Corts, Barcelona, Spain
| | - E. Lorente-Rovira
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain ,Psychiatry Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - A. Luengo
- Psychiatry Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - L. Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,COMSAL research group, FPCEE, Blanquerna Ramon Llull University, Barcelona, Spain
| | - M. Verdaguer
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Departament de Psicologia, Facultat de Psicologia Clínica I de La Salut. Serra Hunter Fellow, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Barcelona, Spain ,Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - H. García-Mieres
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - A. Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain ,Hospital Universitari Institut Pere Mata, Institut d’Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, Reus, Spain
| | - E. Grasa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain ,Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - E. Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain ,Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain ,Salut Mental Parc Taulí. Sabadell (Barcelona), Hospital Universitari–UAB Universitat Autònoma de Barcelona, Barcelona, Spain ,Neuropsiquiatria I Addicions, Hospital del Mar. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - E. Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - T. Pélaez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - M. L. Barrigón
- Departament of Psychiatry, University Hospital Virgen del Rocio, Seville, Spain ,Psychiatry Service, Area de Gestión Sanitaria Sur Granada, Motril, Granada, Spain
| | - J. Gómez-Benito
- Departament de Psicologia Social I Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, Barcelona, Spain , GEIMAC, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | | | - I. Ruiz-Delgado
- Unidad de Salud Mental Comunitaria Malaga Norte, Malaga, Spain
| | - J. Cid
- Mental Health and Addiction Research Group. IdiBGi. Institut d’Assistencia Sanitària, Girona, Spain
| | - S. Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - J. Sevilla-Llewellyn-Jones
- Institute of Psychiatry and Mental Health, Health Research Institute (IdISSC), Clinico San Carlos Hospital, Madrid, Spain
| | | | - S. Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregats, Dr. Pujades 42. Sant Boi de Llobregat 08830, Barcelona, Spain ,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
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18
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Cuesta MJ, Sánchez-Torres AM, Lorente-Omeñaca R, Moreno-Izco L, Peralta V. Cognitive, community functioning and clinical correlates of the Clinical Assessment Interview for Negative Symptoms (CAINS) in psychotic disorders. Eur Arch Psychiatry Clin Neurosci 2021; 271:1537-1546. [PMID: 32895741 DOI: 10.1007/s00406-020-01188-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022]
Abstract
Negative symptoms are a core dimension of schizophrenia and other psychoses that account for a large degree of the poor functional outcomes related to these disorders. Newer assessment scales for negative symptoms, such as the Clinical Assessment Interview for Negative Symptoms (CAINS), provide evidence for separate dimensions of motivational and pleasure (MAP) and expression (EXP) dimensions. This study was aimed at extending the analysis of the clinical, functional and cognitive correlates of CAINS dimensions in a sample of patients with psychotic disorders (n = 98) and 50 healthy controls.A psychopathological evaluation was conducted by using the Comprehensive Assessment of Symptoms and History (CASH). To assess the extrapyramidal signs, the UKU scale was used. Community functioning was evaluated by means of real-world and functional attainment measures. Additionally, a full neuropsychological test battery was administered. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the influencing and predictive factors associated with the CAINS dimensions.The MAP and EXP dimensions showed strong associations with the Scale for the Assessment of Negative Symptoms (SANS) items and were not significantly associated with extra-pyramidal or cognitive deficits. The MAP and EXP CAINS dimensions revealed good predictive validity for real-world functioning and functional attainment measures.These findings suggest that the CAINS scale endorses good convergent validity for the assessment of negative symptoms and is very useful in the prediction of psychosocial functioning. In addition, the CAINS dimensions might provide advantages over old assessment scales on disentangling the complex associations between negative symptoms and cognitive impairment.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
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19
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Moritz S, Xie J, Lion D, Penney D, Jelinek L. Impaired test performance yet spared neurocognitive functioning in individuals with obsessive-compulsive disorder: the role of performance mediators. Cogn Neuropsychiatry 2021; 26:394-407. [PMID: 34431448 DOI: 10.1080/13546805.2021.1967733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although most studies report neurocognitive deficits in patients with obsessive-compulsive disorder (OCD), important exceptions exist, highlighting the possible role of mediators (e.g., poor motivation). This study investigated neurocognitive functioning and potential influences affecting performance in OCD. METHODS Forty-three participants (13 OCD patients, 30 healthy controls) were assessed using a battery of neurocognitive tests. During the assessment, the examiner completed the Impact on Performance Scale (IPS) which measures variables that may impact neurocognitive performance. RESULTS Pooled neurocognitive performance was lower in OCD patients versus healthy controls at a moderate effect size. Patients performed more poorly on the IPS, particularly the Well-Being During Assessment subscale. Performance differences across the two groups were attenuated to a non-significant small-to-medium effect when the IPS was entered as a covariate. A total of 34% of patients showed scores greater than one standard deviation below the mean compared to 9.63% in healthy individuals. Yet, when a conservative impairment criterion (≥2 standard deviations below the mean) was applied, less than 10% of patients displayed deficits. CONCLUSIONS Neurocognitive impairment in OCD is likely exaggerated. In addition to considering important mediators researchers should report the percentage of participants displaying performance deficits rather than mean group differences alone; the latter obscures the high percentage of patients without impairment and thus may unduly foster stigma in this population.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jingyuan Xie
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Despina Lion
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Danielle Penney
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal, Douglas Mental Health University Institute, Montréal, Canada
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Schmid P, Czekaj A, Frick J, Steinert T, Purdon SE, Uhlmann C. The screen for cognitive impairment in psychiatry (SCIP) as a routinely applied screening tool: pathology of acute psychiatric inpatients and cluster analysis. BMC Psychiatry 2021; 21:494. [PMID: 34627191 PMCID: PMC8502259 DOI: 10.1186/s12888-021-03508-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/20/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cognitive dysfunction has been reported in acute psychiatric patients for a long time. The detection of cognitive deficits is crucial both for clinical treatment and for predicting the psychosocial functional level in the further course of the disease. The SCIP is a well-evaluated screening instrument for the examination of cognitive performance in psychiatric patients. We recently integrated the SCIP into our routine admission and discharge assessments on two inpatient wards, and we examined the cognitive profiles of patients with psychotic and affective disorders over the course of their admission. METHODS Shortly after admission, and prior to discharge, patients were routinely referred for examination with the SCIP. A total of 529 assessments were completed on admission, and 227 returned for SCIP at the time of discharge. After standardization of the test results against a normative sample, we examined the normalized test values in terms of percentages of pathological cognitive performance based on the total SCIP score, and each of the SCIP subscale scores. We conducted cluster analysis to identify cognitive subgroups within the clinical sample. RESULTS More than 70% of the SCIP results on admission were pathological. At discharge, improvements were observed, especially on tests with attention and speed components. Cluster analysis identified two groups. The cluster with chronic patients showed poorer results at admission, but greater improvement and reached the level of the others at discharge. CONCLUSIONS The SCIP appears to have value in routine diagnostic assessments, and in the quantification of improvements in cognitive performance during an inpatient stay. The greatest benefit was observed in chronically ill patients with many previous stays. TRIAL REGISTRATION DRKS00019825 (retrospectively registered on 03.12.2019).
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Affiliation(s)
- Petra Schmid
- Department for Psychiatry and Psychotherapy I of the University of Ulm, ZfP Suedwuerttemberg Ravensburg-Weissenau, Weingartshofer Str. 2, D-88214, Ravensburg, Weissenau, Germany.
| | - Agata Czekaj
- Department for Psychiatry and Psychotherapy I of the University of Ulm, ZfP Suedwuerttemberg Ravensburg-Weissenau, Weingartshofer Str. 2, D-88214, Ravensburg, Weissenau, Germany
| | - Jürgen Frick
- Department for Psychiatry and Psychotherapy I of the University of Ulm, ZfP Suedwuerttemberg Ravensburg-Weissenau, Weingartshofer Str. 2, D-88214, Ravensburg, Weissenau, Germany
| | - Tilman Steinert
- Department for Psychiatry and Psychotherapy I of the University of Ulm, ZfP Suedwuerttemberg Ravensburg-Weissenau, Weingartshofer Str. 2, D-88214, Ravensburg, Weissenau, Germany
| | - Scot E Purdon
- Alberta Hospital Edmonton and the Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen Uhlmann
- Department for Psychiatry and Psychotherapy I of the University of Ulm, ZfP Suedwuerttemberg Ravensburg-Weissenau, Weingartshofer Str. 2, D-88214, Ravensburg, Weissenau, Germany
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21
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Bosnjak Kuharic D, Makaric P, Kekin I, Rossini Gajsak L, Zivkovic M, Ostojic D, Silic A, Bajic Z, Lukacevic Lovrencic I, Beezhold J, Rojnic Kuzman M. Changes of neurocognitive status in patients with the first-episode psychosis after 18 months of treatment-A prospective cohort study. Psychiatry Res 2021; 304:114131. [PMID: 34332430 DOI: 10.1016/j.psychres.2021.114131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022]
Abstract
Neurocognitive symptoms exert the most influence on treatment outcomes over the course of schizophrenia, starting from the first-episode of psychosis (FEP) onwards. Our aim was to analyze the neurocognitive status of FEP compared to healthy controls (HC), and its change after 18 months of treatment. We performed a study in a sample of 159 patients with FEP and 100 HC. We followed the patients up for 18 months after initial assessment with a battery of neurocognitive tests. We observed statistically significant improvement in the majority of neurocognitive tests after 18 months, but several tests of specific neurocognitive domains (verbal memory, language functions, executive functions) did not show significant differences between the two assessments. The results for the majority of tests obtained from patients with FEP after 18 months of treatment showed significant deterioration compared with HC. Although our study showed significant improvement of baseline neurocognitive deficits in FEP with treatment, this varied across domains and overall performance remained below that of HC. Thus, while it seems that treatment of FEP may help to delay or restore neurocognitive deterioration, it is unclear whether specific areas of neurocognitive deterioration (e.g. verbal domain) would benefit from more time or specific treatment approaches.
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Affiliation(s)
| | - Porin Makaric
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
| | - Ivana Kekin
- Department of Psychiatry, Zagreb University Hospital Centre, Kispaticeva 12, Zagreb HR-10000, Croatia
| | | | - Maja Zivkovic
- Department of Psychiatry, Zagreb University Hospital Centre, Kispaticeva 12, Zagreb HR-10000, Croatia
| | - Drazenka Ostojic
- University Psychiatric Hospital Vrapce, Zagreb, Croatia; Social Work Study Centre, Faculty of Law, University of Zagreb, Zagreb, Croatia
| | - Ante Silic
- Department of Psychiatry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; Department of Psychology, University Department of Croatian Studies, University of Zagreb, Zagreb, Croatia
| | - Zarko Bajic
- Biometrika Healthcare Research, Zagreb, Croatia; Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | | | - Julian Beezhold
- Norfolk and Suffolk NHS Foundation Trust, Norfolk and Norwich University Hospital, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
| | - Martina Rojnic Kuzman
- Department of Psychiatry, Zagreb University Hospital Centre, Kispaticeva 12, Zagreb HR-10000, Croatia; Zagreb School of Medicine, University of Zagreb, Zagreb, Croatia.
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22
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Neural Correlates of Aberrant Salience and Source Monitoring in Schizophrenia and At-Risk Mental States-A Systematic Review of fMRI Studies. J Clin Med 2021; 10:jcm10184126. [PMID: 34575237 PMCID: PMC8468329 DOI: 10.3390/jcm10184126] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023] Open
Abstract
Cognitive biases are an important factor contributing to the development and symptom severity of psychosis. Despite the fact that various cognitive biases are contributing to psychosis, they are rarely investigated together. In the current systematic review, we aimed at investigating specific and shared functional neural correlates of two important cognitive biases: aberrant salience and source monitoring. We conducted a systematic search of fMRI studies of said cognitive biases. Eight studies on aberrant salience and eleven studies on source monitoring were included in the review. We critically discussed behavioural and neuroimaging findings concerning cognitive biases. Various brain regions are associated with aberrant salience and source monitoring in individuals with schizophrenia and the risk of psychosis. The ventral striatum and insula contribute to aberrant salience. The medial prefrontal cortex, superior and middle temporal gyrus contribute to source monitoring. The anterior cingulate cortex and hippocampus contribute to both cognitive biases, constituting a neural overlap. Our review indicates that aberrant salience and source monitoring may share neural mechanisms, suggesting their joint role in producing disrupted external attributions of perceptual and cognitive experiences, thus elucidating their role in positive symptoms of psychosis. Account bridging mechanisms of these two biases is discussed. Further studies are warranted.
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Liu J, Yang T, Zhou L, Gong J, He Y, Cui X, Luo X, Wu J. Association between schizotypal personality traits and emotional instability: mediation and moderation analysis among Chinese college students. J Affect Disord 2021; 291:83-92. [PMID: 34023751 DOI: 10.1016/j.jad.2021.04.079] [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: 09/24/2020] [Revised: 03/10/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies identified an association between schizophrenia and emotional instability. However, the relationship between schizotypal personality traits and emotional instability has not been explored to date. Furthermore, both mediating and moderating factors need to be identified. METHODS A total of 2936 students completed the Schizotypal Personality Questionnaire (SPQ), the Affective Lability Scale-Short Form (ALS-SF), and the Davos Assessment of Cognitive Biases Scale (DACOBS). RESULTS 1) The total scores of DACOBS (and all dimensions) and ALS-SF (and all dimensions) in the high schizotypal personality trait group were higher than in the low schizotypal personality trait group (all P < 0.05). 2) SPQ score and DACOBS social cognition problems, subjective cognitive problems, jumping to conclusions bias, and external attribution bias subscale scores positively predicted the total score of ALS-SF (or the dimensions of ALS-SF) in both male and female populations (all P < 0.05). 3) In the male population, DACOBS social cognition problems, subjective cognitive problems, jumping to conclusions bias, and external attribution bias subscale scores mediated the relationship between SPQ score and ALS-SF total score (or its subscales). In the female population, DACOBS attention for threat bias, external attribution bias, jumping to conclusions bias, social cognition problems, and subjective cognitive problems subscale scores mediated the relationship between SPQ score and ALS-SF total score (or its subscales). 4) Gender exerted a moderating effect on this relationship between SPQ score and ALS-SF total/anxiety-depression score (all P < 0.05). CONCLUSIONS Schizotypal personality traits might influence emotional instability through cognitive biases, and the degree of this influence varies depending on gender.
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Affiliation(s)
- Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China
| | - Tingyu Yang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Lihua Zhou
- College of Education Science, Hengyang Normal University, Hengyang 421002, China
| | - Jingbo Gong
- Department of Applied Psychology, Hunan University of Chinese Medicine, Changsha 41000, China
| | - Yuqiong He
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xilong Cui
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xuerong Luo
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Junduan Wu
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning 530000, China.
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24
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Anxiety and executive functions relationships in schizophrenia: A meta-analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abramovitch A, Short T, Schweiger A. The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology. Clin Psychol Rev 2021; 86:102007. [PMID: 33864968 DOI: 10.1016/j.cpr.2021.102007] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Research into cognitive functions across psychological disorders suggests that cognitive deficiencies may be present across multiple disorders, potentially pointing to a transdiagnostic phenomenon. More recently, a single dimension model of psychopathology, the p factor, has been proposed, in which cognitive deficits are thought to be an intrinsic construct, assumed to be transdiagnostic. However, no systematic investigation to date tested this hypothesis. The aim of the present study was to systematically review meta-analyses to assess the hypothesis that the C factor (cognitive dysfunction) is transdiagnostic in psychopathology and review potential moderators that may account for such a phenomenon. We conducted a systematic review of meta-analyses examining cognitive function across all disorders for which data were available. Included meta-analyses (n = 82), comprising 97 clinical samples, yielded 1,055 effect sizes. Twelve major disorders/categories (e.g., bipolar disorder, substance use disorders) were included, comprising 29 distinct clinical entities (e.g., euthymic bipolar disorder; alcohol use disorder). Results show that all disorders reviewed are associated with underperformance across cognitive domains, supporting the hypothesis that the C factor (or cognitive dysfunction) is a transdiagnostic factor related to p. To examine moderators that may explain or contribute to c, we first consider important interpretative limitations of neuropsychological data in psychopathology. More crucially, we review oft-neglected motivational and emotional transdiagnostic constructs of p, as prominent contributing constructs to the C factor. These constructs are offered as a roadmap for future research examining these constructs related to p, that contribute, and may account for cognitive dysfunctions in psychopathology.
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Affiliation(s)
| | - Tatiana Short
- Department of Psychology, Texas State University, USA
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26
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Dawes C, Danielmeier C, Haselgrove M, Moran PM. High Schizotypy Predicts Emotion Recognition Independently of Negative Affect. Front Psychiatry 2021; 12:738344. [PMID: 34630186 PMCID: PMC8495418 DOI: 10.3389/fpsyt.2021.738344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Deficits in Emotion Recognition (ER) contribute significantly to poorer functional outcomes in people with schizophrenia. However, rather than reflecting a core symptom of schizophrenia, reduced ER has been suggested to reflect increased mood disorder co-morbidity and confounds of patient status such as medication. We investigated whether ER deficits are replicable in psychometrically defined schizotypy, and whether this putative association is mediated by increased negative affect. Methods: Two hundred and nine participants between the ages of 18 and 69 (66% female) were recruited from online platforms: 80% held an undergraduate qualification or higher, 44% were current students, and 46% were in current employment. Participants were assessed on psychometric schizotypy using the O-LIFE which maps onto the same symptoms structure (positive, negative, and disorganised) as schizophrenia. Negative affect was assessed using the Depression Anxiety and Stress Scale (DASS-21). Emotion Recognition of both positive and negative emotions was assessed using the short version of the Geneva Emotion Recognition Task (GERT-S). Results: Negative schizotypy traits predicted poorer ER accuracy to negative emotions (β = -0.192, p = 0.002) as predicted. Unexpectedly, disorganised schizotypy traits predicted improved performance to negative emotions (β = 0.256, p = 0.007) (primarily disgust). Negative affect was found to be unrelated to ER performance of either valence (both p > 0.591). No measure predicted ER accuracy of positive emotions. Positive schizotypy traits were not found to predict either positive or negative ER accuracy. However, positive schizotypy predicted increased confidence in decisions and disorganised schizotypy predicted reduced confidence in decisions. Discussion: The replication of ER deficits in non-clinical negative schizotypy suggests that the association between negative symptoms and ER deficits in clinical samples may be independent of confounds of patient status (i.e., anti-psychotic medication). The finding that this association was independent of negative affect further suggests ER deficits in patients may also be independent of mood disorder co-morbidity. This association was not demonstrated for the positive symptom dimension of the O-LIFE, which may be due to low levels of this trait in the current sample.
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Yin Y, Tong J, Huang J, Tian B, Chen S, Cui Y, An H, Tan S, Wang Z, Yang F, Tian L, Tong Y, Hong LE, Tan Y. Suicidal ideation, suicide attempts, and neurocognitive dysfunctions among patients with first-episode schizophrenia. Suicide Life Threat Behav 2020; 50:1181-1188. [PMID: 32949038 DOI: 10.1111/sltb.12689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether suicidal ideation or suicide attempts are linked to poor neurocognitive function among individuals with first-episode schizophrenia (FES). METHOD We performed a cross-sectional study on 159 Chinese inpatients (Mage = 27.1 years; 52.2% females) with minimal-treated FES and collected their suicidal history through interviews and medical records. Neurocognitive performance, psychopathology, and depressive symptoms were assessed using the MATRICS Consensus Cognitive Battery, the Positive and Negative Syndrome Scale, and the Calgary Depression Scale for Schizophrenia, respectively. RESULTS Approximately 1/10 FES inpatients had any suicide attempts, and more than 1/4 reported lifetime suicidal ideation. Inpatients with a suicide attempt or suicidal ideation scored significantly worse in the overall seven neurocognitive domains compared with those without past suicidal ideation or a suicide attempt. Linear regression suggested that suicide attempts were mainly associated with lower scores in working memory and speed of processing, after adjusting for education levels. The associations remained robust after further controlling for psychopathological and depressive symptoms. CONCLUSION First-episode schizophrenia patients with suicide attempts had more severely impaired neurocognitive performances in specific domains. Fundamental neurocognitive dysfunctions should be assessed, detected, and treated after their suicide risk assessments.
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Affiliation(s)
- Yi Yin
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Huimei An
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Li Tian
- Department of Physiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Yongsheng Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.,Beijing Suicide Research and Prevention Center, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - L Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
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Moritz S, Scheunemann J, Peters MJV. Effort and liberal acceptance bias in patients with schizophrenia. Cogn Neuropsychiatry 2020; 25:364-370. [PMID: 32791935 DOI: 10.1080/13546805.2020.1805306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: A liberal acceptance bias is implicated in the formation and maintenance of delusions in schizophrenia. The present study tested the hypothesis that patients with schizophrenia are more quickly satisfied with their task performance than controls despite poor objective performance. Methods: Fifty patients with schizophrenia and 50 healthy controls performed the newly developed copy figure task in which participants copy a complex geometrical figure up to eight times until they are satisfied with the result. Objective performance was scored blind to group status. Subjective performance was rated on a 10-point scale. Carefulness of the drawing using anchor points served as a proxy for effort. Results: Patients made as many attempts as controls to copy the figure despite their worse subjective and objective performance. The number of attempts was negatively correlated with (persecutory) delusions and the PANSS total score. Neither effort nor possible frustration due to a plateau in performance was a reason for task termination. Conclusions: This exploratory study is in line with predictions based on the liberal acceptance model. For future studies, we recommend further cross-validating this paradigm and testing whether patients' retrospective assessment of their performance is exaggerated relative to controls. We also suggest that researchers pursue this line of research with personally meaningful material where a decreased threshold of acceptance may more easily translate into the subsequent fixation of ideas.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Maarten J V Peters
- Clinical Psychological Science, Section Clinical Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Neuropsychological profile of children and adolescents with psychosis risk syndrome: the CAPRIS study. Eur Child Adolesc Psychiatry 2020; 29:1311-1324. [PMID: 31897849 DOI: 10.1007/s00787-019-01459-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
Abstract
Neuropsychological underperformance is well described in young adults at clinical high risk for psychosis, but the literature is scarce on the cognitive profile of at-risk children and adolescents. The aim of this study is to describe the neuropsychological profile of a child and adolescent sample of patients with psychosis risk syndrome (PRS) compared to healthy controls and to analyze associations between attenuated psychotic symptoms and cognitive impairment. Cross-sectional baseline data analysis from a longitudinal, naturalistic, case-control, two-site study is presented. Eighty-one help-seeking subjects with PRS and 39 healthy controls (HC) aged between 10 and 17 years of age were recruited. PRS was defined by: positive or negative attenuated symptoms, Brief Limited Intermittent Psychotic Symptoms (BLIPS), genetic risk (first- or second-degree relative), or schizotypal personality disorder plus impairment in functioning. A neuropsychological battery was administered to assess general intelligence, verbal and visual memory, visuospatial abilities, speed processing, attention, and executive functions. The PRS group showed lower general neuropsychological performance scores at a multivariate level and lower scores than controls in general intelligence and executive functions. Lower scores on executive function and poorer attention were associated with high scores of positive attenuated psychotic symptoms. No association with attenuated negative symptoms was found. This study provides evidence of cognitive impairment in PRS children and adolescents and shows a relationship between greater cognitive impairment in executive functions and attention tasks and severe attenuated positive symptoms. However, longitudinal studies are needed to clarify the nature of cognitive impairment as a possible vulnerability marker.
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Kreis I, Moritz S, Pfuhl G. Objective Versus Subjective Effort in Schizophrenia. Front Psychol 2020; 11:1469. [PMID: 32742265 PMCID: PMC7365134 DOI: 10.3389/fpsyg.2020.01469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives Performance on cognitive tasks is often impaired in individuals with schizophrenia (SCZ), possibly resulting from either cognitive deficits (e.g., limited working memory capacity) or diminished mental effort or both. Investment of mental effort itself can be affected by cognitive resources, task load, and motivational factors and has thus proven difficult to measure. Pupil dilation during task performance has been proposed as an objective measure, but it remains unclear to what extent this converges with self-reports of perceived task demands, motivation, and invested effort. The current study tried to elucidate this question. Methods A visual version of the digit span task was administered in a sample of 29 individuals with a diagnosis from the SCZ spectrum and 30 individuals without any psychiatric disorder. Pupil size was recorded during the task, whereas self-reported invested effort and task demand were measured afterward. Results No group difference was found for working memory capacity, but individuals with SCZ showed diminished trial-by-trial recall accuracy, showed reduced pupil dilation across all task load conditions, and reported higher perceived task demands. Conclusion Results indicate reduced effort investment in patients with SCZ, but it remains unclear to what extent this alone could explain the lower recall performance. The lack of a direct link between objective and subjective measures of effort further suggests that both may assess different facets of effort. This has important implications for clinical and research settings that rely on the reliability of neuropsychological test results when assessing cognitive capacity in this patient group.
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Affiliation(s)
- Isabel Kreis
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerit Pfuhl
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Allott K, Steele P, Boyer F, de Winter A, Bryce S, Alvarez-Jimenez M, Phillips L. Cognitive strengths-based assessment and intervention in first-episode psychosis: A complementary approach to addressing functional recovery? Clin Psychol Rev 2020; 79:101871. [DOI: 10.1016/j.cpr.2020.101871] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
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Moritz S, Silverstein SM, Dietrichkeit M, Gallinat J. Neurocognitive deficits in schizophrenia are likely to be less severe and less related to the disorder than previously thought. World Psychiatry 2020; 19:254-255. [PMID: 32394552 PMCID: PMC7215075 DOI: 10.1002/wps.20759] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephen M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, NY, USA
| | - Mona Dietrichkeit
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Feng Y, Wang Z, Lin G, Qian H, Gao Z, Wang X, Li M, Hu X, Li Y. Neurological soft signs and neurocognitive deficits in remitted patients with schizophrenia, their first-degree unaffected relatives, and healthy controls. Eur Arch Psychiatry Clin Neurosci 2020; 270:383-391. [PMID: 31123823 DOI: 10.1007/s00406-019-01024-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 05/15/2019] [Indexed: 01/10/2023]
Abstract
Neurological soft signs (NSS) and neurocognitive deficits (ND) are highly prevalent in schizophrenia, and have been separately proposed as candidate endophenotypes of schizophrenia. However, few relevant studies focus on remitted patients with schizophrenia (RP) and integrate NSS and ND as a composite endophenotype. This study aimed to explore the NSS and ND and examine the comparative relationship between them in RP, their first-degree unaffected relatives (FDR), and healthy controls, furthermore, to seek potential endophenotypes subitems of NSS and ND and create a composite endophenotype. 86 RP, 86 FDR, and 86 healthy controls were included. NSS and ND were independently assessed with Cambridge Neurological Inventory and MATRICSTM Consensus Cognitive Battery. RP had more NSS and ND than FDR in all subitems except disinhibition, information processing speed, working memory, and visual memory. Similarly, FDR presented poorer performance than controls in all subscales except disinhibition, sensory integration, working memory, and visual memory. Six subitems of NSS and ND met the criteria of endophenotype and the three groups were most accurately classified (71.2%) with these subitems working as a composite endophenotype. Moreover, information processing speed, attention, and social cognition were associated with sensory integration in RP and FDR. These findings add evidences that certain subitems of NSS and ND might be the endophenotypes of schizophrenia and integrating these endophenotypes may prove useful in identifying schizophrenia and high-risk individuals. Furthermore, sensory integration and specific cognitive domains covary, hence suggesting an overlap of compromised underlying neural systems.
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Affiliation(s)
- Yingying Feng
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Zongqin Wang
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Guorong Lin
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Hong Qian
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Zuohui Gao
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xiaoli Wang
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Mingcao Li
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xiaohua Hu
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China.
| | - Yi Li
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
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Dietrichkeit M, Grzella K, Nagel M, Moritz S. Using virtual reality to explore differences in memory biases and cognitive insight in people with psychosis and healthy controls. Psychiatry Res 2020; 285:112787. [PMID: 32058878 DOI: 10.1016/j.psychres.2020.112787] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/11/2020] [Accepted: 01/12/2020] [Indexed: 01/31/2023]
Abstract
Memory biases (e.g. overconfidence in false memories) are implicated in the pathogenesis of delusions. Virtual reality (VR) may provide an opportunity to observe such biases and improve cognitive insight in patients with psychosis via corrective feedback. Thirty-nine patients with psychosis and 20 healthy controls explored VR environments designed to elicit false memories and subsequently had to recollect items and faces. We used a randomised-controlled design where half of the sample received performance feedback on the recollection task in order to correct overconfidence. Changes in cognitive insight were measured using the Beck Cognitive Insight Scale. Regarding accuracy, patients performed worse on the social task (recollection of faces) only. Patients displayed overconfidence in false memories for emotions and gave more high-confident responses compared to healthy controls on the social task. Feedback did not improve cognitive insight. Patients rated their cognitive insight higher than healthy controls. Future research should address problems with subjective measurements for cognitive insight. To conclude, patients with psychosis showed impaired social cognition and there was evidence for impaired metacognition, as patients reported higher cognitive insight despite comparable or worse performance as well as overconfidence relative to controls.
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Affiliation(s)
- Mona Dietrichkeit
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany
| | - Karsten Grzella
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany; Clinic of Psychiatry and Psychotherapy, University Luebeck, Luebeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Raffard S, Lebrun C, Bayard S, Macgregor A, Capdevielle D. Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really? Front Psychiatry 2020; 11:731. [PMID: 32848912 PMCID: PMC7406784 DOI: 10.3389/fpsyt.2020.00731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/13/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Misestimation of cognitive functioning has been largely described in individuals with schizophrenia. There is large evidence that correlations between subjectively assessed cognitive functioning and objectively determined cognitive functioning are weak in non clinical individuals and may be more closely related to other psychoaffective or clinical factors than to objective neuropsychological functioning. Surprisingly, no study to date has compared the associations between cognitive complaint and objective measures of cognitive functioning in individuals with schizophrenia and healthy controls. The main objective of this study was to 1) compare cognitive complaint between individuals with schizophrenia and non clinical controls, 2) explore the relationships between cognitive complaint and psychoaffective and clinical factors in the clinical group and 3) compare the relationships between subjective awareness of cognitive functioning and objective neuropsychological assessment in individuals with schizophrenia and non-clinical participants. METHOD In this study 30 individuals with schizophrenia and 20 non-clinical matched controls were included. In addition to objective cognitive measures and subjective cognition assessed by the Subjective Scale To Investigate Cognition In Schizophrenia, measures of psychotic symptoms, depression, and anxiety were included. RESULTS Schizophrenia patients reported higher cognitive complaints in comparison with controls. In individuals with schizophrenia, cognitive complaint subscores were differently associated with depression, anxiety, and negative symptoms. When depression was controlled for, the same number of correlations between self-rated measures of cognition and objective measures of cognition were found in both groups, but accuracy of self-assessment of cognition was lower in the schizophrenia group.When the schizophrenia group was divided into a high cognitive complaint group (SZ High CC) and a low cognitive complaint group (SZ Low CC), findings indicated that self-assessment of cognition in the SZ high CC was highly accurate (correlations with large effect sizes). By contrast the SZ low CC group severely misjudge their cognition. CONCLUSION A significant proportion of patients with schizophrenia can accurately estimate their cognitive skills. Self-awareness of cognitive deficits in individuals with schizophrenia is an heterogenous phenomenon and misestimation of cognitive functioning might have been overestimated, partly due to secondary psychoaffective factors. Caution is warranted before jumping to the conclusion that all individuals with schizophrenia misjudge their cognitive functioning.
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Affiliation(s)
- Stéphane Raffard
- Univ Paul Valéry Montpellier 3, Univ Montpellier, EPSYLON EA 4556, Montpellier, France.,Service Universitaire de Psychiatrie Adulte, Hôpital de la Colombière CHU Montpellier, Montpellier, France
| | - Cindy Lebrun
- Univ Paul Valéry Montpellier 3, Univ Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Sophie Bayard
- Univ Paul Valéry Montpellier 3, Univ Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Alexandra Macgregor
- Service Universitaire de Psychiatrie Adulte, Hôpital de la Colombière CHU Montpellier, Montpellier, France
| | - Delphine Capdevielle
- Service Universitaire de Psychiatrie Adulte, Hôpital de la Colombière CHU Montpellier, Montpellier, France.,Inserm, U1061, Montpellier, France.,University of Montpellier, Montpellier, France
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Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis. Eur Child Adolesc Psychiatry 2020; 29:1693-1703. [PMID: 32036438 PMCID: PMC7641937 DOI: 10.1007/s00787-020-01479-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/23/2020] [Indexed: 12/25/2022]
Abstract
Neurocognitive deficits are associated with impaired global functioning and psychotic symptoms. However, whether symptoms can mediate the relationship between neurocognition and global functioning in adolescent psychosis is unclear. Here, we investigated if symptoms assessed with the Positive And Negative Syndrome Scale (PANSS), mediated the relationship between neurocognitive performance and global functioning in adolescents with non-affective early-onset psychotic disorders (EOP). Sixty-one adolescent EOP patients (age 12-18 years) from 2 Norwegian clinical cohorts were included. Linear regression models were applied to investigate associations between neurocognitive domains from the MATRICS Consensus Cognitive Battery (MCCB) and global functioning. PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. Using the INDIRECT macro for SPSS, mediation effects were tested using bootstrapping with 95% bias corrected confidence intervals. Verbal learning was positively associated with global functioning (P < 0.001) and negatively associated with the disorganized symptom factor (P = 0.002), controlling for age, sex and cohort. Testing of indirect effects, controlling for age, sex and cohort, showed that the Negative (point estimate = 1.56, 95% CI 0.22, 3.47) and Disorganized (point estimate = 1.24, 95% CI 0.05, 3.69) symptom factors significantly mediated the relationship between verbal learning and global functioning. We found that verbal learning, negative and disorganized symptoms influenced global functioning in adolescents with EOP, while reality-distorted positive symptoms did not. These results suggest that assessing these domains in EOP is helpful for planning treatment and rehabilitation programs focusing on functional outcome.
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Engen MJ, Simonsen C, Melle I, Færden A, Lyngstad SH, Haatveit B, Vaskinn A, Ueland T. Cognitive functioning in patients with first-episode psychosis stratified by level of negative symptoms: A 1-year follow-up study. Psychiatry Res 2019; 281:112554. [PMID: 31499342 DOI: 10.1016/j.psychres.2019.112554] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 01/02/2023]
Abstract
We investigate negative symptoms over a 1-year follow-up period with the objective to see how groups defined according to level of symptom severity are related to cognition. Eighty-seven participants with first-episode psychosis (FEP) and matched healthy controls were assessed at baseline and follow-up. FEP participants were sub-grouped based on negative symptom items from the Positive and Negative Syndrome Scale (PANSS-R) with either no, mild, transitory or sustained symptoms over one year. Following an overall MANOVA, groups were compared on cognitive domains and a cognitive composite using ANOVAs. Cognitive course was explored with a MANOVA. We found a group effect on cognition. Participants who sustained negative symptoms were significantly outperformed by participants with no negative symptoms on executive functions and processing speed, and by those with mild or transitory symptoms on verbal learning and memory. Participants with sustained negative symptoms performed significantly poorer on the cognitive composite than those with no or mild negative symptoms. The group with no negative symptoms did not differ significantly from healthy controls on any cognitive measure, and the groups did not differ in cognitive course. Early course of negative symptoms is associated with cognition and could guide clinicians when evaluating need for cognitive assessment.
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Affiliation(s)
- Magnus Johan Engen
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway.
| | - Carmen Simonsen
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway; Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Ann Færden
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Siv Hege Lyngstad
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Beathe Haatveit
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Anja Vaskinn
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, 0373 Oslo, Norway
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Fan F, Xiang H, Tan S, Yang F, Fan H, Guo H, Kochunov P, Wang Z, Hong LE, Tan Y. Subcortical structures and cognitive dysfunction in first episode schizophrenia. Psychiatry Res Neuroimaging 2019; 286:69-75. [PMID: 30921760 PMCID: PMC6475899 DOI: 10.1016/j.pscychresns.2019.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/14/2022]
Abstract
Schizophrenia is associated with widespread cortical and subcortical abnormalities. Studies examining cognitive deficits in schizophrenia have historically focused on cortical deficits; however, many subcortical areas also support cognition. We sought to determine whether deficits in subcortical gray matter are linked to neurocognitive dysfunction in patients with first-episode schizophrenia. This study included 170 patients with first-episode schizophrenia and 88 healthy controls. Clinical symptoms, neurocognitive function, and structural images were assessed. Subcortical volumes were recorded. Patients had significant deficits in all cognitive domains, including processing speed, attention, memory, executive function and social cognition. Patients also demonstrated significantly smaller volumes in the amygdala, hippocampus, thalamus, and total cortical gray matter than did controls after Bonferroni correction for multiple comparisons. Reasoning/problem solving was significantly and positively correlated with the volume of the amygdala and nucleus accumbens in patients. Positive symptoms of psychosis were positively correlated with the volume of the amygdala and nucleus accumbens. In addition, the dose of antipsychotic medication was positively correlated with the volume of the amygdala, nucleus accumbens, caudate, putamen, and pallidum. In conclusion, schizophrenia is associated with profound cognitive deficits. Our findings suggest that subcortical structures contribute to specific domains of cognitive dysfunction in first-episode schizophrenia.
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Affiliation(s)
- Fengmei Fan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China; State Key Laboratory of Cognitive Neuroscience and Learning & International Data Group/McGovern Institute for Brain Research, Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.
| | - Hong Xiang
- Chongqing Three Gorges Central Hospital, Chongqing 404000, China
| | - Shuping Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Hongzhen Fan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Hua Guo
- Zhumadian Psychiatry Hospital, Henan Province, China
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
| | - Yunlong Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China.
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Schnell T, Heekeren K, Daumann J, Gouzoulis-Mayfrank E. Inhibition of return (IOR) in patients with schizophrenia and cannabis use. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:65-72. [PMID: 30184467 DOI: 10.1016/j.pnpbp.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 11/17/2022]
Abstract
Research concerning the spatial orientation in patients with schizophrenia has demonstrated a state independent deficit in inhibition of return (IOR), which has been discussed as a vulnerability marker for schizophrenia. Other recent investigations on brain structure and cognitive processing have revealed less deficits in schizophrenia patients with comorbid cannabis use (SCH + CUD) compared to abstinent schizophrenia patients (SCH). It was hypothesized that these results may reflect a premorbid lower vulnerability in at least a subgroup of comorbid patients. The aim of the present study is to extend previous work by investigating IOR functioning in patients with schizophrenia and cannabis use. This in turn should supplement the existing studies on the vulnerability of this patient group. Therefore, we compared IOR functioning in four groups: 62 patients with schizophrenia and 46 healthy controls, both with and without cannabis use. Participants underwent a covert orienting of attention task (COVAT) with peripheral cues and three stimulus onset asynchronies (SOAs: 200 ms, 400 ms and 800 ms). Both schizophrenia groups displayed delayed IOR with a more pronounced IOR effect in SCH + CUD compared to SCH. In healthy controls, IOR did not seem to be significantly affected by cannabis use. Significant IOR-differences between groups were only seen between SCH patients without cannabis use and both healthy groups at SOA 400 ms. Patterns of cannabis use as well as clinical parameters of psychoses did not affect IOR. Our results may support the hypothesis of IOR as a vulnerability marker for schizophrenia and of a lower biological vulnerability in at least a subgroup of SCH + CUD.
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Affiliation(s)
- Thomas Schnell
- Medical School Hamburg, University of applied Science and Medical University, Department of Clinical Psychology and Psychotherapy, Am Kaiserkai 1, 20457 Hamburg, Germany.
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Jörg Daumann
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- Department of Psychiatry and Psychotherapy, LVR-Hospital Cologne, Wilhelm-Griesinger Str. 23, 51109 Cologne, Germany
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Genome-wide analysis reveals extensive genetic overlap between schizophrenia, bipolar disorder, and intelligence. Mol Psychiatry 2019; 25:844-853. [PMID: 30610197 PMCID: PMC6609490 DOI: 10.1038/s41380-018-0332-x] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/18/2018] [Accepted: 11/29/2018] [Indexed: 02/08/2023]
Abstract
Schizophrenia (SCZ) and bipolar disorder (BD) are severe mental disorders associated with cognitive impairment, which is considered a major determinant of functional outcome. Despite this, the etiology of the cognitive impairment is poorly understood, and no satisfactory cognitive treatments exist. Increasing evidence indicates that genetic risk for SCZ may contribute to cognitive impairment, whereas the genetic relationship between BD and cognitive function remains unclear. Here, we combined large genome-wide association study data on SCZ (n = 82,315), BD (n = 51,710), and general intelligence (n = 269,867) to investigate overlap in common genetic variants using conditional false discovery rate (condFDR) analysis. We observed substantial genetic enrichment in both SCZ and BD conditional on associations with intelligence indicating polygenic overlap. Using condFDR analysis, we leveraged this enrichment to increase statistical power and identified 75 distinct genomic loci associated with both SCZ and intelligence, and 12 loci associated with both BD and intelligence at conjunctional FDR < 0.01. Among these loci, 20 are novel for SCZ, and four are novel for BD. Most SCZ risk alleles (61 of 75, 81%) were associated with poorer cognitive performance, whereas most BD risk alleles (9 of 12, 75%) were associated with better cognitive performance. A gene set analysis of the loci shared between SCZ and intelligence implicated biological processes related to neurodevelopment, synaptic integrity, and neurotransmission; the same analysis for BD was underpowered. Altogether, the study demonstrates that both SCZ and BD share genetic influences with intelligence, albeit in a different manner, providing new insights into their genetic architectures.
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Neuroimaging Studies of Cognitive Function in Schizophrenia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1118:117-134. [PMID: 30747420 DOI: 10.1007/978-3-030-05542-4_6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Persons suffering from schizophrenia present cognitive impairments that have a major functional impact on their lives. Particularly, executive functions and episodic memory are consistently found to be impaired. Neuroimaging allows the investigation of affected areas of the brain associated with these impairments and, moreover, the detection of brain functioning improvements after cognitive remediation interventions. For instance, executive function impairments have been associated with prefrontal cortex volume and thickness; cognitive control impairments are correlated with an increased activation in the anterior cingulate cortex, and episodic memory impairments are linked to hippocampal reduction. Some findings suggest the presence of brain compensatory mechanisms in schizophrenia, e.g. recruiting broader cortical areas to perform identical tasks. Similarly, neuroimaging studies of cognitive remediation in schizophrenia focus differentially on structural, functional and connectivity changes. Cognitive remediation improvements have been reported in two main areas: the prefrontal and thalamic regions. It has been suggested that those changes imply a functional reorganisation of neural networks, and cognitive remediation interventions might have a neuroprotective effect. Future studies should use multimodal neuroimaging procedures and more complex theoretical models to identify, confirm and clarify these and newer outcomes. This chapter highlights neuroimaging findings in anatomical and functional brain correlates of schizophrenia, as well as its application and potential use for identifying brain changes after cognitive remediation.
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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Dysfunction by Disclosure? Stereotype Threat as a Source of Secondary Neurocognitive Malperformance in Obsessive-Compulsive Disorder. J Int Neuropsychol Soc 2018; 24:584-592. [PMID: 29553002 DOI: 10.1017/s1355617718000097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES There is mixed evidence regarding whether patients with obsessive-compulsive disorder (OCD) display substantial neurocognitive deficits. Several studies implicate poor motivation, comorbid disorders, or distraction due to obsessive thoughts as potential causes of secondary malperformance. The present study examined the impact of stereotype threat (i.e., confrontation with a negative stereotype may impair performance) on neuropsychological functioning in individuals with OCD. We hypothesized that a stereotype threat cue emphasizing neurocognitive deficits in OCD (as is often conveyed in disclosure and consent documents that inform patients about the purpose of a study) would compromise patients' test performance relative to a control group who did not receive such cue. METHODS Fifty participants with either a verified or a likely diagnosis of OCD were recruited online and randomly assigned to either an experimental condition aimed to elicit stereotype threat or a control condition. Both groups underwent (objective) memory and attention (Go/NoGo task) assessments and completed questionnaires capturing psychopathology, cognitive complaints, and self-stigma. RESULTS As hypothesized, patients in the stereotype threat condition performed worse on the Go/NoGo task. Groups did not differ on any other measures. CONCLUSIONS Stereotype threat negatively impacted neuropsychological performance on an attention task. The threat cue was perhaps too weak or the stereotype threat was already internalized by the patients and "saturated" at baseline so that no effect emerged on the other measures. Implications for clinical trials are discussed. (JINS, 2018, 24, 584-592).
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Hirjak D, Meyer-Lindenberg A, Kubera KM, Thomann PA, Wolf RC. Motor dysfunction as research domain in the period preceding manifest schizophrenia: A systematic review. Neurosci Biobehav Rev 2018; 87:87-105. [DOI: 10.1016/j.neubiorev.2018.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/08/2018] [Accepted: 01/21/2018] [Indexed: 12/13/2022]
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Moritz S, Bentall RP, Kolbeck K, Roesch-Ely D. Monocausal attribution and its relationship with reasoning biases in schizophrenia. Schizophr Res 2018; 193:77-82. [PMID: 28732799 DOI: 10.1016/j.schres.2017.06.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/20/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aberrant attributional styles are counted to a set of circumscribed cognitive biases that are implicated in the pathogenesis of (paranoid) psychosis. However, evidence for a specific profile (e.g., an exaggerated self-serving bias, other-blaming bias) has become equivocal over the years. More recently, one-sided (monocausal) attributions have been reported in patients with psychosis. METHODS We compared a large sample of patients with diagnosed schizophrenia (n=145) to nonclinical controls (n=30) on a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R). In this task, participants have to assign probability estimates to each of three potential causes (i.e., myself, others, circumstances) for a specific (negative or positive) event. RESULTS Participants with schizophrenia displayed an abolished self-serving bias and showed a significant preference for one-sided/monocausal attributions, which was neither correlated with jumping to conclusions nor overconfidence in errors. School education correlated with less monocausal attributions. We did not find any congruence between attributional styles with core delusional ideas. CONCLUSIONS Our study corroborates earlier investigations showing that monocausal attributions may play a role in the pathogenesis of psychosis; this bias unlikely represents an epiphenomenon of established biases. Unexpectedly, attributional styles (e.g., external-blaming) did not shape delusional contents. The true prevalence of monocausal attributions in psychosis is perhaps underestimated in the study, as groups were equated on school education, which was correlated with monocausal attributions.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Richard P Bentall
- School of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Katharina Kolbeck
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Roesch-Ely
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany
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Moritz S, Mahlke CI, Westermann S, Ruppelt F, Lysaker PH, Bock T, Andreou C. Embracing Psychosis: A Cognitive Insight Intervention Improves Personal Narratives and Meaning-Making in Patients With Schizophrenia. Schizophr Bull 2018; 44:307-316. [PMID: 29106693 PMCID: PMC5814991 DOI: 10.1093/schbul/sbx072] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Schizophrenia is a complex psychiatric disorder with unknown and presumably heterogeneous etiology. While the disorder can have various outcomes, research is predominantly "deficit-oriented" emphasizing the hardship that the disorder inflicts on sufferers as well as their families and society. Beyond symptom reduction, imparting patients with hope and meaning in life is increasingly considered an important treatment target, which may raise self-esteem, and reduce self-stigma and suicidal ideation. The present study compared a psychotherapeutic treatment aimed at improving cognitive insight, individualized metacognitive intervention (MCT+), with an active control in order to elucidate if personal meaning-making and hope can be improved in patients with psychosis across time. A total of 92 patients were randomized to either individualized metacognitive therapy (MCT+) or CogPack (neuropsychological training) and followed up for up to 6 months. The "Subjective Sense in Psychosis Questionnaire" (SUSE) was administered which covers different salutogenetic vs pathogenetic views of the disorder, valence of symptom experiences and the consequences of psychosis. Patients in the MCT+ group showed a significant positive shift in attitudes towards the consequences of their illness over time relative to patients in the active control condition. There was some evidence that MCT+ also enhanced meaning-making. The perceived negative consequences of psychosis were highly correlated with depression and low self-esteem, as well as suicidality. The study shows that a cognitive insight training can improve meaning-making in patients and help them come to terms with their diagnosis.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Candelaria I Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Friederike Ruppelt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center and The Indiana University School of Medicine, Indianapolis, IN
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
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Moritz S, Stöckert K, Hauschildt M, Lill H, Jelinek L, Beblo T, Diedrich S, Arlt S. Are we exaggerating neuropsychological impairment in depression? Reopening a closed chapter. Expert Rev Neurother 2017. [DOI: 10.1080/14737175.2017.1347040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Stöckert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marit Hauschildt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah Lill
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld, Germany
| | - Sabrina Diedrich
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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