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Huo L, Qu D, Pei C, Wu W, Ning Y, Zhou Y, Zhang XY. Alexithymia in chronic schizophrenia and its mediating effect between cognitive deficits and negative symptoms. Schizophr Res 2023; 261:275-280. [PMID: 37866075 DOI: 10.1016/j.schres.2023.10.006] [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: 01/04/2023] [Revised: 06/01/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Although cognition is known to impact clinical symptoms of schizophrenia, few studies investigate the potential mediators of this relationship. This study aimed to examine the relationship between cognitive deficits and negative symptoms in schizophrenia, considering the mediating role of alexithymia as an important psychological variable. Moreover, the prevalence of alexithymia in patients with schizophrenia was investigated. METHODS A total of 689 patients with schizophrenia were recruited from two psychiatric hospitals. All patients completed the Positive and Negative Syndrome Scale (PANSS), 20-item Toronto Alexithymia Scale (TAS-20), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). We used structural equation modeling to examine the hypothesized mediated model. RESULTS In total, 31.5 % of patients with schizophrenia were classified as alexithymia. The path analyses showed that two factors of alexithymia (i.e., the difficulty in identifying feelings and difficulty in describing feelings), played a mediating role in the pathway from cognitive deficits to negative symptoms (all p < .001). LIMITATIONS Self-reported measurement for alexithymia may not be sufficiently reliable due to response bias. CONCLUSION Our findings demonstrated a high occurrence of alexithymia in patients with schizophrenia. Moreover, the mediating role of alexithymia suggests that targeting emotion processing and cognition may be a feasible way to mitigate negative symptoms.
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Affiliation(s)
- Lijuan Huo
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, Guangzhou, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Chenran Pei
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, Guangzhou, China
| | - Weibin Wu
- Foshan Mental Health Center, The Third People's Hospital of Foshan, Foshan, China
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 5180005, China.
| | - Xiang Yang Zhang
- Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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Takahashi T, Sasabayashi D, Takayanagi Y, Higuchi Y, Mizukami Y, Akasaki Y, Nishiyama S, Furuichi A, Kobayashi H, Yuasa Y, Tsujii N, Noguchi K, Suzuki M. Anatomical variations in the insular cortex in individuals at a clinical high-risk state for psychosis and patients with schizophrenia. Front Psychiatry 2023; 14:1192854. [PMID: 37476540 PMCID: PMC10354273 DOI: 10.3389/fpsyt.2023.1192854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction Since the number of insular gyri is higher in schizophrenia patients, it has potential as a marker of early neurodevelopmental deviations. However, it currently remains unknown whether the features of the insular gross anatomy are similar between schizophrenia patients and individuals at risk of psychosis. Furthermore, the relationship between anatomical variations in the insular cortex and cognitive function has not yet been clarified. Methods The gross anatomical features (i.e., the number of gyri and development pattern of each gyrus) of the insular cortex were examined using magnetic resonance imaging, and their relationships with clinical characteristics were investigated in 57 subjects with an at-risk mental state (ARMS) and 63 schizophrenia patients in comparison with 61 healthy controls. Results The number of insular gyri bilaterally in the anterior subdivision was higher in the ARMS and schizophrenia groups than in the control group. The schizophrenia group was also characterized by a higher number of insular gyri in the left posterior subdivision. A well-developed right middle short insular gyrus was associated with symptom severity in first-episode schizophrenia patients, whereas chronic schizophrenia patients with a well-developed left accessory gyrus were characterized by less severe cognitive impairments in motor and executive functions. The features of the insular gross anatomy were not associated with clinical characteristics in the ARMS group. Discussion The features of the insular gross anatomy that were shared in the ARMS and schizophrenia groups may reflect a vulnerability to psychosis that may be attributed to anomalies in the early stages of neurodevelopment. However, the contribution of the insular gross anatomy to the clinical characteristics of schizophrenia may differ according to illness stages.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Arisawabashi Hospital, Toyama, Japan
| | - Yuko Higuchi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yuko Mizukami
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yukiko Akasaki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Shimako Nishiyama
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Health Administration Center, Faculty of Education and Research Promotion, Academic Assembly, University of Toyama, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Haruko Kobayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yusuke Yuasa
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Noa Tsujii
- Department of Child Mental Health and Development, Toyama University Hospital, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
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Mondelli V, Blackman G, Kempton MJ, Pollak TA, Iyegbe C, Valmaggia LR, Amminger P, Barrantes-Vidal N, Bressan R, van der Gaag M, de Haan L, Krebs MO, Nordentoft M, Ruhrmann S, Riecher-Rössler A, Rutten BPF, Sachs G, Koutsouleris N, McGuire P. Serum immune markers and transition to psychosis in individuals at clinical high risk. Brain Behav Immun 2023; 110:290-296. [PMID: 36940754 DOI: 10.1016/j.bbi.2023.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
Individuals at clinical high risk (CHR) for psychosis have been found to have altered cytokine levels, but whether these changes are related to clinical outcomes remains unclear. We addressed this issue by measuring serum levels of 20 immune markers in 325 participants (n = 269 CHR, n = 56 healthy controls) using multiplex immunoassays, and then followed up the CHR sample to determine their clinical outcomes. Among 269 CHR individuals, 50 (18.6 %) developed psychosis by two years. Univariate and machine learning techniques were used to compare levels of inflammatory markers in CHR subjects and healthy controls, and in CHR subjects who had (CHR-t), or had not (CHR-nt) transitioned to psychosis. An ANCOVA identified significant group differences (CHR-t, CHR-nt and controls) and post-hoc tests indicated that VEGF levels and the IL-10/IL-6 ratio were significantly higher in CHR-t than CHR-nt, after adjusting for multiple comparisons. Using a penalised logistic regression classifier, CHR participants were distinguished from controls with an area-under the curve (AUC) of 0.82, with IL-6 and IL-4 levels the most important discriminating features. Transition to psychosis was predicted with an AUC of 0.57, with higher VEGF level and IL-10/IL-6 ratio the most important discriminating features. These data suggest that alterations in the levels of peripheral immune markers are associated with the subsequent onset of psychosis. The association with increased VEGF levels could reflect altered blood-brain-barrier (BBB) permeability, while the link with an elevated IL-10/IL-6 ratio points to an imbalance between anti- and pro-inflammatory cytokines.
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Affiliation(s)
- Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK.
| | - Graham Blackman
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Matthew J Kempton
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Thomas A Pollak
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Conrad Iyegbe
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Lucia R Valmaggia
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
| | - Paul Amminger
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 485 3052, Australia
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver (Spain), Spanish Mental Health Research Network (CIBERSAM), Australia
| | - Rodrigo Bressan
- LiNC - Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP), Australia
| | - Mark van der Gaag
- VU University, Department of Clinical Psychology and Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands
| | - Lieuwe de Haan
- AMC, Academic Psychiatric Centre, Department Early Psychosis, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Arkin Amsterdam, The Netherlands
| | - Marie-Odile Krebs
- University Paris Descartes, Hôpital Sainte-Anne, C'JAAD, Service Hospitalo-Universitaire, Inserm U894, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD 464 Maastricht, The Netherlands; Max-Planck Institute of Psychiatry, Munich, Germany
| | - Gabriele Sachs
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, The Netherlands
| | - Nikolaos Koutsouleris
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK; Medical University of Vienna, Department of Psychiatry and Psychotherapy, The Netherlands; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Philip McGuire
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
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Atypical prediction error learning is associated with prodromal symptoms in individuals at clinical high risk for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:105. [PMID: 36433979 PMCID: PMC9700713 DOI: 10.1038/s41537-022-00302-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
Reductions in the auditory mismatch negativity (MMN) have been well-demonstrated in schizophrenia rendering it a promising biomarker for understanding the emergence of psychosis. According to the predictive coding theory of psychosis, MMN impairments may reflect disturbances in hierarchical information processing driven by maladaptive precision-weighted prediction errors (pwPEs) and enhanced belief updating. We applied a hierarchical Bayesian model of learning to single-trial EEG data from an auditory oddball paradigm in 31 help-seeking antipsychotic-naive high-risk individuals and 23 healthy controls to understand the computational mechanisms underlying the auditory MMN. We found that low-level sensory and high-level volatility pwPE expression correlated with EEG amplitudes, coinciding with the timing of the MMN. Furthermore, we found that prodromal positive symptom severity was associated with increased expression of sensory pwPEs and higher-level belief uncertainty. Our findings provide support for the role of pwPEs in auditory MMN generation, and suggest that increased sensory pwPEs driven by changes in belief uncertainty may render the environment seemingly unpredictable. This may predispose high-risk individuals to delusion-like ideation to explain this experience. These results highlight the value of computational models for understanding the pathophysiological mechanisms of psychosis.
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Sandsten KE, Wainio‐Theberge S, Nordgaard J, Kjaer TW, Northoff G, Parnas J. Relating self-disorders to neurocognitive and psychopathological measures in first-episode schizophrenia. Early Interv Psychiatry 2022; 16:1202-1210. [PMID: 35081668 PMCID: PMC9786869 DOI: 10.1111/eip.13269] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/27/2021] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
AIM The notion of a disturbed self as the core feature of schizophrenia dates back to the founding texts on the illness. Since the development of the psychometric tool for examination of anomalous self-experience (EASE), self-disorders have become accessible to empirical research. Empirical studies have shown that EASE measured self-disorders predict schizophrenia spectrum in prospective studies and consistently show a selective hyper aggregation of self-disorder in schizophrenia and schizotypal disorders. The aim of this study is to investigate the relationship between self-disorders cognitive deficits and symptoms in schizophrenia. METHODS Thirty-five non-acute first-episode patients with schizophrenia and 35 matched healthy controls were evaluated with EASE, cognitive deficits, and symptoms (PANSS positive, negative and general). [Correction added on 28 January 2022, after first online publication: the words, 'evaluated with' were missing and have now been added to the preceding sentence.] RESULTS: The results show that self-disorders and symptoms are correlated among patients with schizophrenia, but not with cognitive deficits. Moreover, with the exception of attentional deficits, neurocognitive impairment was not significantly higher among patients with schizophrenia compared to healthy controls. CONCLUSIONS We argue that this adds support to a view of schizophrenia as being characterized by specific traits of pre-reflective self-disturbance, which are related to the severity of symptoms, whereas neurocognitive impairment reflects a separate or distinct aspect of schizophrenia.
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Affiliation(s)
| | | | - Julie Nordgaard
- Mental Health Center AmagerUniversity Hospital of CopenhagenCopenhagenDenmark
| | | | - Georg Northoff
- University of Ottawa Institute of Mental Health ResearchOttawaOntarioCanada
| | - Josef Parnas
- Mental Health Center GlostrupUniversity Hospital of CopenhagenCopenhagenDenmark
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Chaumette B, Sengupta SM, Lepage M, Malla A, Iyer SN, Kebir O, Dion PA, Rouleau GA, Krebs MO, Shah JL, Joober R. A polymorphism in the glutamate metabotropic receptor 7 is associated with cognitive deficits in the early phases of psychosis. Schizophr Res 2022; 249:56-62. [PMID: 32624350 DOI: 10.1016/j.schres.2020.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023]
Abstract
Schizophrenia is an illness characterized by positive symptoms, negative symptoms, and cognitive impairments. Cognitive impairments occur before the onset of psychosis and could reflect glutamatergic dysregulation. Thus, identifying associations between genetic variations in genes coding for glutamatergic receptors and cognitive impairment in schizophrenia may help in understanding the basis of these deficits and in identifying potential drug targets. In a discovery cohort of 144 first-episode of psychosis patients (FEP), we genotyped 58 candidate Single Nucleotide Polymorphisms (SNPs) located in NMDA and metabotropic glutamatergic receptors. These SNPs were selected according to the results from the Psychiatric Genomic Consortium and were tested for association with intellectual quotient (IQ) as assessed with the Wechsler Intelligence Scales. For replication, we used the ICAAR cohort including 121 ultra-high-risk patients (UHR) with the same cognitive assessment. A polymorphism located in GRM7, rs1396409, was significantly associated with performance IQ in the discovery cohort of FEP. This association was replicated in the UHR cohort. This polymorphism is also associated with total IQ and verbal IQ in the merged dataset, with a predominant effect on the arithmetic subtest. The rs1396409 polymorphism is significantly associated with cognitive impairment during the onset of psychosis. This genetic association highlights the possible impact of glutamatergic genes in cognitive deficits in the early phases of psychosis and enforces the interest for new therapeutic interventions targeting the glutamatergic pathway.
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Affiliation(s)
- Boris Chaumette
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada; Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, CNRS, GDR3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Sarojini M Sengupta
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Oussama Kebir
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, CNRS, GDR3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | - Patrick A Dion
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Marie-Odile Krebs
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, CNRS, GDR3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Associations between symptom and neurocognitive dimensions in clinical high risk for psychosis. Schizophr Res Cogn 2022; 29:100260. [PMID: 35677653 PMCID: PMC9168614 DOI: 10.1016/j.scog.2022.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/22/2022]
Abstract
Introduction Clinical high risk for psychosis (CHR) is associated with mild cognitive impairments. Symptoms are clustered into positive, negative and disorganization symptoms. The association between specific symptom dimensions and cognitive functions remains unclear. The aim of this study was to investigate the associations between cognitive functions and positive, negative, and disorganization symptoms. Method 53 CHR subjects fulfilling criteria for attenuated psychotic syndrome in the Structural Interview for Prodromal Syndromes (SIPS) were assessed for cognitive function. Five cognitive domain z-scores were defined by contrasting with observed scores of a group of healthy controls (n = 40). Principal Components Analyses were performed to construct general cognitive composite scores; one using all subtests and one using the cognitive domains. Associations between cognitive functions and symptoms are presented as Spearman's rank correlations and partial Spearman's rank correlations adjusted for age and gender. Results Positive symptoms were negatively associated with executive functions and verbal memory, and disorganization symptoms with poorer verbal fluency. Negative symptoms were associated with better executive functioning. There were no significant associations between the general cognitive composites and any of the symptom domains, except for a trend for positive symptoms. Conclusion In line with previous research, data indicated associations between positive symptoms and poorer executive functioning. Negative symptoms may not be related to executive functions in CHR the same way as in psychosis. Our results could indicate that attenuated positive symptoms are more related to cognitive deficits in CHR than positive symptoms in schizophrenia and FEP.
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Hedges EP, See C, Si S, McGuire P, Dickson H, Kempton MJ. Meta-analysis of longitudinal neurocognitive performance in people at clinical high-risk for psychosis. Psychol Med 2022; 52:2009-2016. [PMID: 35821623 PMCID: PMC9386433 DOI: 10.1017/s0033291722001830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
Persons at clinical high-risk for psychosis (CHR) are characterised by specific neurocognitive deficits. However, the course of neurocognitive performance during the prodromal period and over the onset of psychosis remains unclear. The aim of this meta-analysis was to synthesise results from follow-up studies of CHR individuals to examine longitudinal changes in neurocognitive performance. Three electronic databases were systematically searched to identify articles published up to 31 December 2021. Thirteen studies met inclusion criteria. Study effect sizes (Hedges' g) were calculated and pooled for each neurocognitive task using random-effects meta-analyses. We examined whether changes in performance between baseline and follow-up assessments differed between: (1) CHR and healthy control (HC) individuals, and (2) CHR who did (CHR-T) and did not transition to psychosis (CHR-NT). Meta-analyses found that HC individuals had greater improvements in performance over time compared to CHR for letter fluency (g = -0.32, p = 0.029) and digit span (g = -0.30, p = 0.011) tasks. Second, there were differences in longitudinal performance of CHR-T and CHR-NT in trail making test A (TMT-A) (g = 0.24, p = 0.014) and symbol coding (g = -0.51, p = 0.011). Whilst CHR-NT improved in performance on both tasks, CHR-T improved to a lesser extent in TMT-A and had worsened performance in symbol coding over time. Together, neurocognitive performance generally improved in all groups at follow-up. Yet, evidence suggested that improvements were less pronounced for an overall CHR group, and specifically for CHR-T, in processing speed tasks which may be a relevant domain for interventions aimed to enhance neurocognition in CHR populations.
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Affiliation(s)
- Emily P. Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Cheryl See
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Shuqing Si
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
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AĞDANLI O, TOPUZOGLU A, KARABAY N, ALPTEKİN K. Corpus Callosum Volume in Patients with First-Episode Psychosis. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.789999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Onur AĞDANLI
- Sağlık Bakanlığı, İzmir Katip Çelebi Üniverstesi Atatürk Eğitim Araştırma Hastanesi, Psikiyatri Kliniği
| | - Ahmet TOPUZOGLU
- MARMARA ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, HALK SAĞLIĞI ANABİLİM DALI
| | - Nuri KARABAY
- Dokuz Eylül Üniversitesi Tıp Fakültesi Dahili Bilimler, Radyoloji Anabilim Dalı
| | - Köksal ALPTEKİN
- DOKUZ EYLÜL ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RUH SAĞLIĞI VE HASTALIKLARI ANABİLİM DALI
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10
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Barch DM, Karcher N, Moran E. Reinventing schizophrenia - Embracing complexity and complication. Schizophr Res 2022; 242:7-11. [PMID: 34893361 DOI: 10.1016/j.schres.2021.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, United States of America; Department of Psychiatry, Washington University, United States of America; Department of Radiology, Washington University, United States of America.
| | - Nicole Karcher
- Department of Psychiatry, Washington University, United States of America
| | - Erin Moran
- Department of Psychological & Brain Sciences, Washington University, United States of America
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Belvederi Murri M, Bertelli R, Carozza P, Berardi L, Cantarelli L, Croce E, Antenora F, Curtarello EMA, Simonelli G, Recla E, Girotto B, Grassi L. First-episode psychosis in the Ferrara Mental Health Department: Incidence and clinical course within the first 2 years. Early Interv Psychiatry 2021; 15:1738-1748. [PMID: 33264815 DOI: 10.1111/eip.13095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 01/26/2023]
Abstract
AIM To examine the incidence of with first-episode psychosis (FEP) in the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, and to examine the association between the Duration of Untreated Psychosis (DUP) and the clinical course. METHODS Participants recruited in 2013-2019 were assessed with the Health of the Nation Outcome Scale (HoNOS) every 6 months for 24 months. Hierarchical growth models analysed changes of global severity (HoNOS total scores) and symptom dimensions. Regression modelled factors associated with remission (HoNOS < 8) and clinical improvement (<12). RESULTS The incidence of FEP was 21.5 (95%CI: 21.2-21.9) cases per 100 000 person year. Among participants (n = 86, mean age 23, 76% males), baseline HoNOS scores were higher for those with a longer DUP. More than half subjects reached clinical remission (61.6%) or improvement (82.6%), while very few (2.3%) were re-hospitalized. HoNOS total scores decayed with a mixed linear/quadratic trend, with a slower decay among migrants. A longer DUP was associated with reduced improvements of positive symptoms and lower likelihood of clinical improvement (OR: 0.84; 95%CI: 0.73-0.96). CONCLUSIONS Patients from the FEP program of Ferrara reached good clinical outcomes. Nonetheless, individuals with a longer DUP may need additional clinical attention. Systematic monitoring of clinical outcomes may be an optimal strategy to improve the outcomes of FEP in the real world.
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Affiliation(s)
- Martino Belvederi Murri
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Raffaella Bertelli
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Lorenzo Berardi
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Luca Cantarelli
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Enrico Croce
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Fabio Antenora
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Gabriele Simonelli
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elisabetta Recla
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Barbara Girotto
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
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12
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Bartolomeo LA, Chapman HC, Raugh IM, Strauss GP. Delay discounting in youth at clinical high-risk for psychosis and adults with schizophrenia. Psychol Med 2021; 51:1898-1905. [PMID: 32248851 DOI: 10.1017/s0033291720000677] [Citation(s) in RCA: 12] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Schizophrenia (SZ) is typically preceded by a prodromal (i.e. pre-illness) period characterized by attenuated positive symptoms and declining functional outcome. Negative symptoms are prominent among individuals at clinical high-risk (CHR) for psychosis (i.e. those with prodromal syndromes) and highly predictive of conversion to illness. Mechanisms underlying negative symptoms in the CHR population are unclear. Two studies were conducted to evaluate whether abnormalities in a reward processing mechanism thought to be core to negative symptoms in SZ, value representation, also exist in CHR individuals and whether they are associated with negative symptoms transphasically. METHODS Study 1 included 33 individuals in the chronic phase of illness who have been diagnosed with schizophrenia or schizoaffective disorder (SZ) and 40 healthy controls (CN). Study 2 included 37 CHR participants and 45 CN. In both studies, participants completed the delay discounting (DD) task as a measure of value representation and the Brief Negative Symptom Scale was rated to measure negative symptoms. RESULTS Results indicated that patients with SZ had steeper discounting rates than CN, indicating impairments in value representation. However, CHR participants were unimpaired on the DD task. In both studies, steeper discounting was associated with greater severity of negative symptoms. CONCLUSIONS These findings suggest that deficits in value representation are associated with negative symptoms transphasically.
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Affiliation(s)
| | | | - Ian M Raugh
- Department of Psychology, University of Georgia, USA
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13
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Aase I, Langeveld JH, Johannessen JO, Joa I, Dalen I, Ten Velden Hegelstad W. Cognitive predictors of longitudinal positive symptom course in clinical high risk for psychosis. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 26:100210. [PMID: 34381698 PMCID: PMC8340303 DOI: 10.1016/j.scog.2021.100210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
Background Clinical High Risk (CHS) for psychosis is a state in which positive symptoms are predominant but do not reach a level of severity that fulfils the criteria for a psychotic episode. The aim of this study has been to investigate whether cognition in subjects with newly detected CHR affects the longitudinal development of positive symptoms. Methods Fifty-three CHR individuals fulfilling the criteria for attenuated positive syndrome in the Structural Interview for Prodromal Syndromes (SIPS) were included. At inclusion, all participants completed a neurocognitive battery consisting of tests measuring attention, verbal memory, verbal fluency, executive functions and general intelligence. Cognitive domain z-scores were defined by contrasting with observed scores of a group of matched healthy controls (n = 40). Associations between cognitive performance at inclusion and longitudinal measures of positive symptoms were assessed by using generalised linear models including non-linear effects of time. All regression models were adjusted for age and gender. Results Overall, SIPS positive symptoms declined over the time period, with a steeper decline during the first six months. Deficits in executive functions were assossiated witn a higher load of positive symptoms at baseline (p=0.006), but also to a faster improvement (p=0.030), wheras those with poor verbal fluency improved more slowly (p=0.018). Conclusion To our knowledge, this is the first study that follows CHR subjects by means of frequent clinical interviews over a sustained period of time. The study provides evidence of an association between executive functions, including verbal fluency, with the evolvement of positive symptoms.
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Affiliation(s)
- Ingvild Aase
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Hendrik Langeveld
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Inge Joa
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Ingvild Dalen
- Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway.,Research Department, Stavanger University Hospital, P. O. 8100, 4068 Stavanger, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Center for Clinical Research in Psychosis, Clinic for Adult Mental Health Care, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
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14
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Dawoodbhoy FM, Delaney J, Cecula P, Yu J, Peacock I, Tan J, Cox B. AI in patient flow: applications of artificial intelligence to improve patient flow in NHS acute mental health inpatient units. Heliyon 2021; 7:e06993. [PMID: 34036191 PMCID: PMC8134991 DOI: 10.1016/j.heliyon.2021.e06993] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Growing demand for mental health services, coupled with funding and resource limitations, creates an opportunity for novel technological solutions including artificial intelligence (AI). This study aims to identify issues in patient flow on mental health units and align them with potential AI solutions, ultimately devising a model for their integration at service level. Method Following a narrative literature review and pilot interview, 20 semi-structured interviews were conducted with AI and mental health experts. Thematic analysis was then used to analyse and synthesise gathered data and construct an enhanced model. Results Predictive variables for length-of-stay and readmission rate are not consistent in the literature. There are, however, common themes in patient flow issues. An analysis identified several potential areas for AI-enhanced patient flow. Firstly, AI could improve patient flow by streamlining administrative tasks and optimising allocation of resources. Secondly, real-time data analytics systems could support clinician decision-making in triage, discharge, diagnosis and treatment stages. Finally, longer-term, development of solutions such as digital phenotyping could help transform mental health care to a more preventative, personalised model. Conclusions Recommendations were formulated for NHS trusts open to adopting AI patient flow enhancements. Although AI offers many promising use-cases, greater collaborative investment and infrastructure are needed to deliver clinically validated improvements. Concerns around data-use, regulation and transparency remain, and hospitals must continue to balance guidelines with stakeholder priorities. Further research is needed to connect existing case studies and develop a framework for their evaluation.
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Affiliation(s)
- Fatema Mustansir Dawoodbhoy
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jack Delaney
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Paulina Cecula
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jiakun Yu
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Iain Peacock
- Imperial College London Business School, London, UK.,Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Joseph Tan
- Imperial College London Business School, London, UK.,Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Benita Cox
- Imperial College London Business School, London, UK
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15
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Smoking Is Related to Reduced Motivation, But Not Global Cognition, in the First Two Years of Treatment for First Episode Psychosis. J Clin Med 2021; 10:jcm10081619. [PMID: 33920376 PMCID: PMC8069411 DOI: 10.3390/jcm10081619] [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] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Smoking is highly prevalent in people with psychotic disorders, even in the earliest phases of the illness. The neural mechanisms of nicotine dependence and psychosis overlap and may also be linked to deficits in neurocognition and motivation in psychosis. Both neurocognition and motivation are recognized as important clinical targets, though previous research examining the effects of smoking on these features has been inconsistent. Here, we examine the relationships between smoking status and neurocognition and motivation over the first two years of treatment for psychosis through a secondary analysis of the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) dataset. In a sample of 404 individuals with first-episode psychosis, we examined linear mixed-effects models with the group (smoker vs. non-smoker) by time (baseline, 12-month, 24-month) interaction as a predictor of global cognition and motivation. While all individuals showed enhanced global cognition and motivation over the 24-month course of treatment, non-smokers showed significantly greater gains in motivation. These changes in motivation also corresponded to improvements in functioning over the 24-month period. No significant effects of smoking were observed for global cognition. Our findings suggest that motivation and smoking cessation may be important early treatment targets for first-episode psychosis programs.
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16
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Mollon J, Knowles EEM, Mathias SR, Rodrigue A, Moore TM, Calkins ME, Gur RC, Peralta JM, Weiner DJ, Robinson EB, Gur RE, Blangero J, Almasy L, Glahn DC. Genetic influences on externalizing psychopathology overlap with cognitive functioning and show developmental variation. Eur Psychiatry 2021; 64:e29. [PMID: 33785081 PMCID: PMC8080212 DOI: 10.1192/j.eurpsy.2021.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Questions remain regarding whether genetic influences on early life psychopathology overlap with cognition and show developmental variation. METHODS Using data from 9,421 individuals aged 8-21 from the Philadelphia Neurodevelopmental Cohort, factors of psychopathology were generated using a bifactor model of item-level data from a psychiatric interview. Five orthogonal factors were generated: anxious-misery (mood and anxiety), externalizing (attention deficit hyperactivity and conduct disorder), fear (phobias), psychosis-spectrum, and a general factor. Genetic analyses were conducted on a subsample of 4,662 individuals of European American ancestry. A genetic relatedness matrix was used to estimate heritability of these factors, and genetic correlations with executive function, episodic memory, complex reasoning, social cognition, motor speed, and general cognitive ability. Gene × Age analyses determined whether genetic influences on these factors show developmental variation. RESULTS Externalizing was heritable (h2 = 0.46, p = 1 × 10-6), but not anxious-misery (h2 = 0.09, p = 0.183), fear (h2 = 0.04, p = 0.337), psychosis-spectrum (h2 = 0.00, p = 0.494), or general psychopathology (h2 = 0.21, p = 0.040). Externalizing showed genetic overlap with face memory (ρg = -0.412, p = 0.004), verbal reasoning (ρg = -0.485, p = 0.001), spatial reasoning (ρg = -0.426, p = 0.010), motor speed (ρg = 0.659, p = 1x10-4), verbal knowledge (ρg = -0.314, p = 0.002), and general cognitive ability (g)(ρg = -0.394, p = 0.002). Gene × Age analyses revealed decreasing genetic variance (γg = -0.146, p = 0.004) and increasing environmental variance (γe = 0.059, p = 0.009) on externalizing. CONCLUSIONS Cognitive impairment may be a useful endophenotype of externalizing psychopathology and, therefore, help elucidate its pathophysiological underpinnings. Decreasing genetic variance suggests that gene discovery efforts may be more fruitful in children than adolescents or young adults.
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Affiliation(s)
- Josephine Mollon
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emma E M Knowles
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel R Mathias
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda Rodrigue
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tyler M Moore
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica E Calkins
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ruben C Gur
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juan Manuel Peralta
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas of the Rio Grande Valley, Brownsville, Texas, USA
| | - Daniel J Weiner
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Elise B Robinson
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Raquel E Gur
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas of the Rio Grande Valley, Brownsville, Texas, USA
| | - Laura Almasy
- Department of Genetics, Perelman School of Medicine, Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David C Glahn
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut, USA
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17
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Crabtree J, Hudson JL, Brockman R, Newton-John T. Spatial working memory, not IQ or executive function, discriminates early psychosis and clinically vulnerable creative individuals. Early Interv Psychiatry 2021; 15:47-56. [PMID: 31910493 DOI: 10.1111/eip.12909] [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: 06/07/2019] [Revised: 11/13/2019] [Accepted: 12/14/2019] [Indexed: 12/01/2022]
Abstract
AIM While associations between creativity and psychopathology have been well researched, the specific cognitive processes that distinguish highly creative from those with psychopathology warrant further investigation. This study will examine whether IQ, executive function, cognitive inhibition or spatial working memory differentiate individuals with early psychosis, clinically vulnerable creative individuals, creative controls and non-creative controls. METHODS The study sample consisted of 110 participants: early psychosis (n = 21); clinically vulnerable creative controls (n = 25); creative controls (n = 30) and non-creative control (n = 34). The Diagnostic Interview for Psychosis assessed early psychosis participants and the Mini Neuropsychiatric Interview was used to screen for psychopathology in the remaining groups. Several cognitive tests were administered: IQ, neurocognitive measures of executive function and spatial working memory. Creativity was assessed using the Torrance Test of Creativity and Creative Achievement Questionnaire. A measure of vividness of mental imagery was also given. RESULTS Across all cognitive tests, spatial working memory differentiated the early psychosis group from both creative and non-creative control groups. Spatial working memory predicted group membership but vivid imagery was a better predictor of creative achievement. The early psychosis, clinically vulnerable creative and creative groups all recorded significantly higher results on creative achievement and creative cognition compared to non-creative controls. CONCLUSIONS Our results provide further support for spatial working memory as an early neuro-cognitive marker for early psychosis. Spatial working memory, rather than IQ or executive function, may also be an early protective factor for clinically vulnerable young creative individuals.
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Affiliation(s)
- Julie Crabtree
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Robert Brockman
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, New South Wales, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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18
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Strauss GP, Pelletier-Baldelli A, Visser KF, Walker EF, Mittal VA. Reprint of: A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis. Schizophr Res 2021; 227:63-71. [PMID: 33526203 DOI: 10.1016/j.schres.2021.01.001] [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: 04/01/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/04/2023]
Abstract
Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.
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Affiliation(s)
| | | | | | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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19
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Correlations between age, biomedical variables, and cognition in patients with schizophrenia. Schizophr Res Cogn 2020; 22:100182. [PMID: 32577406 PMCID: PMC7303996 DOI: 10.1016/j.scog.2020.100182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To illustrate the influence of clinical variables on cognition performance in patients with schizophrenia (SCZ). Methods Using the 66nao Brain Training device (a novel measurement tool), the cognitive performance of 99 patients with SCZ was evaluated. Patients were diagnosed by the ICD-10 diagnostic criteria for SCZ, and their age were 16–68 years old. Furthermore, we explored the relationship between age, biomedical variables and specific cognitive domains in patients with SCZ. Patients were divided into two groups: various of cognitive domains impairment group and non-impairment group according to the norm scores. All data were analyzed using RStudio Version 1.0.44 (RStudio, Inc.) Results Patients with SCZ had obvious cognitive impairment in total and five subdomains of cognitive function. We found that 1) SCZ patients with impaired cognitive total score experienced significant older age and longer illness duration compared with those with normal cognitive total score. 2) SCZ patients with impaired memory experienced significant older age compared with those with normal memory. 3) SCZ patients with impaired attention showed significant lower serum triglyceride (TG) level compared with those with normal attention. 4) SCZ patients with impaired flexibility performed significant longer illness duration compared with those with normal flexibility. 5) SCZ patients with impaired cognitive agility performed significant older age, longer duration, and higher systolic blood pressure (SBP) compared with those with normal cognitive agility. 6) The age, illness duration and SBP in patients with impaired time perception were marginally different from those of subjects with normal time perception. Conclusion There are five dimensions (memory, attention, flexibility, cognitive agility, and time perception) of cognitive dysfunction in SCZ patients. Age, illness duration, TG, and SBP might play vital roles in various subdomains of the cognitive deficits respectively in patients with SCZ.
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20
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Grey-matter abnormalities in clinical high-risk participants for psychosis. Schizophr Res 2020; 226:120-128. [PMID: 31740178 PMCID: PMC7774586 DOI: 10.1016/j.schres.2019.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/28/2019] [Accepted: 08/31/2019] [Indexed: 01/10/2023]
Abstract
The current study examined the presence of abnormalities in cortical grey-matter (GM) in a sample of clinical high-risk (CHR) participants and examined relationships with psychosocial functioning and neurocognition. CHR-participants (n = 114), participants who did not fulfil CHR-criteria (CHR-negative) (n = 39) as well as a group of healthy controls (HC) (n = 49) were recruited. CHR-status was assessed using the Comprehensive Assessment of At-Risk Mental State (CAARMS) and the Schizophrenia Proneness Interview, Adult Version (SPI-A). The Brief Assessment of Cognition in Schizophrenia Battery (BACS) as well as tests for emotion recognition, working memory and attention were administered. In addition, role and social functioning as well as premorbid adjustment were assessed. No significant differences in GM-thickness and intensity were observed in CHR-participants compared to CHR-negative and HC. Circumscribed abnormalities in GM-intensity were found in the visual and frontal cortex of CHR-participants. Moreover, small-to-moderate correlations were observed between GM-intensity and neuropsychological deficits in the CHR-group. The current data suggest that CHR-participants may not show comprehensive abnormalities in GM. We discuss the implications of these findings for the pathophysiological theories of early stage-psychosis as well as methodological issues and the impact of different recruitment strategies.
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21
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Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
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22
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Glenthøj LB, Mariegaard L, Kristensen TD, Wenneberg C, Medalia A, Nordentoft M. Self-perceived cognitive impairments in psychosis ultra-high risk individuals: associations with objective cognitive deficits and functioning. NPJ SCHIZOPHRENIA 2020; 6:31. [PMID: 33188204 PMCID: PMC7666210 DOI: 10.1038/s41537-020-00124-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
There is a scarcity of evidence on subjectively reported cognitive difficulties in individuals at ultra-high risk (UHR) for psychosis and whether these self-perceived cognitive difficulties may relate to objective cognitive deficits, psychopathology, functioning, and adherence to cognitive remediation (CR). Secondary, exploratory analyses to a randomized, clinical trial were conducted with 52 UHR individuals receiving a CR intervention. Participants completed the Measure of Insight into Cognition—Self Report (MIC-SR), a measure of daily life cognitive difficulties within the domains of attention, memory, and executive functions along with measures of neuropsychological test performance, psychopathology, functioning, and quality of life. Our study found participants with and without objectively defined cognitive deficits reported self-perceived cognitive deficits of the same magnitude. No significant relationship was revealed between self-perceived and objectively measured neurocognitive deficits. Self-perceived cognitive deficits associated with attenuated psychotic symptoms, overall functioning, and quality of life, but not with adherence to, or neurocognitive benefits from, a CR intervention. Our findings indicate that UHR individuals may overestimate their cognitive difficulties, and higher levels of self-perceived cognitive deficits may relate to poor functioning. If replicated, this warrants a need for both subjective and objective cognitive assessment in at-risk populations as this may guide psychoeducational approaches and pro-functional interventions. Self-perceived cognitive impairments do not seem to directly influence CR adherence and outcome in UHR states. Further studies are needed on potential mediator between self-perceived cognitive deficits and functioning and quality of life.
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Affiliation(s)
- Louise Birkedal Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900, Hellerup, Denmark. .,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark.
| | - Lise Mariegaard
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark
| | - Tina Dam Kristensen
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark
| | - Alice Medalia
- Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark
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23
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Allott K, Brewer W, Mcgorry PD, Proffitt T. Referrers' Perceived Utility and Outcomes of Clinical Neuropsychological Assessment in an Adolescent and Young Adult Public Mental Health Service. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2010.00002.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kelly Allott
- Orygen Youth Health Research Centre, Centre for Youth Mental Health
| | - Warrick Brewer
- Orygen Youth Health Research Centre, Centre for Youth Mental Health
| | | | - Tina‐marie Proffitt
- Orygen Youth Health Research Centre, Centre for Youth Mental Health
- Department of Psychology, The University of Melbourne, Parkville, Melbourne
- School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
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24
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Wigman JTW, Pijnenborg GHM, Bruggeman R, Vos M, Wessels A, Oosterholt I, Nauta M, Stelwagen R, Otto L, Wester A, Wunderink L, Sportel E, Boonstra N. Onset and transition of and recovery from adverse development: Study methodology. Early Interv Psychiatry 2020; 14:568-576. [PMID: 31691504 PMCID: PMC7496076 DOI: 10.1111/eip.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/07/2019] [Accepted: 09/24/2019] [Indexed: 01/26/2023]
Abstract
AIM Early intervention programs for first-episode psychosis have led to the awareness that the period before onset of a first episode is important in light of early intervention. This has induced a focus on the so-called 'at risk mental state' (ARMS). Individuals with ARMS are at increased risk for later psychotic disorder, but also for other psychiatric disorders as well as poor psychosocial functioning. Thus, adequate detection and treatment of ARMS is essential. METHODS Since 2018, screening for and treatment of ARMS is recommended standard care in the Netherlands. Implementation is still ongoing. We initiated a naturalistic long-term cohort study of ARMS individuals, the onset and transition of and recovery from adverse development (OnTheROAD) study, with the aim to monitor course and outcome of symptoms and psychosocial functioning over time, as well as patterns of comorbidity and associations with factors of risk and resilience. To this end, participants complete a broad battery of instruments at baseline and yearly follow-up assessments up to 3 years. Outcome is defined in terms of symptom severity level, functioning and quality of life. In particular, we aim to investigate the impact of negative symptoms as part of the ARMS concept. Results from this study can aid in refining the existing ARMS criteria, understanding the developmental course of ARMS and investigating the hypothesized pluripotentiality in outcome of ARMS. New knowledge may inform the further development of specialized early interventions. RESULTS AND CONCLUSIONS In this article, we describe the rationale, outline and set-up of OnTheROAD.
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Affiliation(s)
- Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Gerdina H M Pijnenborg
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Department of Psychology, University of Groningen, Groningen, The Netherlands.,GGZ (Mental Health Organization) Drenthe, Assen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Maarten Vos
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Anita Wessels
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mediant Mental Health Organization, Enschede, The Netherlands
| | - Inez Oosterholt
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Dimence Mental Health Organization, Deventer, The Netherlands
| | - Maaike Nauta
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Department of Psychology, University of Groningen, Groningen, The Netherlands.,Accare Youth Mental Health Organization, Groningen, The Netherlands
| | - Renee Stelwagen
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Lana Otto
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Anniek Wester
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Lex Wunderink
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mental Health Organization Friesland, Leeuwarden, The Netherlands
| | - Esther Sportel
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,GGZ (Mental Health Organization) Drenthe, Assen, The Netherlands
| | - Nynke Boonstra
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mental Health Organization Friesland, Leeuwarden, The Netherlands
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25
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Self-Reported Cognitive Functions Predict the Trajectory of Paranoid Ideation Over a 15-Year Prospective Follow-Up. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background
This study investigated whether self-reported cognitive functions (i.e. task orientation, distractibility, persistence, flexibility, and perseverance) predict the trajectory of paranoid ideation over a 15-year prospective follow-up in adulthood.
Methods
The participants came from the population-based Young Finns study (N = 1210‒1213). Paranoid ideation was assessed with the Paranoid Ideation Scale of the Symptom Checklist-90 Revised (SCL-90R) in 1997, 2001, 2007, and 2012. Self-reported cognitive functions were evaluated in 1997 with the Task orientation, Distractibility, Persistence, and Flexibility scales of the DOTS-R (the Revised Dimensions of Temperament Survey) and the Perseverance scale of the FCB-TI (the Formal Characteristics of Behaviour – Temperament Inventory). The data was analyzed using growth curve models that were adjusted for age, sex, and socioeconomic factors in childhood and adulthood.
Results
Low self-reported task orientation, low persistence, high distractibility, low flexibility, and high perseverance predicted higher level of paranoid ideation over the 15-year follow-up.
Conclusions
Self-reported cognitive functions seem to predict paranoid ideation over a long-term follow-up. Promoting cognitive functions in early interventions may have long-term protective influences against the development of paranoid ideation in non-clinical populations.
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26
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Strauss GP, Pelletier-Baldelli A, Visser KF, Walker EF, Mittal VA. A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis. Schizophr Res 2020; 222:104-112. [PMID: 32522469 PMCID: PMC7572550 DOI: 10.1016/j.schres.2020.04.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022]
Abstract
Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.
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Affiliation(s)
- Gregory P. Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA,Correspondence concerning this article should be addressed to Gregory P. Strauss, Ph.D., . Phone: +1-706-542-0307. Fax: +1-706-542-3275. University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602
| | | | | | | | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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27
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Tyson JW, House EM, Donovan AL. Assessing Youth with Psychotic Experiences: A Phenomenological Approach. Child Adolesc Psychiatr Clin N Am 2020; 29:1-13. [PMID: 31708039 DOI: 10.1016/j.chc.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Psychotic experiences may be part of normal development or indicate a wide range of mental disorders. This article shows how a systematic, domain-based, phenomenological approach to assessing psychotic symptoms in youth facilitates the gathering of the nuanced clinical information necessary to understand a child's specific experience. Mapping this information onto a narrative timeline, while understanding the evolution and developmental context of psychotic experiences, is essential in making an accurate diagnostic formulation and appropriate treatment plan for youth presenting with psychotic experiences.
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Affiliation(s)
- John W Tyson
- First Episode and Early Psychosis Program, Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA 02114, USA.
| | - Ellen M House
- Augusta University/University of Georgia Medical Partnership, Health Science Campus, Russell Hall, 1425 Prince Avenue, Athens, GA 30602, USA
| | - Abigail L Donovan
- First Episode and Early Psychosis Program, Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA 02114, USA
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28
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Abstract
The development of effective intervention and prevention strategies among individuals with psychosis risk syndromes may help to reduce symptomatology and conversion to a psychotic disorder. Although strides have been made in this area, more work is needed, particularly given the setbacks that remain (such as heterogeneity among this group). There has been a shift with the introduction of clinical staging models toward expanding current intervention and prevention efforts to a more developmental and transdiagnostic approach. With this, this article seeks to review treatments both recently and currently discussed in the staging literature, introduce advances in psychosis risk syndrome treatments that may be beneficial to consider in clinical staging heuristics, and pinpoint other promising options.
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Affiliation(s)
- Tina Gupta
- Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA
| | - Vijay A Mittal
- Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA.,Department of Psychiatry, Northwestern University, 420 E. Superior Street, Chicago, IL, 60611, USA.,Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208, USA.,Department of Medical Social Sciences, Northwestern University, 420 E. Superior Street, Chicago, IL, 60611, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, 633 N. St. Claire Street, Chicago, IL, 60611, USA
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29
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Do cognitive and neuropsychological functioning deficits coincide with hippocampal alteration during first-psychotic episode? CNS Spectr 2019; 24:472-478. [PMID: 30507369 DOI: 10.1017/s1092852918001293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Numerous studies shown that structural hippocampal alterations are present in subjects at high risk of developing psychosis or schizophrenia. These findings indicate that in a subset of patients undergoing first-psychosis episode (FPE), hippocampal volume alterations are accompanied by associated cognitive and neuropsychological deficits. The combination of psychological deficits and neuroanatomical alterations, in turn, appears to increase treatment complexity and worsen clinical outcomes. OBJECTIVE We aim to determine whether cognitive and neuropsychological functioning deficits precede or follow hippocampal alterations during early onset psychosis. METHODS This cross-sectional study describes 3 case-studies of adolescent subjects, ages 16-17, admitted at the child and adolescent inpatient psychiatric unit in lieu of first psychotic episode. We conducted detailed structured clinical psychiatric interviews, anatomical-structural magnetic resonance imaging (MRI), sleep-deprived electroencephalogram (EEG) recordings, laboratory testing, and a comprehensive battery of psychological testing to better understand their clinical pictures. RESULTS Psychological testing in each patient demonstrated the presence of low to borderline intellectual functioning coupled with neuropsychological deficits in different psychiatric domains. Interestingly, these changes coincided with structural MRI alterations in the hippocampal area. CONCLUSIONS Our case report adds to the armamentarium of literature signifying that radiologically detectable alterations of the hippocampus may occur either concomitantly or closely following the development of early cognitive deficits in patients with FPE.
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30
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Koren D, Scheyer R, Reznik N, Adres M, Apter A, Parnas J, Seidman LJ. Basic self-disturbance, neurocognition and metacognition: A pilot study among help-seeking adolescents with and without attenuated psychosis syndrome. Early Interv Psychiatry 2019; 13:434-442. [PMID: 29052951 DOI: 10.1111/eip.12500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/19/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
AIM The goal of this pilot study was to assess the association between basic self-disturbance (SD) and deficits in neurocognitive and metacognitive functioning among help-seeking adolescents with and without attenuated psychosis syndrome (APS). METHODS Sixty-one non-psychotic, help-seeking adolescents (age 13-18) were assessed with the examination of anomalous self-experience, the structured interview for prodromal syndromes and a new metacognitive approach to neurocognitive assessment applied to two non-social (executive functions and verbal memory) and two social (theory of mind and emotion recognition) domains. After each answer, subjects were also requested to indicate their level of confidence in the answer and to decide whether they desired it to be "counted" toward their total score on the task. Each volunteered answer earned a 5-cent gain if correct, but an equal fine if wrong. RESULTS As hypothesized, metacognitive monitoring and control had a significant contribution to the prediction of SD over and above neurocognitive functioning and attenuated psychotic symptoms. However, the direction of this association was positive rather than negative. Also, inconsistent with or hypothesis, it was not moderated by the presence of APS. CONCLUSIONS These pilot results provide preliminary support a modest association between SD and metacognition, which is not reducible to neurocognition and APS. In addition, they raise an intriguing possibility regarding metacognitive monitoring and control being indicators of hyper-reflectivity that characterizes individuals with SD. However, further research with larger samples and high-stress assessment conditions are needed to assess this possibility.
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Affiliation(s)
- Dan Koren
- Psychology Department, University of Haifa, Haifa, Israel
| | - Ravit Scheyer
- Psychology Department, University of Haifa, Haifa, Israel
| | - Noa Reznik
- Psychology Department, University of Haifa, Haifa, Israel
| | - Merav Adres
- Psychology Department, University of Haifa, Haifa, Israel
| | - Alan Apter
- Psychological Medicine Clinic, Schneider Children Medical Center, Petach Tikva, Israel
| | - Josef Parnas
- Psychiatric Center, Glostrup-Hvidovre, Faculty of Health and Medical Sciences, University of Copenhagen, Brøndby, Denmark.,Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark
| | - Larry J Seidman
- The Massachusetts Mental Health Center, Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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31
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Bolt LK, Amminger GP, Farhall J, McGorry PD, Nelson B, Markulev C, Yuen HP, Schäfer MR, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger GE, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, Allott KA. Neurocognition as a predictor of transition to psychotic disorder and functional outcomes in ultra-high risk participants: Findings from the NEURAPRO randomized clinical trial. Schizophr Res 2019; 206:67-74. [PMID: 30558978 DOI: 10.1016/j.schres.2018.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/30/2018] [Accepted: 12/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurocognitive impairments experienced by individuals at ultra-high risk (UHR) for psychosis are potential predictors of outcome within this population, however there is inconsistency regarding the specific neurocognitive domains implicated. This study aimed to examine whether baseline neurocognition predicted transition to psychosis, or functional outcomes, at medium-term (mean = 3.4 years) follow-up, while controlling for other clinical/treatment variables associated with transition to psychosis. METHOD Analysis of data collected as part of a multi-centre RCT of omega-3 fatty acids and cognitive-behavioural case management (NEURAPRO) for UHR individuals was conducted on the 294 participants (134 males, 160 females) who completed neurocognitive assessment (Brief Assessment of Cognition for Schizophrenia) at baseline. Transition to psychosis was determined using the Comprehensive Assessment of At-Risk Mental States (CAARMS), and functioning was measured with the Global Functioning: Social and Role Scales. RESULTS Mean baseline z-scores indicated that UHR participants performed a quarter to half a standard deviation below normative means in all domains (range mean z = -0.24 to -0.47), except for executive functioning (mean z = 0.16). After adjusting for covariates, poorer Executive (p = .010) and Motor (p = .030) functions were predictive of transition to psychosis. Processing Speed and Verbal Fluency were significant predictors of role functioning at 12 months (p = .004), and social functioning at medium-term follow-up (p = .015), respectively. CONCLUSIONS Neurocognitive abilities are independent predictors of both transition to psychosis and functional outcomes within the UHR population. Further research is needed to determine the best combination of risk variables in UHR individuals for prediction of psychosis transition, functioning and other psychopathology outcomes.
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Affiliation(s)
- Luke K Bolt
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
| | - G Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia.
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
| | - Miriam R Schäfer
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Nilufar Mossaheb
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.
| | - Monika Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.
| | - Stefan Smesny
- Department of Psychiatry, University Hospital Jena, Jena, Germany.
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Gregor Emanuel Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland.
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong.
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Centers, the Netherlands.
| | - Dorien H Nieman
- Department of Psychiatry, Amsterdam University Medical Centers, the Netherlands.
| | | | | | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore.
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England, United Kingdom of Great Britain and Northern Ireland; North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire National Health Service Partnership Trust, Coventry, England, United Kingdom of Great Britain and Northern Ireland.
| | - Alison Ruth Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland.
| | - Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
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32
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Lin CH, Lane HY. Early Identification and Intervention of Schizophrenia: Insight From Hypotheses of Glutamate Dysfunction and Oxidative Stress. Front Psychiatry 2019; 10:93. [PMID: 30873052 PMCID: PMC6400883 DOI: 10.3389/fpsyt.2019.00093] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/08/2019] [Indexed: 12/22/2022] Open
Abstract
Schizophrenia is a severe mental disorder which leads to functional deterioration. Early detection and intervention are vital for better prognosis. However, the diagnosis of schizophrenia still depends on clinical observation to date. Without reliable biomarkers, schizophrenia is difficult to detect in its early phase. Further, there is no approved medication for prodromal schizophrenia because current antipsychotics fail to show satisfactory efficacy and safety. Therefore, to develop an effective early diagnostic and therapeutic approach for schizophrenia, especially in its prodromal phase, is crucial. Glutamate signaling dysfunction and dysregulation of oxidative stress have been considered to play important roles in schizophrenic prodrome. The N-methyl-D-aspartate receptor (NMDAR) is one of three types of ionotropic glutamate receptors. In this article, we reviewed literature regarding NMDAR hypofunction, oxidative stress, and the linkage between both in prodromal schizophrenia. The efficacy of NMDAR enhancers such as D-amino acid oxidase inhibitor was addressed. Finally, we highlighted potential biomarkers related to NMDAR and oxidative stress regulation, and therefore suggested the strategies of early detection and intervention of prodromal schizophrenia. Future larger-scale studies combining biomarkers and novel drug development for early psychosis are warranted.
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Affiliation(s)
- Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
- Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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33
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Gilmour G, Porcelli S, Bertaina-Anglade V, Arce E, Dukart J, Hayen A, Lobo A, Lopez-Anton R, Merlo Pich E, Pemberton DJ, Havenith MN, Glennon JC, Harel BT, Dawson G, Marston H, Kozak R, Serretti A. Relating constructs of attention and working memory to social withdrawal in Alzheimer’s disease and schizophrenia: issues regarding paradigm selection. Neurosci Biobehav Rev 2019; 97:47-69. [DOI: 10.1016/j.neubiorev.2018.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 08/29/2018] [Accepted: 09/27/2018] [Indexed: 12/12/2022]
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34
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Kim HK, Park HY, Seo E, Bang M, Song YY, Lee SY, Kim KR, Park JY, Kang JI, Lee E, An SK. Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis. Front Psychiatry 2019; 10:459. [PMID: 31293463 PMCID: PMC6606785 DOI: 10.3389/fpsyt.2019.00459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/11/2019] [Indexed: 01/31/2023] Open
Abstract
Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%-30% within 1-2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ2(1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31-0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.
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Affiliation(s)
- Hyun Kyu Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunchong Seo
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Yun Young Song
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Young Lee
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Park
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Graduate Program in Cognitive Science, Yonsei University, Seoul, South Korea
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35
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Anda L, Brønnick KK, Johannessen JO, Joa I, Kroken RA, Johnsen E, Rettenbacher M, Fathian F, Løberg EM. Cognitive Profile in Ultra High Risk for Psychosis and Schizophrenia: A Comparison Using Coordinated Norms. Front Psychiatry 2019; 10:695. [PMID: 31632305 PMCID: PMC6779770 DOI: 10.3389/fpsyt.2019.00695] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Cognitive impairment is not only a core aspect of schizophrenia but also commonly observed in help-seeking youth at ultra high risk for psychosis (UHR), with potential implications for prognosis and individualized treatment. However, there is no consensus on the cognitive profile in the UHR state, partly due to lack of valid comparisons of performance in established schizophrenia and UHR. Objectives: To compare the cognitive functioning and profile of UHR subjects to a sample with schizophrenia, they were split into two groups based on duration of illness. Comparisons were made using coordinated norms based on healthy controls reflecting the younger UHR age spectrum. Methods: Participants for UHR (n = 51) and schizophrenia groups (n = 19 and n = 22) were included from the Prevention of Psychosis and Bergen Psychosis 2 projects. All subjects completed a comprehensive neurocognitive test battery aiming to measure speed of processing, working memory, verbal learning, reasoning, and problem solving, as well as visual problem solving. Cognitive functioning was compared between groups based on coordinated norms using z-scores derived by regression modeling from an age-matched healthy control group (n = 61). Results: UHR subjects showed significantly impaired speed of processing (p < 0.001) working memory (p = 0.042) and verbal learning, reasoning, and problem solving (p = 0.007) as compared to the control group. Visual problem-solving skills appeared unimpaired. UHR subjects significantly outperformed the schizophrenia group with duration of illness >3 years for speed of processing and working memory (both p < 0.001). There were no significant differences in performance between the UHR group and the group with duration of schizophrenia <3 years. Conclusion: Cognitive performance is impaired in UHR subjects as compared to healthy controls and should thus be monitored when a person is deemed at high risk of psychotic illness. Spatial skills, as measured by tests using physical objects, appear less affected than other domains. The pattern of impairment is similar to that of a group with recent onset schizophrenia but is less severe than in a group with duration of illness <3 years.
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Affiliation(s)
- Liss Anda
- TIPS Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kolbjørn K Brønnick
- SESAM Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Norwegian Centre for Mental Disorders Research, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Norwegian Centre for Mental Disorders Research, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Farivar Fathian
- Outpatient Department, NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Norwegian Centre for Mental Disorders Research, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
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36
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Sanada K, de Azúa SR, Nakajima S, Alberich S, Ugarte A, Zugasti J, Vega P, Martínez-Cengotitabengoa M, González-Pinto A. Correlates of neurocognitive functions in individuals at ultra-high risk for psychosis - A 6-month follow-up study. Psychiatry Res 2018; 268:1-7. [PMID: 29986171 DOI: 10.1016/j.psychres.2018.06.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 01/30/2023]
Abstract
Cognitive deficits are evident at the prodromal phase of psychosis. It has been noted that brain-derived neurotrophic factor (BDNF) is correlated with cognition in both preclinical and clinical studies. However, to our knowledge, no study has evaluated blood BDNF levels and their association with cognitive impairment in individuals at ultra-high risk for psychosis (UHR). We included 13 individuals at UHR and 30 healthy controls (HC) matched by sex, age, and educational level. Plasma BDNF levels were measured at baseline and 6 months. Neurocognitive functions (executive functions, speed of processing, verbal learning and memory, working memory) were examined at 6 months. Regression analyses were conducted to examine the relationship between BDNF levels and cognitive performance. BDNF levels were lower in UHR group than in HC group both at baseline and at 6 months (P = 0.001, and P = 0.007, respectively). There were no associations between plasma BDNF levels and all of the cognitive domains in both groups. Our findings showed that peripheral BDNF levels were not related to cognitive deficits in UHR and HC groups while the lower BDNF level in the former persisted up to 6 months. Further research is needed in a large sample.
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Affiliation(s)
- Kenji Sanada
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
| | - Sonia Ruiz de Azúa
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Susana Alberich
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Amaia Ugarte
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Jone Zugasti
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Patricia Vega
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Mónica Martínez-Cengotitabengoa
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country; National Distance Education University (UNED), Spain
| | - Ana González-Pinto
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country.
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Lam M, Lee J, Rapisarda A, See YM, Yang Z, Lee SA, Abdul-Rashid NA, Kraus M, Subramaniam M, Chong SA, Keefe RSE. Longitudinal Cognitive Changes in Young Individuals at Ultrahigh Risk for Psychosis. JAMA Psychiatry 2018; 75:929-939. [PMID: 30046827 PMCID: PMC6142925 DOI: 10.1001/jamapsychiatry.2018.1668] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Cognitive deficits are a key feature of risk for psychosis. Longitudinal changes in cognitive architecture may be associated with the social and occupational functioning in young people. OBJECTIVES To examine longitudinal profiles of cognition in individuals at ultrahigh risk (UHR) for psychosis, compared with healthy controls, and to investigate the association of cognition with functioning. DESIGN, SETTING, AND PARTICIPANTS This study has a multiple-group prospective design completed in 24 months and was conducted from January 1, 2009, to November 11, 2012, as part of the Longitudinal Youth at-Risk Study conducted in Singapore. Participants either were recruited from psychiatric outpatient clinics, educational institutions, and community mental health agencies or self-referred. Follow-up assessments were performed every 6 months for 2 years or until conversion to psychosis. Individuals with medical causes for psychosis, current illicit substance use, or color blindness were excluded. Data analysis was conducted from June 2014 to May 2018. MAIN OUTCOMES AND MEASURES Neuropsychological, perceptual, and social cognitive tasks; semi-structured interviews, and the Structured Clinical Interview for DSM-IV Axis I disorders were administered every 6 months. The UHR status of nonconverters, converters, remitters, and nonremitters was monitored. Cognitive domain scores and functioning were investigated longitudinally. RESULTS In total, 384 healthy controls and 173 UHR individuals between ages 14 and 29 years were evaluated prospectively. Of the 384 healthy controls, 153 (39.8%) were female and 231 (60.2%) were male with a mean (SD) age of 21.69 (3.26) years. Of the 173 individuals at UHR for psychosis, 56 (32.4%) were female and 117 (67.6%) were male with a mean (SD) age of 21.27 (3.52) years). After 24 months of follow-up, 383 healthy controls (99.7%) and 122 individuals at UHR for psychosis (70.5%) remained. Baseline cognitive deficits were associated with psychosis conversion later (mean odds ratio [OR], 1.66; combined 95% CI, 1.08-2.83; P = .04) and nonremission of UHR status (mean OR, 1.67; combined 95% CI, 1.09-2.95; P = .04). Five cognitive components-social cognition, attention, verbal fluency, general cognitive function, and perception-were obtained from principal components analysis. Longitudinal component structure change was observed in general cognitive function (maximum vertical deviation = 0.59; χ2 = 8.03; P = .01). Group-by-time interaction on general cognitive function (F = 12.23; η2 = 0.047; P < .001) and perception (F = 8.33; η2 = 0.032; P < .001) was present. Changes in attention (F = 5.65; η2 = 0.013; P = .02) and general cognitive function (F = 7.18; η2 = 0.014; P = .01) accounted for longitudinal changes in social and occupational functioning. CONCLUSIONS AND RELEVANCE Individuals in this study who met the UHR criteria appeared to demonstrate cognitive deficits, and those whose UHR status remitted were seen to recover cognitively. Cognition appeared as poor in nonremitters and appeared to be associated with poor functional outcome. This study suggests that cognitive dimensions are sensitive to the identification of young individuals at risk for psychosis and to the longitudinal course of those at highest risk.
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Affiliation(s)
- Max Lam
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health,
Singapore, Singapore,Department of General Psychiatry 1, Institute of
Mental Health, Singapore, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health,
Singapore, Singapore,Neuroscience and Behavioural Disorders, Duke-NUS
Medical School, Singapore, Singapore
| | - Yuen Mei See
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Zixu Yang
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Sara-Ann Lee
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | | | - Michael Kraus
- Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, North Carolina
| | | | - Siow-Ann Chong
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Richard S. E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, North Carolina
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38
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Gagnon G, Kumar S, Maltais JR, Voineskos AN, Mulsant BH, Rajji TK. Superior memory performance in healthy individuals with subclinical psychotic symptoms but without genetic load for schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 13:7-11. [PMID: 30105212 PMCID: PMC6085406 DOI: 10.1016/j.scog.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- G Gagnon
- Department of Psychology, McGill University, Montreal, Canada.,McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
| | - S Kumar
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - J-R Maltais
- Department of Psychiatry, University of Sherbrooke, Sherbrooke, Canada
| | - A N Voineskos
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - B H Mulsant
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - T K Rajji
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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39
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Eisenacher S, Rausch F, Ainser F, Englisch S, Becker A, Mier D, Fenske S, Meyer-Lindenberg A, Kirsch P, Zink M. Early cognitive basic symptoms are accompanied by neurocognitive impairment in patients with an 'at-risk mental state' for psychosis. Early Interv Psychiatry 2018; 12:586-595. [PMID: 27169782 DOI: 10.1111/eip.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/15/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
AIM Patients with an increased risk for psychosis ('at-risk mental state' (ARMS)) present various neurocognitive deficits. Not least because of differences in identifying the ARMS, results of previous studies are inconsistent. In most studies ARMS-patients are classified by the experience of attenuated psychotic symptoms (APS) and/or brief limited intermittent psychotic symptoms (BLIPS). Few studies additionally assessed cognitive basic symptoms (BS). A comprehensive assessment in the very early stage of the ARMS is missing. METHODS In the present study we characterized ARMS-patients for cognitive BS (ARMS-BS), APS and BLIPS (ARMS-A/B) according to the Early Recognition Inventory based on IRAOS (ERIraos). Furthermore, we assessed neurocognitive deficits using the MATRICS consensus cognitive battery for schizophrenia with a primary hypothesis regarding working memory performance. Groups of 38 ARMS-patients and 38 healthy controls were matched for age, gender, education and premorbid verbal intelligence. RESULTS Between-group comparisons revealed significant poorer working memory performance in addition to lower verbal learning and problem solving, slower processing speed and lower global neurocognitive functioning in ARMS-patients as compared to controls. ARMS-BS did not differ from ARMS-A/B. CONCLUSIONS These results underscore the presence of cognitive limitations in patients only presenting with cognitive BS. Knowledge of these early cognitive deviations supports the inclusion of early ARMS-stages into a comprehensive concept of the psychosis risk state. Therapeutic interventions already applied at this stage might prevent deterioration of constraints. Longitudinal and interventional studies investigating the interaction of cognitive BS and neurocognitive as well as metacognitive deficits are warranted.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
| | - Franziska Rausch
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
| | - Fabian Ainser
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
| | - Anna Becker
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Sabrina Fenske
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
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Nelson B, Amminger GP, Yuen HP, Wallis N, Kerr MJ, Dixon L, Carter C, Loewy R, Niendam TA, Shumway M, Morris S, Blasioli J, McGorry PD. Staged Treatment in Early Psychosis: A sequential multiple assignment randomised trial of interventions for ultra high risk of psychosis patients. Early Interv Psychiatry 2018; 12:292-306. [PMID: 28719151 PMCID: PMC6054879 DOI: 10.1111/eip.12459] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/19/2017] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
AIM Previous research indicates that preventive intervention is likely to benefit patients "at risk" of psychosis, in terms of functional improvement, symptom reduction and delay or prevention of onset of threshold psychotic disorder. The primary aim of the current study is to test outcomes of ultra high risk (UHR) patients, primarily functional outcome, in response to a sequential intervention strategy consisting of support and problem solving (SPS), cognitive-behavioural case management and antidepressant medication. A secondary aim is to test biological and psychological variables that moderate and mediate response to this sequential treatment strategy. METHODS This is a sequential multiple assignment randomised trial (SMART) consisting of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). The intervention is of 12 months duration in total and participants will be followed up at 18 months and 24 months post baseline. CONCLUSION This paper reports on the rationale and protocol of the Staged Treatment in Early Psychosis (STEP) study. With a large sample of 500 UHR participants this study will investigate the most effective type and sequence of treatments for improving functioning and reducing the risk of developing psychotic disorder in this clinical population.
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Affiliation(s)
- Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G. Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicky Wallis
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Melissa J. Kerr
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, New York, New York
| | - Cameron Carter
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Rachel Loewy
- Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Martha Shumway
- Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Sarah Morris
- National Institute of Mental Health, Bethesda, MD, USA
| | - Julie Blasioli
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D. McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Şizofrenide Nörobilişsel Bozukluklar Ve İşlevsellikle İlişkisi. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.424417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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42
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Evaluating verbal learning and memory in patients with an at-risk mental state or first episode psychosis using structural equation modelling. PLoS One 2018; 13:e0196936. [PMID: 29746524 PMCID: PMC5944996 DOI: 10.1371/journal.pone.0196936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 04/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Verbal learning and memory are impaired not only in patients with a first episode of psychosis (FEP) but also-to a lower extent-in those with an at-risk mental state for psychosis (ARMS). However, little is known about the specific nature of these impairments. Hence, we aimed to study learning and memory processes in ARMS and FEP patients by making use of structural equation modelling. METHODS Verbal learning was assessed with the California Verbal Learning Test (CVLT) in 98 FEP patients, 126 ARMS patients and 68 healthy controls (HC) as part of the Basel early detection of psychosis (FePsy) study. The four-factorial CFA model of Donders was used to estimate test performance on latent variables of the CVLT and growth curve analysis was used to model the learning curve. The latter allows disentangling initial recall, which is strongly determined by attentional processes, from the learning rate. RESULTS The CFA model revealed that ARMS and FEP patients were impaired in Attention Span, Learning Efficiency and Delayed Memory and that FEP patients were additionally impaired in Inaccurate Memory. Additionally, ARMS-NT, but not ARMS-T, performed significantly worse than HC on Learning Efficiency. The growth curve model indicated that FEP patients were impaired in both initial recall and learning rate and that ARMS patients were only impaired in the learning rate. CONCLUSIONS Since impairments were more pronounced in the learning rate than the initial recall, our results suggest that the lower scores in the CVLT reported in previous studies are more strongly driven by impairments in the rate of learning than by attentional processes.
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Pflueger MO, Calabrese P, Studerus E, Zimmermann R, Gschwandtner U, Borgwardt S, Aston J, Stieglitz RD, Riecher-Rössler A. The neuropsychology of emerging psychosis and the role of working memory in episodic memory encoding. Psychol Res Behav Manag 2018; 11:157-168. [PMID: 29785144 PMCID: PMC5953273 DOI: 10.2147/prbm.s149425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Episodic memory encoding and working memory (WM) deficits are among the first cognitive signs and symptoms in the course of schizophrenia spectrum disorders. However, it is not clear whether the deficit pattern is generalized or specific in nature. We hypothesized that encoding deficits at an early stage of the disease might be due to the more fundamental WM deficits. Methods We examined episodic memory encoding and WM by administering the California Verbal Learning Test, a 2-back task, and the Wisconsin Card Sorting Test in 90 first-episode psychosis (FE) patients and 116 individuals with an at-risk mental state for psychosis (ARMS) compared to 57 healthy subjects. Results Learning progress, but not span of apprehension, was diminished to a similar extent in both the ARMS and the FE. We showed that this was due to WM impairment by applying a structural equation approach. Conclusion Thus, we conclude that verbal memory encoding deficits are secondary to primary WM impairment in emerging psychosis.
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Affiliation(s)
- Marlon O Pflueger
- Department of Forensic Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Ronan Zimmermann
- Department of Neurology and Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology and Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Jacqueline Aston
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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Yu ZM, Zhao Y, Zhan JQ, Luo T, Xiong JW, Yu B, Wei B, Yang YJ. Treatment Responses of Cognitive Function and Plasma Asymmetric Dimethylarginine to Atypical Antipsychotic in Patients With Schizophrenia. Front Psychiatry 2018; 9:733. [PMID: 30687138 PMCID: PMC6335386 DOI: 10.3389/fpsyt.2018.00733] [Citation(s) in RCA: 4] [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: 11/02/2018] [Accepted: 12/13/2018] [Indexed: 01/25/2023] Open
Abstract
Cognitive deficits represent a core feature of schizophrenia. Previous studies have demonstrated that plasma asymmetric dimethylarginine (ADMA) was increased in patients with schizophrenia and correlated with cognitive impairments. Atypical antipsychotics can produce cognitive benefits in schizophrenia patients. In this study, we conducted a prospective observation trial to explore whether plasma ADMA may serve as an indicator for evaluating cognitive improvements induced by atypical antipsychotics in patients with schizophrenia. A total of 41 schizophrenia patients with acute exacerbation were enrolled and 29 patients completed this study. These recruited patients were drug-naive or had no exposure to antipsychotics for at least 3 months. Thirty healthy individuals were recruited as a control group. Positive and Negative Syndrome Scale (PANSS) and a neuropsychological battery were used to evaluate schizophrenic symptoms and cognitive function, respectively. Plasma ADMA was measured by high-performance liquid chromatography (HPLC). We found that schizophrenia patients with acute exacerbation had significantly poorer cognitive performances and higher plasma ADMA levels than control individuals (p < 0.05). After 2 months of atypical antipsychotic treatment, patients showed significant improvements in processing speed, working memory, attention, and executive function (all p < 0.01). Plasma ADMA levels in patients after treatment were significantly decreased compared to baseline (2.42 ± 0.84 vs. 1.55 ± 0.34 μmol/L; t = 6.491, p < 0.001). Correlation analysis reveals that there is a significant correlation of the decrease in ADMA with improvements in working memory (r = -0.413, p = 0.026) and attention (r = -0.417, p = 0.025). Collectively, our results suggest that atypical antipsychotics improve cognitive function in schizophrenia patients with acute exacerbation, in parallel with decreased plasma ADMA levels. Plasma ADMA levels may be an indicator of cognitive recovery in schizophrenia.
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Affiliation(s)
- Zhi-Min Yu
- Department of Psychiatry, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China
| | - Ying Zhao
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin-Qiong Zhan
- Biological Psychiatry Laboratory, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China
| | - Tao Luo
- Department of Psychiatry, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China
| | - Jian-Wen Xiong
- Department of Psychiatry, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China
| | - Bin Yu
- Department of Psychiatry, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China
| | - Bo Wei
- Department of Psychiatry, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China
| | - Yuan-Jian Yang
- Department of Psychiatry, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China.,Biological Psychiatry Laboratory, Jiangxi Mental Hospital/Affiliated Mental Hospital of Nanchang University, Nanchang, China
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45
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Do cognitive deficits predict negative emotionality and aggression in schizophrenia? Psychiatry Res 2018; 259:350-357. [PMID: 29120842 DOI: 10.1016/j.psychres.2017.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/12/2017] [Accepted: 11/01/2017] [Indexed: 11/20/2022]
Abstract
Schizophrenia is associated with an elevated risk of aggression. Cognitive deficits have been associated with inpatient aggression and future violence. The relationship between cognitive deficits and violent behavior has however been inconsistent across studies. In addition, studies have failed to inform how cognitive deficits may contribute to aggression in schizophrenia. The current study examined the association of cognitive deficits with schizophrenia-related aggression and violent offending. It also explored the putative mediating role of negative emotionality on the impact of cognitive deficits on aggression. People with schizophrenia and schizoaffective disorder (N = 78) were recruited from a state hospital. Participants were classified based on their history of violent offending. Participants completed measures of cognition, symptoms, and aggression. Deficits in working memory, reasoning/problem-solving, and verbal learning were the most prioritized for the prediction of violent offender status. Violent offenders demonstrated greater impairments in most cognitive domains especially working memory and verbal learning. Offenders also demonstrated greater negative emotionality, excitement/agitation, and incidents of verbal and physical aggression. Negative emotionality and excitement/agitation fully transmitted the effect of cognitive deficits on impulsive aggression in meditational models. Cognitive deficits increase the risk of impulsive aggression in schizophrenia via inefficient regulation of negative affective states.
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46
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From the psychosis prodrome to the first-episode of psychosis: No evidence of a cognitive decline. J Psychiatr Res 2018; 96:231-238. [PMID: 29121595 PMCID: PMC7663810 DOI: 10.1016/j.jpsychires.2017.10.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/05/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023]
Abstract
Cognitive deficits have an important role in the neurodevelopment of schizophrenia and other psychotic disorders. However, there is a continuing debate as to whether cognitive impairments in the psychosis prodrome are stable predictors of eventual psychosis or undergo a decline due to the onset of psychosis. In the present study, to determine how cognition changes as illness emerges, we examined baseline neurocognitive performance in a large sample of helping-seeking youth ranging in clinical state from low-risk for psychosis through individuals at clinical high-risk (CHR) for illness to early first-episode patients (EFEP). At baseline, the MATRICS Cognitive Consensus battery was administered to 322 individuals (205 CHRs, 28 EFEPs, and 89 help-seeking controls, HSC) that were part of the larger Early Detection, Intervention and Prevention of Psychosis Program study. CHR individuals were further divided into those who did (CHR-T; n = 12, 6.8%) and did not (CHR-NT, n = 163) convert to psychosis over follow-up (Mean = 99.20 weeks, SD = 21.54). ANCOVAs revealed that there were significant overall group differences (CHR, EFEP, HSC) in processing speed, verbal learning, and overall neurocognition, relative to healthy controls (CNTL). In addition, the CHR-NTs performed similarly to the HSC group, with mild to moderate cognitive deficits relative to the CTRL group. The CHR-Ts mirrored the EFEP group, with large deficits in processing speed, working memory, attention/vigilance, and verbal learning (>1 SD below CNTLs). Interestingly, only verbal learning impairments predicted transition to psychosis, when adjusting for age, education, symptoms, antipsychotic medication, and neurocognitive performance in the other domains. Our findings suggest that large neurocognitive deficits are present prior to illness onset and represent vulnerability markers for psychosis. The results of this study further reinforce that verbal learning should be specifically targeted for preventive intervention for psychosis.
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Redman SL, Corcoran CM, Kimhy D, Malaspina D. Effects of early trauma on psychosis development in clinical high-risk individuals and stability of trauma assessment across studies: a review. ARCHIVES OF PSYCHOLOGY (CHICAGO, ILL.) 2017; 1:28. [PMID: 29400347 PMCID: PMC5791764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Early trauma (ET), though broadly and inconsistently defined, has been repeatedly linked to numerous psychological disturbances, including various developmental stages of psychotic disorders. The prodromal phase of psychosis highlights a unique and relevant population that provides insight into the critical periods of psychosis development. As such, a relatively recent research focus on individuals at clinical high risk (CHR) for psychosis reveals robust associations of early life trauma exposures with prodromal symptoms and function in these cohorts. While prevalence rates of ET in CHR cohorts remain consistently high, methodological measures of traumatic experiences vary across studies, presenting potential problems for reliability and validity of results. This review aims to 1) highlight the existing evidence identifying associations of ET, of multiple forms, with both symptom severity and transition rates to psychosis in CHR individuals, 2) present data on the variability among trauma assessments and its implications for conclusions about its relationship with clinical variables, 3) describe cognitive deficits common in CHR cohorts, including perceptual and neurocognitive impairments, and their neural correlates, that may modify the relationship of ET to symptoms, and 4) propose future directions for standardization of trauma assessment in CHR cohorts to better understand its clinical and cognitive correlates.
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Affiliation(s)
- Samantha L. Redman
- Corresponding Author: Samantha Redman, Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 53 E 96 Street, New York, NY 10128, phone: 212-659-8756,
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48
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Moritz S, Klein JP, Desler T, Lill H, Gallinat J, Schneider BC. Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills? Psychol Med 2017; 47:2602-2612. [PMID: 28485257 DOI: 10.1017/s0033291717000939] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Most original studies and all meta-analyses conducted to date converge on the conclusion that patients with schizophrenia display rather generalized neurocognitive deficits. For the present study, we reopen this seemingly closed chapter and examine whether important influences, such as lack of motivation and negative attitudes towards cognitive assessment, result in poorer secondary neuropsychological performance. METHOD A sample of 50 patients with an established diagnosis of schizophrenia were tested for routine neurocognitive assessment and compared to 60 nonclinical volunteers. Before and after the assessment, subjective momentary influences were examined (e.g. motivation, concerns about assessment, fear about poor outcome) for their impact on performance using a new questionnaire called the Momentary Influences, Attitudes and Motivation Impact (MIAMI) on Cognitive Performance Scale. RESULTS As expected, patients performed significantly worse than controls on all neurocognitive domains tested (large effect size, on average). However, patients also displayed more subjective momentary impairment, as well as more fears about the outcome and less motivation than controls. Mediation analyses indicated that these influences contributed to (secondary) poorer neurocognitive performance. Differences in neurocognitive scores shrank to a medium effect size, on average, when MIAMI scores were accounted for. CONCLUSIONS The data argue that performance on measures of neurocognition in schizophrenia are to a considerable extent due to secondary factors. Poor motivation, fears and momentary impairments distinguished patients from controls and these variables heavily impacted performance. Before concluding that neurocognitive deficits in psychiatric patients are present, clinicians should take these confounding influences into account. Although patients with schizophrenia achieved, on average, worse test scores than controls, a large subgroup displayed spared performance.
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Affiliation(s)
- S Moritz
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - J P Klein
- Department of Psychiatry and Psychotherapy,Lübeck University,Ratzeburger Allee 160, 23538 Lübeck,Germany
| | - T Desler
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - H Lill
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - J Gallinat
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - B C Schneider
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
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49
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Barber AD, Lindquist MA, DeRosse P, Karlsgodt KH. Dynamic Functional Connectivity States Reflecting Psychotic-like Experiences. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:443-453. [PMID: 29735154 DOI: 10.1016/j.bpsc.2017.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) are associated with lower social and occupational functioning, and lower executive function. Emerging evidence also suggests that PLEs reflect neural dysfunction resembling that of psychotic disorders. METHODS The present study examined dynamic connectivity related to a measure of PLEs derived from the Achenbach Adult Self-Report, in an otherwise-healthy sample of adults from the Human Connectome Project. A total of 76 PLE-endorsing and 153 control participants were included in the final sample. To characterize network dysfunction, dynamic connectivity states were examined across large-scale resting-state networks using dynamic conditional correlation and k-means clustering. RESULTS Three dynamic states were identified. The PLE-endorsing group spent more time than the control group in state 1, a state reflecting hyperconnectivity within visual regions and hypoconnectivity within the default mode network, and less time in state 2, a state characterized by robust within-network connectivity for all networks and strong default mode network anticorrelations. Within the PLE-endorsing group, worse executive function was associated with more time spent in and more transitions into state 1 and less time spent in and fewer transitions into state 3. CONCLUSIONS PLEs are associated with altered large-scale brain dynamics, which tip the system away from spending more time in states reflecting more "typical" connectivity patterns toward more time in states reflecting visual hyperconnectivity and default mode hypoconnectivity.
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Affiliation(s)
- Anita D Barber
- Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, New York.
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Pamela DeRosse
- Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, New York
| | - Katherine H Karlsgodt
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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50
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Eckfeld A, Karlsgodt KH, Haut KM, Bachman P, Jalbrzikowski M, Zinberg J, van Erp TGM, Cannon TD, Bearden CE. Disrupted Working Memory Circuitry in Adolescent Psychosis. Front Hum Neurosci 2017; 11:394. [PMID: 28848413 PMCID: PMC5550407 DOI: 10.3389/fnhum.2017.00394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/17/2017] [Indexed: 12/02/2022] Open
Abstract
Individuals with schizophrenia (SZ) consistently show deficits in spatial working memory (WM) and associated atypical patterns of neural activity within key WM regions, including the dorsolateral prefrontal cortex (dlPFC) and parietal cortices. However, little research has focused on adolescent psychosis (AP) and potential age-associated disruptions of WM circuitry that may occur in youth with this severe form of illness. Here we utilized each subject's individual spatial WM capacity to investigate task-based neural dysfunction in 17 patients with AP (16.58 ± 2.60 years old) as compared to 17 typically developing, demographically comparable adolescents (18.07 ± 3.26 years old). AP patients showed lower behavioral performance at higher WM loads and lower overall WM capacity compared to healthy controls. Whole-brain activation analyses revealed greater bilateral precentral and right postcentral activity in controls relative to AP patients, when controlling for individual WM capacity. Seed-based psychophysiological interaction (PPI) analyses revealed significantly greater co-activation between the left dlPFC and left frontal pole in controls relative to AP patients. Significant group-by-age interactions were observed in both whole-brain and PPI analyses, with AP patients showing atypically greater neural activity and stronger coupling between WM task activated brain regions as a function of increasing age. Additionally, AP patients demonstrated positive relationships between right dlPFC neural activity and task performance, but unlike healthy controls, failed to show associations between neural activity and out-of-scanner neurocognitive performance. Collectively, these findings are consistent with atypical WM-related functioning and disrupted developmental processes in youth with AP.
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Affiliation(s)
- Ariel Eckfeld
- Department of Psychology, UCLALos Angeles, CA, United States
| | | | - Kristen M. Haut
- Department of Psychiatry, Rush University Medical CenterChicago, IL, United States
| | - Peter Bachman
- Department of Psychiatry, University of PittsburghPittsburgh, PA, United States
| | - Maria Jalbrzikowski
- Department of Psychiatry, University of PittsburghPittsburgh, PA, United States
| | - Jamie Zinberg
- Semel Institute for Neuroscience and Human Behavior, UCLALos Angeles, CA, United States
| | - Theo G. M. van Erp
- Department of Psychiatry and Human Behavior, University of California, IrvineIrvine, CA, United States
| | - Tyrone D. Cannon
- Departments of Psychology and Psychiatry, Yale UniversityNew Haven, CT, United States
| | - Carrie E. Bearden
- Department of Psychology, UCLALos Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, UCLALos Angeles, CA, United States
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