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Khosravani V, Sharifibastan F, Aghaeimazraji M, Berk M, Samimi Ardestani SM. The contribution of alexithymia, childhood maltreatment, impulsivity, C-reactive protein, lipid profile, and thyroid hormones to aggression and psychological distress (depression and anxiety) in schizophrenia. Psychoneuroendocrinology 2024; 167:107087. [PMID: 38820716 DOI: 10.1016/j.psyneuen.2024.107087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
There are individual effects of alexithymia, childhood maltreatment, impulsivity, and some biological markers on aggression and psychological distress in schizophrenia. However, the combined effects of these psychological and biological markers have not yet been fully studied. This study therefore aimed to investigate the influence of these psychological and biological markers on aggression and psychological distress (e.g., depression and anxiety) in inpatients with schizophrenia (n = 355). Participants completed self-report and clinician-rated scales, and blood samples were collected. There were no significant differences between patients with and without alexithymia regarding biological markers. Patients with childhood maltreatment exhibited higher levels of free triiodothyronine (FT3) and C-reactive protein (CRP), as well as lower total cholesterol (TC) levels, compared to non-traumatized individuals. Aggression was positively predicted by psychological distress, alexithymia, childhood maltreatment, impulsivity, CRP, and FT3, and negatively by TC and low-density lipoprotein cholesterol. Negative symptoms, childhood maltreatment, alexithymia, aggression, and CRP positively, and high-density lipoprotein cholesterol negatively emerged as predictors of psychological distress. The study highlights the connections between childhood maltreatment, alexithymia, impulsivity, and potentially related biological dysregulation in explaining aggression and negative mood states as a bio-psychological model of aggression and mood in schizophrenia.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farangis Sharifibastan
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Psychosocial Science, University of Bergen, Norway
| | - Morteza Aghaeimazraji
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Michael Berk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; University of Melbourne, Florey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Orygen, Parkville, Victoria, Australia
| | - Seyed Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rosén Rasmussen A, Handest P, Vollmer-Larsen A, Parnas J. Pseudoneurotic Symptoms in the Schizophrenia Spectrum: A Longitudinal Study of Their Relation to Psychopathology and Clinical Outcomes. Schizophr Bull 2024; 50:871-880. [PMID: 38227579 PMCID: PMC11283190 DOI: 10.1093/schbul/sbad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND HYPOTHESIS Nonpsychotic symptoms (depression, anxiety, obsessions, etc.) are frequent in schizophrenia-spectrum disorders and are usually conceptualized as comorbidity or transdiagnostic symptoms. However, in twentieth century foundational psychopathological literature, many nonpsychotic symptoms with specific phenomenology (here termed pseudoneurotic symptoms) were considered relatively typical of schizophrenia. In this prospective study, we investigated potential associations of pseudoneurotic symptoms with diagnostic status, functional outcome as well as psychopathological dimensions of schizophrenia. STUDY DESIGN First-admitted patients (N = 121) diagnosed with non-affective psychosis, schizotypal disorder, or other mental illness were examined at initial hospitalization and 5 years later with a comprehensive assessment of psychopathology. Informed by the literature, we constructed scales targeting pseudoneurotic symptoms and other, more general, nonpsychotic symptoms. STUDY RESULTS Pseudoneurotic symptoms aggregated in schizophrenia-spectrum groups compared to other mental illnesses and occurred at similar levels at baseline and follow-up. They longitudinally predicted poorer social and occupational functioning in schizophrenia-spectrum patients over a 5-year-period but not transition to schizophrenia-spectrum disorders from other mental illnesses. Finally, the level of pseudoneurotic symptoms correlated with disorder of basic self at both assessments and with positive and negative symptoms at follow-up. The scale targeting general nonpsychotic symptoms did not show this pattern of associations. CONCLUSIONS The study supports that a group of nonpsychotic symptoms, ie, pseudoneurotic symptoms, are associated with schizophrenia-spectrum disorders and linked with temporally stable psychopathology, particularly disorder of the basic self. Their prospective association with social and occupational functioning needs replication.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Amager, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Josef Parnas
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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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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Ragazzi TCC, Shuhama R, da Silva PHR, Corsi-Zuelli F, Loureiro CM, da Roza DL, Leoni RF, Menezes PR, Del-Ben CM. Neurocognition and brain functional connectivity in a non-clinical population-based sample with psychotic experiences. Schizophr Res 2024; 267:156-164. [PMID: 38547718 DOI: 10.1016/j.schres.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/17/2024] [Accepted: 03/17/2024] [Indexed: 05/21/2024]
Abstract
We characterized the neurocognitive profile of communed-based individuals and unaffected siblings of patients with psychosis from Brazil reporting psychotic experiences (PEs). We also analyzed associations between PEs and the intra and inter-functional connectivity (FC) in the Default Mode Network (DMN), the Fronto-Parietal Network (FPN) and the Salience Network (SN) measured by functional magnetic resonance imaging. The combined sample of communed-based individuals and unaffected siblings of patients with psychosis comprised 417 (neurocognition) and 85 (FC) volunteers who were divided as having low (<75th percentile) and high (≥75th percentile) PEs (positive, negative, and depressive dimensions) assessed by the Community Assessment of Psychic Experiences. The neurocognitive profile and the estimated current brief intellectual quotient (IQ) were assessed using the digit symbol (processing speed), arithmetic (working memory), block design (visual learning) and information (verbal learning) subtests of Wechsler Adult Intelligence Scale-third edition. Logistic regression models were performed for neurocognitive analysis. For neuroimaging, we used the CONN toolbox to assess FC between the specified regions, and ROI-to-ROI analysis. In the combined sample, high PEs (all dimensions) were related to lower processing speed performance. High negative PEs were related to poor visual learning performance and lower IQ, while high depressive PEs were associated with poor working memory performance. Those with high negative PEs presented FPN hypoconnectivity between the right and left lateral prefrontal cortex. There were no associations between PEs and the DMN and SN FC. Brazilian individuals with high PEs showed neurocognitive impairments like those living in wealthier countries. Hypoconnectivity in the FPN in a community sample with high PEs is coherent with the hypothesis of functional dysconnectivity in schizophrenia.
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Affiliation(s)
- Taciana Cristina Carvalho Ragazzi
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Rosana Shuhama
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Pedro Henrique Rodrigues da Silva
- Department of Physics, InBrain Laboratory, Faculty of Philosophy Sciences and Letters of Ribeirão Preto-University of Sao Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-901 Ribeirão Preto, São Paulo, Brazil.
| | - Fabiana Corsi-Zuelli
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Camila Marcelino Loureiro
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Daiane Leite da Roza
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil; Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
| | - Renata Ferranti Leoni
- Department of Physics, InBrain Laboratory, Faculty of Philosophy Sciences and Letters of Ribeirão Preto-University of Sao Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-901 Ribeirão Preto, São Paulo, Brazil.
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Brazil, Population Mental Health Research Centre, Brazil, 455, Dr. Arnaldo Avenue, Cerqueira César, 01246903 São Paulo, São Paulo, Brazil.
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
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Clemmensen L, Lund CN, Andresen BS, Midtgaard J, Glenthøj LB. Study protocol for RUFUS-A randomized mixed methods pilot clinical trial investigating the relevance and feasibility of rumination-focused cognitive behavioral therapy in the treatment of patients with emergent psychosis spectrum disorders. PLoS One 2024; 19:e0297118. [PMID: 38271383 PMCID: PMC10810475 DOI: 10.1371/journal.pone.0297118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Psychosis spectrum disorders are characterized by both positive and negative symptoms, but whereas there is good effect of treatment on positive symptoms, there is still a scarcity of effective interventions aimed at reducing negative symptoms. Rumination has been proposed as an important and fundamental factor in the development and maintenance of symptoms across psychiatric diagnoses, and there is a need to develop effective interventions targeting rumination behaviors and negative symptoms in patients with psychotic disorders. The aim of the current study is to investigate the feasibility and acceptability of group rumination-focused cognitive behavioral therapy (RFCBT) in the treatment of young people with psychosis spectrum disorders as well as investigating potential indications of treatment efficacy. METHODS AND ANALYSIS The study is a mixed-method clinical randomized controlled pilot trial with a target sample of 60 patients, who are randomized to either receive 13 weeks of group RFCBT or 13 weeks of treatment as usual (TAU). All patients are examined at the start of the project and at the 13-week follow-up. We will compare changes in outcomes from baseline to posttreatment between group RFCBT and TAU. In addition, qualitative analyzes are carried out to explore feasibility and acceptability and to uncover the patients' experience of receiving the intervention.
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Affiliation(s)
- Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Center on Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Julie Midtgaard
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- VIRTU Research Group, Copenhagen Research Center on Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Kirpinar MM, Demirel OF. The Relationship Between Depressive Symptoms and Psychological Variables in Patients With Schizophrenia. J Psychiatr Pract 2024; 30:13-22. [PMID: 38227723 DOI: 10.1097/pra.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Depressive symptoms are common in schizophrenia and can be seen at any stage of the disease. Although various models have been proposed to explain the development of depression in schizophrenia, studies investigating related psychological factors are scarce and the studies that have been done usually focus on only a small number of possible factors. OBJECTIVE The goal of this study was to investigate the predictability of some psychological factors on depression in patients with schizophrenia. For this purpose, patients with high and low depression scores were compared. METHODS Two groups of individuals with schizophrenia, with (n=29) and without (n=31) depression, as determined by scores on the Calgary Depression Scale in Schizophrenia, were compared using a sociodemographic data form, the Positive and Negative Syndrome Scale (PANSS), the Beck Anxiety Inventory, the Rotter Internal-External Locus 2024 of Control Scale, the Multidimensional Scale of Perceived Social Support, and the Stress Coping Styles Scale. RESULTS No differences were found between the 2 groups in terms of sociodemographic and clinical characteristics, social support scores, and coping styles. Statistically significant differences were found between the groups on the PANSS positive, negative, and general psychopathology subscales, in PANSS total scores, in anxiety scores, and in locus of control scores. CONCLUSIONS This study showed that high levels of negative, positive, and general psychopathological symptoms, external locus of control, and high anxiety scores may be predictive of depression in individuals with schizophrenia. Studies that examine psychological factors in larger patient groups may provide the opportunity to detect and target these factors earlier in the course of schizophrenia, thereby reducing morbidity and mortality.
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Affiliation(s)
- Mehmet Murat Kirpinar
- KIRPINAR and DEMIREL: Department of Psychiatry, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Böge K, Hallford DJ, Pillny M. Mindfulness, psychological flexibility and their relationship with psychopathology in persons with schizophrenia-spectrum-disorders and healthy controls - A multicenter cross-sectional study. Psychiatry Res 2023; 330:115591. [PMID: 37979316 DOI: 10.1016/j.psychres.2023.115591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
The precise nature of the relationship between mindfulness, psychological flexibility (PF) and psychopathology in schizophrenia spectrum disorders (SSD) remains largely unclear and warrants further investigation. We recruited 43 persons with SSD and 43 controls. Our findings revealed that SSD showed lower mindfulness and PF than controls. Mindfulness was associated with higher PS, anticipatory pleasure, behavioral activation, and lower depressive and negative symptoms. PS was associated with lower depressive and negative symptoms and higher anticipatory pleasure and behavioral activation. The outcomes imply that targeting mindfulness and PF may prove beneficial in alleviating the amotivational psychopathology exhibited in SSD.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin, Campus Benjamin Franklin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - David J Hallford
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
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Fekih-Romdhane F, Hajje R, Haddad C, Hallit S, Azar J. Exploring negative symptoms heterogeneity in patients diagnosed with schizophrenia and schizoaffective disorder using cluster analysis. BMC Psychiatry 2023; 23:595. [PMID: 37582728 PMCID: PMC10428523 DOI: 10.1186/s12888-023-05101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Dissecting the heterogeneity of schizophrenia may help foster progress in understanding its etiology and lay the groundwork for the development of new treatment options for primary or enduring negative symptoms (NS). In this regard, the present study aimed to: (1) to use cluster analysis to identify subgroups of Lebanese patients diagnosed with either schizophrenia or schizoaffective disorder based on NS clusters, and (2) to relate the statistically-derived subgroups to clinically relevant external validators (including measures if state and trait depression, stigma, insight, loneliness, social support). METHOD A total of 202 adult long-stay, chronic, and clinically remitted patients (166 diagnosed with schizophrenia and 36 with schizoaffective disorder) were enrolled. A cluster analysis approach was adopted to classify patients based on the five NS domains social withdrawal, emotional withdrawal, alogia, avolition and anhedonia. RESULTS A three-cluster solution was obtained based on unique NS profiles, and divided patients into (1) low NS (LNS; 42.6%) which characterized by the lowest mean scores in all NS domains, (2) moderate NS (MNS; 25.7%), and (3) high NS (HNS; 31.7%). Post-hoc comparisons showed that depression (state and trait), loneliness and social support could accurately distinguish the schizophrenia subgroups. Additionally, individuals in the HNS cluster had longer duration of illness, longer duration of hospitalization, and were given higher dosages of antipsychotic medication compared to those in the other clusters, but these differences did not achieve the statistical significance. CONCLUSION Findings provide additional support to the categorical model of schizophrenia by confirming the existence of three alternate subtypes based on NS. The determination of distinct NS subgroups within the broad heterogeneous population of people diagnosed with schizophrenia may imply that each subgroup possibly has unique underlying mechanisms and necessitates different treatment approaches.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Romy Hajje
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Jocelyne Azar
- School of Medicine, Lebanese American University, Byblos, Lebanon
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de Winter L, Vermeulen JM, Couwenbergh C, van Weeghel J, Hasson-Ohayon I, Mulder CL, Boonstra N, Veling W, de Haan L. Short- and long-term changes in symptom dimensions among patients with schizophrenia spectrum disorders and different durations of illness: A meta-analysis. J Psychiatr Res 2023; 164:416-439. [PMID: 37429186 DOI: 10.1016/j.jpsychires.2023.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Abstract
In schizophrenia spectrum disorders, improvement in symptoms varies between patients with short and long durations of illness. In this meta-analysis we provided an overview of both short- and long-term symptomatic improvement for patients with schizophrenia spectrum disorders with distinct durations of illness. We included 82 longitudinal studies assessing the course of positive, negative, depressive and disorganization symptoms. We analyzed effect sizes of change in four subgroups based on durations of illness at baseline: <2 years, 2-5 years, 5-10 years, >10 years. Potential moderators were explored using meta-regression and sensitivity analyses. Overall, we found large improvements of positive symptoms and small improvements of negative, depressive, and disorganization symptoms. Positive and disorganization symptoms improved relatively stronger for patients earlier in the course of illness, whereas negative and depressive symptoms showed modest improvement regardless of duration of illness. Improvement of symptoms was associated with higher baseline severity of positive symptoms, a younger age, a smaller subsample with schizophrenia, and, specifically for negative symptoms, higher baseline severity of depressive symptoms. Future research should focus on exploring ways to optimize improvement in negative and depressive symptoms for patients with schizophrenia spectrum disorders.
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Affiliation(s)
- Lars de Winter
- Phrenos Center of Expertise, Utrecht, the Netherlands; Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, the Netherlands.
| | - Jentien M Vermeulen
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
| | | | - Jaap van Weeghel
- Phrenos Center of Expertise, Utrecht, the Netherlands; Tranzo, Tilburg University, Tilburg, the Netherlands
| | | | - Cornelis L Mulder
- Epidemiological and Social Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands; Parnassia Psychiatric Institute, the Netherlands
| | - Nynke Boonstra
- NHL Stenden University of Applied Science, Leeuwarden, the Netherlands; Utrecht University Medical Center, Utrecht, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
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Liu M, Yang Z, Guo Y, Jiang J, Yang K. MICAR: nonlinear association rule mining based on maximal information coefficient. Knowl Inf Syst 2022. [DOI: 10.1007/s10115-022-01730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Christensen R, Haenschel C, Gaigg SB, Fett AKJ. Loneliness, positive, negative and disorganised Schizotypy before and during the COVID-19 pandemic. Schizophr Res Cogn 2022; 29:100243. [PMID: 35223431 PMCID: PMC8860670 DOI: 10.1016/j.scog.2022.100243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
Loneliness is common in psychosis and occurs along a continuum. Here we investigate inter-relationships between loneliness, three-dimensional schizotypy, and depressive symptoms before and during the COVID-19 pandemic. The sample included 507 university students (48.3% participated before and 51.7% during the COVID-19 pandemic) who completed the Multidimensional Schizotypy Scale-Brief, the Counseling Center Assessment of Psychological Symptoms depression scale and the University of California, Los Angeles Loneliness Scale. Schizotypy and depression scores were regressed onto loneliness individually and in multiple regressions. The cohorts did not differ in any of the schizotypy domains (all p > .29). Depressive symptoms (p = .05) and loneliness (p = .006) were higher during the pandemic than before. Across cohorts, loneliness was significantly associated with positive (β = 0.23, p < .001), negative (β = 0.44, p < .001), and disorganised schizotypy (β = 0.44, p < .001), and with depression (β = 0.72, p < .001). Schizotypy together explained a significant amount of variance in loneliness (R2 = 0.26), with significant associations with positive (β = −0.09, p = .047), negative (β = 0.31, p < .001) and disorganised schizotypy (β = 0.34, p < .001). When depression was included (β = 0.69, p < .001), only positive (β = −0.09, p = .008) and negative schizotypy (β = 0.22, p < .001) significantly predicted loneliness. When all schizotypy dimensions and depression were considered together, only negative schizotypy and depression significantly predicted loneliness. Loneliness and depressive symptoms were higher during the pandemic, but this did not relate to cohort differences in schizotypy. Loneliness is uniquely associated with negative schizotypy and depression, but not disorganised schizotypy. Certain aspects of positive schizotypy may protect against loneliness. Loneliness and depressive symptoms were higher in students during the COVID-19 pandemic than before. Cohorts of students assessed before and during the pandemic showed similar levels of schizotypy.
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Affiliation(s)
- Ronja Christensen
- Department of Psychology, City, University of London, London ECIV 0HB, UK.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, De Crespigny Park, SE5 8AF London, UK
| | - Corinna Haenschel
- Department of Psychology, City, University of London, London ECIV 0HB, UK
| | - Sebastian B Gaigg
- Department of Psychology, City, University of London, London ECIV 0HB, UK
| | - Anne-Kathrin J Fett
- Department of Psychology, City, University of London, London ECIV 0HB, UK.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, De Crespigny Park, SE5 8AF London, UK
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Jimeno N, Gomez-Pilar J, Poza J, Hornero R, Vogeley K, Meisenzahl E, Lichtenstein TK, Rosen M, Kambeitz J, Klosterkötter J, Schultze-Lutter F. (Attenuated) hallucinations join basic symptoms in a transdiagnostic network cluster analysis. Schizophr Res 2022; 243:43-54. [PMID: 35231833 DOI: 10.1016/j.schres.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022]
Abstract
Hallucinations are considered characteristic symptoms of psychosis and part of the 'psychosis superspectrum' of the Hierarchical Taxonomy Of Psychopathology (HiTOP) initiative. To gain insight into their psychopathological relevance, we studied their dimensional placement within a single dense transdiagnostic network constituting of basic symptoms as well as of attenuated and frank psychotic, and related symptoms. Newman's modularity analysis was used to detect symptom clusters in an earlier generated network (Jimeno, N., et al., 2020. Main symptomatic treatment targets in suspected and early psychosis: New insights from network analysis. Schizophr. Bull. 46, 884-895. https://doi.org/10.1093/schbul/sbz140). The constituting 86 symptoms were assessed with the Schizophrenia Proneness Instrument, Adult version (SPI-A), the Structured Interview for Psychosis-Risk Syndromes (SIPS), and the Positive And Negative Syndrome Scale (PANSS) in three adult samples of an early detection service: clinical high-risk (n = 203), first-episode psychosis (n = 153), and major depression (n = 104). Three clusters were detected: "subjective disturbances", "positive symptoms and behaviors", and "negative and anxious-depressive symptoms". The predominately attenuated hallucinations of both SIPS and PANSS joined the basic symptoms in "subjective disturbances", whereas other positive symptoms entered "positive symptoms and behaviors". Our results underline the importance of insight in separating true psychotic hallucinations from other hallucinatory experiences that, albeit phenomenologically similar are still experienced with some insight, i.e., are present in an attenuated form. We conclude that, strictly, hallucinations held with any degree of insight should not be used to diagnose transition to or presence of frank psychoses and, relatedly, to justify antipsychotic medication.
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Affiliation(s)
- Natalia Jimeno
- Department of Psychiatry, School of Medicine, University of Valladolid, Valladolid, Spain; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; GINCYL, Research Group on Clinical Neuroscience of Castile and Leon, Valladolid, Spain.
| | - Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER-BBN, Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Jesus Poza
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER-BBN, Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain; IMUVA, Mathematics Research Institute, University of Valladolid, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER-BBN, Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain; IMUVA, Mathematics Research Institute, University of Valladolid, Valladolid, Spain
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; INM3, Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Theresa K Lichtenstein
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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13
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Porter L, Jones C, Fox A. Reliability of the Calgary depression scale for schizophrenia: A meta-analysis. Schizophr Res 2022; 240:32-45. [PMID: 34920367 DOI: 10.1016/j.schres.2021.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND A challenge for clinicians working with individuals diagnosed with schizophrenia is distinguishing depressive symptoms from negative symptoms of schizophrenia. The Calgary Depression Scale for Schizophrenia (CDSS) was developed for this purpose. No review has previously explored its reliability across multiple studies using advanced statistical means. OBJECTIVES This meta-analysis aimed to quantify the CDSS' internal consistency, inter-rater reliability (IRR) and test-retest reliability. METHOD A systematic literature search was conducted to find articles reporting on the CDSS' reliability. Articles were screened against the inclusion and exclusion criteria, with data extracted from 40 studies. Overall meta-analytic effects were calculated, and for internal consistency and IRR coefficients subsequent analyses explored between-study variation. The small test-retest reliability dataset limited analysis. FINDINGS The internal consistency meta-analytic effect was 0.83 (95% CI:0.82-0.84). Higgins I2 indicated an acceptable level of variation between studies' alpha estimates. This suggests all items in the CDSS are measuring the same construct (i.e. symptoms of depression). The IRR meta-analytic effect was 0.88 (95% CI:0.86-0.91), with Higgins I2 indicating high levels of heterogeneity. This was not deemed problematic variance as it is within levels expected for psychometric measures and, therefore, considered acceptable for this literature. This reflects high level of agreement between different raters when using the CDSS on the same client. CONCLUSIONS This review suggests the CDSS has good internal consistency and excellent IRR. Further research will help understand its test-retest reliability.
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Affiliation(s)
- Laura Porter
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland.
| | - Christopher Jones
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Fox
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland
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14
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Lam AHY, Cheung YTD, Wong KH, Leung SF, Chien WT. Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion. Neuropsychiatr Dis Treat 2022; 18:75-85. [PMID: 35046658 PMCID: PMC8760986 DOI: 10.2147/ndt.s338133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Studies have shown that rumination plays a significant mediating role between dispositional mindfulness (DM) and psychopathological symptoms in both clinical and non-clinical populations. However, no studies have examined this pathway in people with schizophrenia spectrum disorders (SSDs). METHODS A cross-sectional, clinician-administered survey was conducted among people with SSDs (n = 52) in a community setting. Participants completed the Chinese versions of the Depression Anxiety Stress Scale, Five Facet Mindfulness Questionnaire-Short Form, Psychotic Symptom Rating Scale and Scale for the Assessment of Negative Symptoms. Structural equation modelling was performed to examine the pathways of mindfulness facets, rumination, negative emotions and psychotic symptoms. RESULTS Two facets of mindfulness (nonjudging and acting with awareness) reduced rumination and negative emotional status. Rumination fully mediated the relationship between nonjudging and negative emotions and partially mediated the relationship between acting with awareness and negative emotions. Furthermore, rumination and negative emotions sequentially mediated the relationship between acting with awareness and hallucination (B = -0.44, 95% confidence interval [CI] = -0.338 to -0.045, p = 0.01) and between nonjudging and hallucination (B = -0.356, 95% CI = -0.255 to -0.008, p = 0.034). The model fit the data well (χ2(2) = 1.318, p = 0.517, Tucker-Lewis index = 1.075, comparative fit index = 1, standardised root mean residual = 0.0251, root mean square error of approximation = 0.0001). CONCLUSION Rumination and negative emotions serially mediated the relationship between DM and hallucination. The findings support the contribution of changes across transdiagnostic mediators underlying the therapeutic effects of mindfulness training. Further research examining the transdiagnostic processes of DM in influencing clinical outcomes in SSDs is warranted.
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Affiliation(s)
- Angie Ho Yan Lam
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yee Tak Derek Cheung
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kwan Ho Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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15
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Havers L, Cardno A, Freeman D, Ronald A. The Latent Structure of Negative Symptoms in the General Population in Adolescence and Emerging Adulthood. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac009. [PMID: 35156042 PMCID: PMC8827402 DOI: 10.1093/schizbullopen/sgac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Negative symptoms predict adverse outcomes within psychotic disorders, in individuals at high-risk for psychosis, and in young people in the community. There is considerable interest in the dimensional structure of negative symptoms in clinical samples, and accumulating evidence suggests a 5-factor structure. Little is known about the underlying structure of negative symptoms in young people despite the importance of this developmental stage for mental health. We used confirmatory factor analysis to test the structure of parent-reported negative symptoms at mean ages 16.32 (SD 0.68, N = 4974), 17.06 (SD 0.88, N = 1469) and 22.30 (SD 0.93, N = 5179) in a community sample. Given previously reported associations between total negative symptoms and genome-wide polygenic scores (GPS) for major depressive disorder (MDD) and schizophrenia in adolescence, we assessed associations between individual subdomains and these GPSs. A 5-factor model of flat affect, alogia, avolition, anhedonia, and asociality provided the best fit at each age and was invariant over time. The results of our linear regression analyses showed associations between MDD GPS with avolition, flat affect, anhedonia, and asociality, and between schizophrenia GPS with avolition and flat affect. We showed that a 5-factor structure of negative symptoms is present from ages 16 to 22 in the community. Avolition was most consistently associated with polygenic liability to MDD and schizophrenia, and alogia was least associated. These findings highlight the value of dissecting negative symptoms into psychometrically derived subdomains and may offer insights into early manifestation of genetic risk for MDD and schizophrenia.
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Affiliation(s)
- Laura Havers
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Alastair Cardno
- Division of Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Angelica Ronald
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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16
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Liu J, Wang D, Zhou H, Zhao NO, Wu HE, Zhang X. Deficit syndrome in Chinese patients with first-episode drug naïve schizophrenia: Prevalence, demographic and clinical characteristics. Asian J Psychiatr 2021; 65:102861. [PMID: 34547594 DOI: 10.1016/j.ajp.2021.102861] [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: 07/03/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deficit syndrome (DS) is a common subgroup of schizophrenia. However, few studies have examined the prevalence and risk factors for DS in Chinese Han patients with schizophrenia. The aim of this study was to assess prevalence, demographic and clinical characteristics of DS in Chinese Han patients with first-episode drug naïve (FEDN) schizophrenia. METHODS In total, 235 patients with schizophrenia were recruited, and clinical and demographic data were collected. The Positive and Negative Syndrome Scale (PANSS) was utilized for the psychopathological symptoms, and the 17-item Hamilton Depression Rating Scale (HDRS-17) for depressive symptoms. The Proxy for the Deficit Syndrome (PDS) was adopted to identify DS. RESULTS The prevalence of DS in the cohort of first-episode schizophrenia patients was 23.0%. Compared to those patients without DS, patients with DS had younger age, lower education level, and were more likely to be single. Further, DS patients had significantly lower scores of positive symptoms, general psychopathology, and depression than non-DS patients. Patients with DS had fewer suicide attempts, but they had more severe negative symptoms and cognitive impairment (all p < 0.05). Multiple regression showed that poor cognitive functioning, lower levels of depression and younger age at onset were predictors of DS. CONCLUSIONS Chinese Han patients with FEDN schizophrenia have high prevalence of DS. Some demographic and clinical parameters may be associated with DS.
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Affiliation(s)
- Junyao Liu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Huixia Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ning Olivia Zhao
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiangyang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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17
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Bergmann N, Hahn E, Hahne I, Zierhut M, Ta TMT, Bajbouj M, Pijnenborg GHM, Böge K. The Relationship Between Mindfulness, Depression, Anxiety, and Quality of Life in Individuals With Schizophrenia Spectrum Disorders. Front Psychol 2021; 12:708808. [PMID: 34531796 PMCID: PMC8438172 DOI: 10.3389/fpsyg.2021.708808] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/03/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Schizophrenia spectrum disorders (SSD) are frequently accompanied by comorbid depressive and anxiety symptoms, as well as impaired quality of life (QoL). A growing body of evidence has demonstrated the relevance of mindfulness for SSD in recent years. The study examined the association between mindfulness, depression, anxiety, and QoL. Materials and Methods: A total of 83 participants with SSD were recruited at the in- and outpatient psychiatric hospital care. Participants completed the Southampton Mindfulness Questionnaire, Comprehensive Inventory for Mindful Experiences, and Freiburger Mindfulness Inventory, the Depression, Anxiety, Stress Scale to assess depression and anxiety, and the WHO-QoL Questionnaire. Multiple regression analyses examined the relationship between mindfulness and QoL and the mediating role of depression and anxiety. Results: Mindfulness had a significant statistical positive effect on QoL domains physical health, psychological, and environmental QoL in patients with SSD. Depression was identified as a significant mediator of this relationship. Conclusion: This study provides novel insight into mindfulness' mechanisms and paves the way for a process-oriented approach to treat SSD. The results provide first evidence for the process-based value of mindfulness for SSD; future studies can focus on the role of mindfulness for central therapeutic processes of change by employing longitudinal designs.
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Affiliation(s)
- Niklas Bergmann
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Inge Hahne
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marco Zierhut
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Geradina Henrika Maria Pijnenborg
- Department Clinical Psychology and Experimental Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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18
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Herniman SE, Cotton SM, Allott KA, Phillips LJ, Wood SJ. The psychometric validity of the Montgomery-Åsberg Depression Rating Scale (MADRS) in recent onset schizophrenia spectrum disorders. Schizophr Res 2021; 228:373-381. [PMID: 33548838 DOI: 10.1016/j.schres.2020.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022]
Abstract
Earlier recognition and accurate assessment of depressive symptoms is important to improving outcomes in individuals with recent-onset schizophrenia spectrum disorders (termed SSD hereafter)-regardless of whether positive psychotic symptoms are present or have resolved. The Montgomery-Åsberg Depression Rating Scale (MADRS) is frequently used to assess depressive symptoms in SSD, but no study has examined the psychometric validity of MADRS scores in individuals exclusively with SSD and sub-grouped by those with and without positive psychotic symptoms. This study involved baseline data from the Psychosis Recent Onset GRoningen Survey (PROGR-S). Measures used were: MADRS, depressive and negative subscales of Positive and Negative Syndrome Scale (PANSSD, PANSSN), and Schedules for Clinical Assessment in Neuropsychiatry (SCAN). The MADRS total score had sufficient concurrent validity with PANSSD (evidence by ρ≥0.70), and insufficient divergent validity with PANSSN (evidenced by ρ ≥0.30), in the full cohort and when sub-grouped by positive psychotic symptoms. In symptom networks, divergent communities comprising either MADRS or PANSSN items were found, except the MADRS item inability to feel overlapped with PANSSN items. The most divergent MADRS items were sadness, pessimism, and suicidal thoughts. The MADRS total score had sufficient predictive validity for determining caseness for MDD based on SCAN, but the optimal cut-off differed in those with and without positive psychotic symptoms (MADRS≥18 versus MADRS≥11). The MADRS has sufficient validity for assessing depressive symptoms in SSD. Since scores might depend upon symptoms of SSD, MADRS≥11 and the presence of sadness, pessimism, or suicidal ideation might be the best indicator of MDD in SSD.
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Affiliation(s)
- Sarah E Herniman
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Sue M Cotton
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Kelly A Allott
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen J Wood
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Psychology, University of Birmingham, Birmingham, UK
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19
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Quek YF, Yang Z, Dauwels J, Lee J. The Impact of Negative Symptoms and Neurocognition on Functioning in MDD and Schizophrenia. Front Psychiatry 2021; 12:648108. [PMID: 34381384 PMCID: PMC8350050 DOI: 10.3389/fpsyt.2021.648108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/25/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction: Negative symptoms, neurocognitive deficits and functional impairment are prevalent in individuals with major depressive disorder (MDD) and schizophrenia (SCZ). However, unlike neurocognitive deficits, little is known about the role of negative symptoms toward functioning in individuals with MDD. On the other hand, both factors are well-studied in individuals with SCZ. Thus, this study aimed to examine the contributions of negative symptoms and neurocognitive impairments in functioning in individuals with MDD, compared to individuals with SCZ. Methods: Participants included 50 individuals with MDD, 49 individuals with SCZ and 49 healthy controls. The following measures were administered-Negative Symptom Assessment (NSA-16), Brief Assessment of Cognition in Schizophrenia (BACS), Patient Health Questionnaire (PHQ-9), and MIRECC-Global Assessment of Functioning (MIRECC-GAF) to evaluate negative symptoms, neurocognition, depressive symptoms, and functioning respectively. Results: Both MDD and SCZ groups had significantly more severe negative symptoms, depressive symptoms, and poorer functioning than healthy controls. Individuals with SCZ performed significantly poorer on the BACS than the other two groups. Both negative symptoms and neurocognition were significantly correlated with social and occupational functioning in SCZ. Motivation subdomain of the negative symptoms was significantly correlated with occupational functioning, while depressive symptoms correlated with functioning in MDD. Conclusion: Both negative symptoms and neurocognitive deficits appear to play differential roles on individual domains of functioning between MDD and SCZ. Future longitudinal studies with larger sample sizes should be done for a better understanding about the associations between the factors and functioning.
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Affiliation(s)
- Yue Feng Quek
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Zixu Yang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Justin Dauwels
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore.,North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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20
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Salagre E, Grande I, Solé B, Mezquida G, Cuesta MJ, Díaz-Caneja CM, Amoretti S, Lobo A, González-Pinto A, Moreno C, Pina-Camacho L, Corripio I, Baeza I, Bergé D, Verdolini N, Carvalho AF, Vieta E, Bernardo M. Exploring Risk and Resilient Profiles for Functional Impairment and Baseline Predictors in a 2-Year Follow-Up First-Episode Psychosis Cohort Using Latent Class Growth Analysis. J Clin Med 2020; 10:E73. [PMID: 33379225 PMCID: PMC7796026 DOI: 10.3390/jcm10010073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Abstract
Being able to predict functional outcomes after First-Episode Psychosis (FEP) is a major goal in psychiatry. Thus, we aimed to identify trajectories of psychosocial functioning in a FEP cohort followed-up for 2 years in order to find premorbid/baseline predictors for each trajectory. Additionally, we explored diagnosis distribution within the different trajectories. A total of 261 adults with FEP were included. Latent class growth analysis identified four distinct trajectories: Mild impairment-Improving trajectory (Mi-I) (38.31% of the sample), Moderate impairment-Stable trajectory (Mo-S) (18.39%), Severe impairment-Improving trajectory (Se-I) (12.26%), and Severe impairment-Stable trajectory (Se-S) (31.03%). Participants in the Mi-I trajectory were more likely to have higher parental socioeconomic status, less severe baseline depressive and negative symptoms, and better premorbid adjustment than individuals in the Se-S trajectory. Participants in the Se-I trajectory were more likely to have better baseline verbal learning and memory and better premorbid adjustment than those in the Se-S trajectory. Lower baseline positive symptoms predicted a Mo-S trajectory vs. Se-S trajectory. Diagnoses of Bipolar disorder and Other psychoses were more prevalent among individuals falling into Mi-I trajectory. Our findings suggest four distinct trajectories of psychosocial functioning after FEP. We also identified social, clinical, and cognitive factors associated with more resilient trajectories, thus providing insights for early interventions targeting psychosocial functioning.
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Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Manuel J. Cuesta
- Department of Psychiatry, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Covadonga M. Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, BIOARABA Health Research Institute, University of the Basque Country, 01009 Vitoria, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain;
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain;
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), 08041 Barcelona, Spain
| | - Immaculada Baeza
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Child and Adolescent Psychiatry and Psychology Department, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic of Barcelona, SGR-881, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Daniel Bergé
- Hospital del Mar Medical Research Institute, CIBERSAM, Autonomous University of Barcelona, 08003 Barcelona, Spain;
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - André F. Carvalho
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON M6J 1H4, Canada;
- The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
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García-Mieres H, De Jesús-Romero R, Ochoa S, Feixas G. Beyond the cognitive insight paradox: Self-reflectivity moderates the relationship between depressive symptoms and general psychological distress in psychosis. Schizophr Res 2020; 222:297-303. [PMID: 32518005 DOI: 10.1016/j.schres.2020.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND People with psychosis experience significant emotional burden and distress associated with the symptomatic consequences of their mental disorder, thus difficulting their recovery. Several studies have found self-reflectivity, a dimension of cognitive insight, to be associated with effects which taken together may seem paradoxical, by predicting less psychotic symptom severity but more depression. To elucidate this issue, we examined the influence of psychotic symptoms, depressive symptoms, and self-reflectivity, on psychological distress. Further, we tested whether self-reflectivity moderated the relationship between depressive symptoms and psychological distress. METHODS Seventy-six outpatients with psychotic-spectrum disorders were assessed using measures of psychotic symptoms, depressive symptoms, cognitive insight (i.e., self-reflectivity, self-certainty) and psychological distress. RESULTS A regression model revealed that depressive, positive symptoms and the interaction between depressive symptoms and self-reflectivity had a significant effect on psychological distress. The moderation analysis showed that higher levels of self-reflectivity were related to less psychological distress associated with depressive mood. CONCLUSIONS The role of self-reflectivity on depression and distress may be more complex than a direct effect. Interventions targeted to improve metacognition by enhancing self-reflectivity might be important for lowering the psychological distress associated with depressive symptoms in people with psychosis.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
| | - Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 47405, IN, United States
| | | | - Susana Ochoa
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain
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