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Nuechterlein KH, Nasrallah H, Velligan D. Measuring Cognitive Impairments Associated With Schizophrenia in Clinical Practice: Overview of Current Challenges and Future Opportunities. Schizophr Bull 2024:sbae051. [PMID: 39088730 DOI: 10.1093/schbul/sbae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND Cognitive impairment associated with schizophrenia (CIAS) negatively impacts daily functioning, quality of life, and recovery, yet effective pharmacotherapies and practical assessments for clinical practice are lacking. Despite the pivotal progress made with establishment of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for clinical research, implementation of the full MCCB is too time-consuming and cost-ineffective for most clinicians in clinical practice. STUDY DESIGN Here we discuss current assessments in relation to delivery format (interview-based and performance-based), validity, ease of use for clinicians and patients, reliability/reproducibility, cost-effectiveness, and suitability for clinical implementation. Key challenges and future opportunities for improving cognitive assessments are also presented. STUDY RESULTS Current assessments that require 30 min to complete would have value in clinical settings, but the associated staff training and time required might preclude their application in most clinical settings. Initial profiling of cognitive deficits may require about 30 min to assist in the selection of evidence-based treatments; follow-up monitoring with brief assessments (10-15 min in duration) to detect treatment-related effects on global cognition may complement this approach. Guidance on validated brief cognitive tests for the strategic monitoring of treatment effects on CIAS is necessary. CONCLUSIONS With increased advancements in technology-based and remote assessments, development of validated formats of remote and in-person assessment, and the necessary training models and infrastructure required for implementation, are likely to be of increasing clinical relevance for future clinical practice.
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Affiliation(s)
- Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Henry Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Dawn Velligan
- Division of Schizophrenia and Related Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX
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McCutcheon RA, Keefe RSE, McGuire PK. Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment. Mol Psychiatry 2023; 28:1902-1918. [PMID: 36690793 PMCID: PMC10575791 DOI: 10.1038/s41380-023-01949-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
Cognitive deficits are a core feature of schizophrenia, account for much of the impaired functioning associated with the disorder and are not responsive to existing treatments. In this review, we first describe the clinical presentation and natural history of these deficits. We then consider aetiological factors, highlighting how a range of similar genetic and environmental factors are associated with both cognitive function and schizophrenia. We then review the pathophysiological mechanisms thought to underlie cognitive symptoms, including the role of dopamine, cholinergic signalling and the balance between GABAergic interneurons and glutamatergic pyramidal cells. Finally, we review the clinical management of cognitive impairments and candidate novel treatments.
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Affiliation(s)
- Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
- Oxford health NHS Foundation Trust, Oxford health NHS Foundation Trust, Oxford, UK.
| | - Richard S E Keefe
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Philip K McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford health NHS Foundation Trust, Oxford health NHS Foundation Trust, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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3
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Mundy P. Research on social attention in autism and the challenges of the research domain criteria (RDoC) framework. Autism Res 2023; 16:697-712. [PMID: 36932883 DOI: 10.1002/aur.2910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
The fuzzy nature of categories of psychopathology, such as autism, leads to significant research challenges. Alternatively, focusing research on the study of a common set of important and well-defined psychological constructs across psychiatric conditions may make the fundamental etiological processes of psychopathology easier to discern and treat (Cuthbert, 2022). The development of the research domain criteria (RDoC) framework is designed to guide this new research approach (Insel et al., 2010). However, progress in research may be expected to continually refine and reorganize the understanding of the specifics of these mental processes (Cuthbert & Insel, 2013). Moreover, knowledge gleaned from the study of both normative and atypical development can be mutually informative in the evolution of our understanding of these fundamental processes. A case in point is the study of social attention. This Autism 101 commentary provides an educational summary of research over the last few decades indicates that social attention is major construct in the study of human social-cognitive development, autism and other forms of psychopathology. The commentary also describes how this research can inform the Social Process dimension of the RDoC framework.
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Affiliation(s)
- Peter Mundy
- School of Education, Department of Psychiatry and the MIND Institute, University of California at Davis, Davis, California, USA
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4
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Comparing the functional neuroanatomy of proactive and reactive control between patients with schizophrenia and healthy controls. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:203-215. [PMID: 36418846 PMCID: PMC10166198 DOI: 10.3758/s13415-022-01036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/27/2022]
Abstract
Cognitive control deficits are associated with impaired executive functioning in schizophrenia. The Dual Mechanisms of Control framework suggests that proactive control requires sustained dorsolateral prefrontal activity, whereas reactive control marshals a larger network. However, primate studies suggest these processes are maintained by dual-encoding regions. To distinguish between these theories, we compared the distinctiveness of proactive and reactive control functional neuroanatomy. In a reanalysis of data from a previous study, 47 adults with schizophrenia and 56 controls completed the Dot Pattern Expectancy task during an fMRI scan examining proactive and reactive control in frontoparietal and medial temporal regions. Areas suggesting specialized control or between-group differences were tested for association with symptoms and task performance. Elastic net models additionally explored these areas' predictive abilities regarding performance. Most regions were active in both reactive and proactive control. However, evidence of specialized proactive control was found in the left middle and superior frontal gyri. Control participants showed greater proactive control in the left middle and right inferior frontal gyri. Elastic net models moderately predicted task performance and implicated various frontal gyri regions in control participants, with additional involvement of anterior cingulate and posterior parietal regions for reactive control. Elastic nets for patient participants implicated the inferior and superior frontal gyri, and posterior parietal lobe. Specialized cognitive control was unassociated with either performance or schizophrenia symptomatology. Future work is needed to clarify the distinctiveness of proactive and reactive control, and its role in executive deficits in severe psychopathology.
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Frattaroli N, Geljic M, Runkowska D, Darke H, Reddyhough C, Mills T, Mitchell M, Hill R, Carter O, Sundram S. Cognitive and perceptual impairments in schizophrenia extend to other psychotic disorders but not schizotypy. Schizophr Res Cogn 2022; 30:100266. [PMID: 35959485 PMCID: PMC9361330 DOI: 10.1016/j.scog.2022.100266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Natalie Frattaroli
- Department of Psychiatry, School of Clinical Sciences, Monash University. Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Mia Geljic
- Department of Psychiatry, School of Clinical Sciences, Monash University. Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Dominika Runkowska
- Department of Psychiatry, School of Clinical Sciences, Monash University. Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Hayley Darke
- Department of Psychiatry, School of Clinical Sciences, Monash University. Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Caitlin Reddyhough
- Melbourne School of Psychological Sciences, Redmond Barry Building, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, VIC 3010, Australia
| | - Taylor Mills
- Department of Psychiatry, School of Clinical Sciences, Monash University. Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Melbourne School of Psychological Sciences, Redmond Barry Building, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, VIC 3010, Australia
| | - Matthew Mitchell
- Melbourne School of Psychological Sciences, Redmond Barry Building, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, VIC 3010, Australia
| | - Rachel Hill
- Department of Psychiatry, School of Clinical Sciences, Monash University. Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Olivia Carter
- Melbourne School of Psychological Sciences, Redmond Barry Building, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, VIC 3010, Australia
| | - Suresh Sundram
- Department of Psychiatry, School of Clinical Sciences, Monash University. Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Mental Health Program, Monash Health, Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Corresponding author at: Department of Psychiatry, School of Clinical Sciences, Monash University, Level 3 P-Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia.
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Barch DM, Boudewyn MA, Carter CC, Erickson M, Frank MJ, Gold JM, Luck SJ, MacDonald AW, Ragland JD, Ranganath C, Silverstein SM, Yonelinas A. Cognitive [Computational] Neuroscience Test Reliability and Clinical Applications for Serious Mental Illness (CNTRaCS) Consortium: Progress and Future Directions. Curr Top Behav Neurosci 2022; 63:19-60. [PMID: 36173600 DOI: 10.1007/7854_2022_391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The development of treatments for impaired cognition in schizophrenia has been characterized as the most important challenge facing psychiatry at the beginning of the twenty-first century. The Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) project was designed to build on the potential benefits of using tasks and tools from cognitive neuroscience to better understanding and treat cognitive impairments in psychosis. These benefits include: (1) the use of fine-grained tasks that measure discrete cognitive processes; (2) the ability to design tasks that distinguish between specific cognitive domain deficits and poor performance due to generalized deficits resulting from sedation, low motivation, poor test taking skills, etc.; and (3) the ability to link cognitive deficits to specific neural systems, using animal models, neuropsychology, and functional imaging. CNTRICS convened a series of meetings to identify paradigms from cognitive neuroscience that maximize these benefits and identified the steps need for translation into use in clinical populations. The Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRaCS) Consortium was developed to help carry out these steps. CNTRaCS consists of investigators at five different sites across the country with diverse expertise relevant to a wide range of the cognitive systems identified as critical as part of CNTRICs. This work reports on the progress and current directions in the evaluation and optimization carried out by CNTRaCS of the tasks identified as part of the original CNTRICs process, as well as subsequent extensions into the Positive Valence systems domain of Research Domain Criteria (RDoC). We also describe the current focus of CNTRaCS, which involves taking a computational psychiatry approach to measuring cognitive and motivational function across the spectrum of psychosis. Specifically, the current iteration of CNTRaCS is using computational modeling to isolate parameters reflecting potentially more specific cognitive and visual processes that may provide greater interpretability in understanding shared and distinct impairments across psychiatric disorders.
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Affiliation(s)
- Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
| | | | | | | | | | - James M Gold
- Maryland Psychiatric Research Center, Baltimore, MD, USA
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Morris SE, Sanislow CA, Pacheco J, Vaidyanathan U, Gordon JA, Cuthbert BN. Revisiting the seven pillars of RDoC. BMC Med 2022; 20:220. [PMID: 35768815 PMCID: PMC9245309 DOI: 10.1186/s12916-022-02414-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2013, a few years after the launch of the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative, Cuthbert and Insel published a paper titled "Toward the future of psychiatric diagnosis: the seven pillars of RDoC." The RDoC project is a translational research effort to encourage new ways of studying psychopathology through a focus on disruptions in normal functions (such as reward learning or attention) that are defined jointly by observable behavior and neurobiological measures. The paper outlined the principles of the RDoC research framework, including emphases on research that acquires data from multiple measurement classes to foster integrative analyses, adopts dimensional approaches, and employs novel methods for ascertaining participants and identifying valid subgroups. DISCUSSION To mark the first decade of the RDoC initiative, we revisit the seven pillars and highlight new research findings and updates to the framework that are related to each. This reappraisal emphasizes the flexible nature of the RDoC framework and its application in diverse areas of research, new findings related to the importance of developmental trajectories within and across neurobehavioral domains, and the value of computational approaches for clarifying complex multivariate relations among behavioral and neurobiological systems. CONCLUSION The seven pillars of RDoC have provided a foundation that has helped to guide a surge of new studies that have examined neurobehavioral domains related to mental disorders, in the service of informing future psychiatric nosology. Building on this footing, future areas of emphasis for the RDoC project will include studying central-peripheral interactions, developing novel approaches to phenotyping for genomic studies, and identifying new targets for clinical trial research to facilitate progress in precision psychiatry.
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Affiliation(s)
- Sarah E Morris
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA.
| | | | - Jenni Pacheco
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA
| | - Uma Vaidyanathan
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA.,Present affiliation: Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Joshua A Gordon
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA
| | - Bruce N Cuthbert
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA
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Online Left-Hemispheric In-Phase Frontoparietal Theta tACS for the Treatment of Negative Symptoms of Schizophrenia. J Pers Med 2021; 11:jpm11111114. [PMID: 34834466 PMCID: PMC8625275 DOI: 10.3390/jpm11111114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Negative symptoms represent an unmet need for schizophrenia treatment. The effect of theta frequency transcranial alternating current stimulation (theta-tACS) applied during working memory (WM) tasks on negative symptoms has not been demonstrated as of yet. We conducted a randomized, double-blind, sham-controlled trial of 36 stabilized schizophrenia patients, randomized to receive either twice daily, 6 Hz 2 mA, 20 min sessions of in-phase frontoparietal tACS or sham for five consecutive weekdays. Participants were concurrently engaged in WM tasks during stimulation. The primary outcome measure was the change over time in the Positive and Negative Syndrome Scale (PANSS) negative subscale score measured from baseline through to the 1-month follow-up. Secondary outcome measures were other symptom clusters, neurocognitive performance, and relevant outcomes. The intention-to-treat analysis demonstrated greater reductions in PANSS negative subscale scores at the end of stimulation in the active (−13.84%) than the sham (−3.78%) condition, with a large effect size (Cohen’s d = 0.96, p = 0.006). The positive effect endured for at least one month. Theta-tACS also showed efficacies for cognitive symptoms, WM capacity, and psychosocial functions. Online theta-tACS offers a novel approach to modulate frontoparietal networks to treat negative symptoms of schizophrenia. The promising results require large-scale replication studies in patients with predominantly negative symptoms.
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9
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Blain SD, Sassenberg TA, Xi M, Zhao D, DeYoung CG. Extraversion but not depression predicts reward sensitivity: Revisiting the measurement of anhedonic phenotypes. J Pers Soc Psychol 2021; 121:e1-e18. [PMID: 33119388 PMCID: PMC8081762 DOI: 10.1037/pspp0000371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Recently, increasing efforts have been made to define and measure dimensional phenotypes associated with psychiatric disorders. One example is a probabilistic reward task developed by Pizzagalli, Jahn, and O'Shea (2005) to assess anhedonia, by measuring response to a differential reinforcement schedule. This task has been used in many studies, which have connected blunted reward response in the task to depressive symptoms, across clinical groups and in the general population. The current study attempted to replicate these findings in a large community sample and also investigated possible associations with Extraversion, a personality trait linked to reward sensitivity. Participants (N = 299) completed the probabilistic reward task, as well as the Beck Depression Inventory, Personality Inventory for the DSM-5, Big Five Inventory, and Big Five Aspect Scales. Our direct replication attempts used bivariate correlations and analysis of variance models. Follow-up and extension analyses used structural equation models to assess relations among reward sensitivity, depression, Extraversion, and Neuroticism. No significant associations were found between reward sensitivity and depression, thus failing to replicate previous findings. Reward sensitivity (both modeled as response bias aggregated across blocks and as response bias controlling for baseline) showed positive associations with Extraversion, but not Neuroticism. Findings suggest reward sensitivity as measured by this task may be related primarily to Extraversion and its pathological manifestations, rather than to depression per se, consistent with existing models that conceptualize depressive symptoms as combining features of Neuroticism and low Extraversion. Findings are discussed in broader contexts of dimensional psychopathology frameworks, replicable science, and behavioral task reliability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Scott D Blain
- Department of Psychology, University of Minnesota, Twin Cities
| | | | - Muchen Xi
- Department of Psychology, University of Minnesota, Twin Cities
| | - Daiqing Zhao
- Department of Psychology, University of Minnesota, Twin Cities
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Twin Cities
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10
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Pratt DN, Barch DM, Carter CS, Gold JM, Ragland JD, Silverstein SM, MacDonald AW. Reliability and Replicability of Implicit and Explicit Reinforcement Learning Paradigms in People With Psychotic Disorders. Schizophr Bull 2021; 47:731-739. [PMID: 33914891 PMCID: PMC8084427 DOI: 10.1093/schbul/sbaa165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Motivational deficits in people with psychosis may be a result of impairments in reinforcement learning (RL). Therefore, behavioral paradigms that can accurately measure these impairments and their change over time are essential. METHODS We examined the reliability and replicability of 2 RL paradigms (1 implicit and 1 explicit, each with positive and negative reinforcement components) given at 2 time points to healthy controls (n = 75), and people with bipolar disorder (n = 62), schizoaffective disorder (n = 60), and schizophrenia (n = 68). RESULTS Internal consistency was acceptable (mean α = 0.78 ± 0.15), but test-retest reliability was fair to low (mean intraclass correlation = 0.33 ± 0.25) for both implicit and explicit RL. There were no clear effects of practice for these tasks. Largely, performance on these tasks shows intact implicit and impaired explicit RL in psychosis. Symptom presentation did not relate to performance in any robust way. CONCLUSIONS Our findings replicate previous literature showing spared implicit RL and impaired explicit reinforcement in psychosis. This suggests typical basal ganglia dopamine release, but atypical recruitment of the orbitofrontal and dorsolateral prefrontal cortices. However, we found that these tasks have only fair to low test-retest reliability and thus may not be useful for assessing change over time in clinical trials.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Deanna M Barch
- Department of Psychology, Washington University, St. Louis, MO
| | - Cameron S Carter
- Department of Psychiatry, University of California at Davis, Davis, CA
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - John D Ragland
- Department of Psychiatry, University of California at Davis, Davis, CA
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11
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Guo JY, Niendam TA, Auther AM, Carrión RE, Cornblatt BA, Ragland JD, Adelsheim S, Calkins R, Sale TG, Taylor SF, McFarlane WR, Carter CS. Predicting psychosis risk using a specific measure of cognitive control: a 12-month longitudinal study. Psychol Med 2020; 50:2230-2239. [PMID: 31507256 DOI: 10.1017/s0033291719002332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Identifying risk factors of individuals in a clinical-high-risk state for psychosis are vital to prevention and early intervention efforts. Among prodromal abnormalities, cognitive functioning has shown intermediate levels of impairment in CHR relative to first-episode psychosis and healthy controls, highlighting a potential role as a risk factor for transition to psychosis and other negative clinical outcomes. The current study used the AX-CPT, a brief 15-min computerized task, to determine whether cognitive control impairments in CHR at baseline could predict clinical status at 12-month follow-up. METHODS Baseline AX-CPT data were obtained from 117 CHR individuals participating in two studies, the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP) and the Understanding Early Psychosis Programs (EP) and used to predict clinical status at 12-month follow-up. At 12 months, 19 individuals converted to a first episode of psychosis (CHR-C), 52 remitted (CHR-R), and 46 had persistent sub-threshold symptoms (CHR-P). Binary logistic regression and multinomial logistic regression were used to test prediction models. RESULTS Baseline AX-CPT performance (d-prime context) was less impaired in CHR-R compared to CHR-P and CHR-C patient groups. AX-CPT predictive validity was robust (0.723) for discriminating converters v. non-converters, and even greater (0.771) when predicting CHR three subgroups. CONCLUSIONS These longitudinal outcome data indicate that cognitive control deficits as measured by AX-CPT d-prime context are a strong predictor of clinical outcome in CHR individuals. The AX-CPT is brief, easily implemented and cost-effective measure that may be valuable for large-scale prediction efforts.
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Affiliation(s)
- Joyce Y Guo
- Department of Psychiatry and Behavioral Sciences, Imaging Research Center, the University of California at Davis, Sacramento, CA, USA
- Department of Psychology, Center for Neuroscience, the University of California at Davis, Davis, CA, USA
| | - Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, Imaging Research Center, the University of California at Davis, Sacramento, CA, USA
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA
| | - Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA
| | - J Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, Imaging Research Center, the University of California at Davis, Sacramento, CA, USA
| | | | - Roderick Calkins
- Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Oregon, USA
| | - Tamara G Sale
- Regional Research Institute for Human Services, Portland State University, Oregon, USA
| | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - William R McFarlane
- Regional Research Institute for Human Services, Portland State University, Oregon, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, Imaging Research Center, the University of California at Davis, Sacramento, CA, USA
- Department of Psychology, Center for Neuroscience, the University of California at Davis, Davis, CA, USA
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12
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Kern RS, Reddy LF, Cohen AN, Young AS, Green MF. Effects of aerobic exercise on cardiorespiratory fitness and social functioning in veterans 40 to 65 years old with schizophrenia. Psychiatry Res 2020; 291:113258. [PMID: 32763533 DOI: 10.1016/j.psychres.2020.113258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
The usual physical activity level of people with chronic histories of schizophrenia is very low. In this pilot study, we examined the effects of an easy to implement aerobic exercise (AE) program on cardiorespiratory fitness and social functioning in 54 Veterans aged 40-65 years old with schizophrenia. Participants were randomized 2:1 to AE (36 forty-minute sessions conducted 3 times per week over 12 weeks) versus a non-aerobic stretching exercise condition conducted under the same regimen and timeframe. Cardiorespiratory fitness improved significantly within the AE group (p<.0001), and differed significantly from the comparison group (p<.02; Cohen's d=.41). Trend-level improvements were seen in social functioning within the AE group (p<.09) and showed a similar trend level difference in the between-group comparison (p<.06; Cohen's d=.35). Improvements in social functioning were significantly related to gains in cardiorespiratory fitness (r=.42; p<.01). AE effects on other physical and mental health indices were also examined. Overall, the AE intervention was well-tolerated, safe, and showed low rates of attrition after the commencement of training. Our findings indicate it is feasible to improve cardiorespiratory fitness in this clinical population, and there is suggestive evidence that the interventions aimed to do so may also benefit social functioning.
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Affiliation(s)
- Robert S Kern
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America.
| | - L Felice Reddy
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Amy N Cohen
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Alexander S Young
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Michael F Green
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
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13
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Feuerstahler LM, Waller N, MacDonald A. Improving Measurement Precision in Experimental Psychopathology Using Item Response Theory. EDUCATIONAL AND PSYCHOLOGICAL MEASUREMENT 2020; 80:695-725. [PMID: 32616955 PMCID: PMC7307489 DOI: 10.1177/0013164419892049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Although item response models have grown in popularity in many areas of educational and psychological assessment, there are relatively few applications of these models in experimental psychopathology. In this article, we explore the use of item response models in the context of a computerized cognitive task designed to assess visual working memory capacity in people with psychosis as well as healthy adults. We begin our discussion by describing how item response theory can be used to evaluate and improve unidimensional cognitive assessment tasks in various examinee populations. We then suggest how computerized adaptive testing can be used to improve the efficiency of cognitive task administration. Finally, we explore how these ideas might be extended to multidimensional item response models that better represent the complex response processes underlying task performance in psychopathological populations.
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Affiliation(s)
- Leah M. Feuerstahler
- Fordham University, Bronx, NY, USA
- Leah M. Feuerstahler, Department of
Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA.
| | - Niels Waller
- University of Minnesota, Twin Cities,
Minneapolis, MN, USA
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14
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Morè L, Lauterborn JC, Papaleo F, Brambilla R. Enhancing cognition through pharmacological and environmental interventions: Examples from preclinical models of neurodevelopmental disorders. Neurosci Biobehav Rev 2020; 110:28-45. [PMID: 30981451 DOI: 10.1016/j.neubiorev.2019.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 12/29/2022]
Abstract
In this review we discuss the role of environmental and pharmacological treatments to enhance cognition with special regards to neurodevelopmental related disorders and aging. How the environment influences brain structure and function, and the interactions between rearing conditions and gene expression, are fundamental questions that are still poorly understood. We propose a model that can explain some of the discrepancies in findings for effects of environmental enrichment on outcome measures. Evidence of a direct causal correlation of nootropics and treatments that enhanced cognition also will be presented, and possible molecular mechanisms that include neurotrophin signaling and downstream pathways underlying these processes are discussed. Finally we review recent findings achieved with a wide set of behavioral and cognitive tasks that have translational validity to humans, and should be useful for future work on devising appropriate therapies. As will be discussed, the collective findings suggest that a combinational therapeutic approach of environmental enrichment and nootropics could be particularly successful for improving learning and memory in both developmental disorders and normal aging.
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Affiliation(s)
- Lorenzo Morè
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, PR1 2XT, Preston, UK.
| | - Julie C Lauterborn
- Department of Anatomy & Neurobiology, School of Medicine, University of California, Irvine, CA, 92617, USA.
| | - Francesco Papaleo
- Genetics of Cognition Laboratory, Istituto Italiano di Tecnologia, Via Morego, 30, 16163, Genova, Italy.
| | - Riccardo Brambilla
- Neuroscience and Mental Health Research Institute (NMHRI), Division of Neuroscience, School of Biosciences, Cardiff University, CF24 4HQ, Cardiff, UK.
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15
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Smucny J, Iosif AM, Eaton NR, Lesh TA, Ragland JD, Barch DM, Gold JM, Strauss ME, MacDonald AW, Silverstein SM, Carter CS. Latent Profiles of Cognitive Control, Episodic Memory, and Visual Perception Across Psychiatric Disorders Reveal a Dimensional Structure. Schizophr Bull 2020; 46:154-162. [PMID: 30953588 PMCID: PMC6942157 DOI: 10.1093/schbul/sbz025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although meta-analyses suggest that schizophrenia (SZ) is associated with a more severe neurocognitive phenotype than mood disorders such as bipolar disorder, considerable between-subject heterogeneity exists in the phenotypic presentation of these deficits across mental illnesses. Indeed, it is unclear whether the processes that underlie cognitive dysfunction in these disorders are unique to each disease or represent a common neurobiological process that varies in severity. Here we used latent profile analysis (LPA) across 3 distinct cognitive domains (cognitive control, episodic memory, and visual integration; using data from the CNTRACS consortium) to identify distinct profiles of patients across psychotic illnesses. LPA was performed on a sample of 223 psychosis patients (59 with Type I bipolar disorder, 88 with SZ, and 76 with schizoaffective disorder). Seventy-three healthy control participants were included for comparison but were not included in sample LPA. Three latent profiles ("Low," "Moderate," and "High" ability) were identified as the underlying covariance across the 3 domains. The 3-profile solution provided highly similar fit to a single continuous factor extracted by confirmatory factor analysis, supporting a unidimensional structure. Diagnostic ratios did not significantly differ between profiles, suggesting that these profiles cross diagnostic boundaries (an exception being the Low ability profile, which had only one bipolar patient). Profile membership predicted Brief Psychiatric Rating Scale and Young Mania Rating Scale symptom severity as well as everyday communication skills independent of diagnosis. Biological, clinical and methodological implications of these findings are discussed.
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Affiliation(s)
- Jason Smucny
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA
| | - Ana-Maria Iosif
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA
| | - Nicholas R Eaton
- Department of Psychology, State University of New York Stony Brook, Stony Brook, NY
| | - Tyler A Lesh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA
| | - J Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA
| | - Deanna M Barch
- Department of Psychology, Washington University in St. Louis, St. Louis, MO
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Catonsville, MD
| | - Milton E Strauss
- Department of Psychology, University of New Mexico, Albuquerque, NM
| | | | - Steven M Silverstein
- Departments of Psychiatry and Ophthalmology, Rutgers – The State University of New Jersey, New Brunswick, NJ
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA
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16
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Kraus MS, Gold JM, Barch DM, Walker TM, Chun CA, Buchanan RW, Csernansky JG, Goff DC, Green MF, Jarskog LF, Javitt DC, Kimhy D, Lieberman JA, McEvoy JP, Mesholam-Gately RI, Seidman LJ, Ball MP, Kern RS, McMahon RP, Robinson J, Marder SR, Keefe RSE. The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100161. [PMID: 31832342 PMCID: PMC6889798 DOI: 10.1016/j.scog.2019.100161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/24/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
Abstract
In comparison to batteries of standard neuropsychological tests, cognitive neuroscience tests may offer a more specific assessment of discrete neurobiological processes that may be aberrant in schizophrenia. However, more information regarding psychometric properties and correlations with standard neuropsychological tests and functional measures is warranted to establish their validity as treatment outcome measures. The N-back and AX-Continuous Performance Task (AX-CPT) are two promising cognitive neuroscience tests designed to measure specific components of working memory and contextual processing respectively. In the current study, we report the psychometric properties of multiple outcome measures from these two tests as well as their correlations with standard neuropsychological measures and functional capacity measures. The results suggest that while the AX-CPT and N-back display favorable psychometric properties, they do not exhibit greater sensitivity or specificity with functional measures than standard neurocognitive tests.
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Affiliation(s)
- Michael S Kraus
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States of America
| | - Trina M Walker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | | | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - John G Csernansky
- Department of Psychiatry, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America
| | - Donald C Goff
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Michael F Green
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, United States of America
| | - Daniel C Javitt
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jeffrey A Lieberman
- Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, United States of America
| | - Joseph P McEvoy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - M Patricia Ball
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Robert S Kern
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Robert P McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James Robinson
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - Stephen R Marder
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
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17
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Hogeveen J, Krug MK, Geddert RM, Ragland JD, Solomon M. Compensatory Hippocampal Recruitment Supports Preserved Episodic Memory in Autism Spectrum Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:97-109. [PMID: 31676207 DOI: 10.1016/j.bpsc.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The degree to which individuals with autism spectrum disorder (ASD) evidence impairments in episodic memory relative to their typically developing (TD) counterparts remains unclear. According to a prominent view, ASD is associated with deficits in encoding associations between items and recollecting precise context details. Here, we evaluated behavioral and neural evidence for this impaired relational binding hypothesis using a task involving relational encoding and recollection during functional magnetic resonance imaging. METHODS Adolescents and young adults (nASD = 47, nTD = 60) performed the Relational and Item-Specific Encoding task during functional magnetic resonance imaging, including item and associative recognition testing. We modeled functional recruitment within the medial temporal lobes (MTLs), and connectivity between MTL and the posterior medial (PM) network thought to underlie relational memory. The impaired relational binding model would predict a behavioral deficit driven by aberrant recruitment and connectivity of MTL and the PM network. RESULTS The ASD and TD groups showed indistinguishable item and associative recognition performance. During relational encoding, the ASD group demonstrated increased hippocampal recruitment, and decreased connectivity between MTL and PM regions relative to the TD group. Within ASD, hippocampal recruitment and MTL-PM connectivity were inversely correlated. CONCLUSIONS The lack of a behavioral deficit in ASD does not support the impaired relational binding hypothesis. Instead, the current data suggest that increased recruitment of the hippocampus compensates for decreased MTL-PM connectivity to support preserved episodic memory in ASD. These findings suggest a compensatory neurodevelopmental mechanism that may support preserved cognitive domains in ASD: local hyperrecruitment may offset connectivity aberrations in individuals with ASD relative to TD subjects.
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Affiliation(s)
- Jeremy Hogeveen
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico; Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico.
| | - Marie K Krug
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California; MIND Institute, University of California, Davis, Davis, California
| | - Raphael M Geddert
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - J Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California; Imaging Research Center, University of California, Davis, Davis, California
| | - Marjorie Solomon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California; MIND Institute, University of California, Davis, Davis, California; Imaging Research Center, University of California, Davis, Davis, California
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18
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Öngür D, Carter CS, Gur RE, Perkins D, Sawa A, Seidman LJ, Tamminga C, Huggins W, Hamilton C. Common Data Elements for National Institute of Mental Health-Funded Translational Early Psychosis Research. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:10-22. [PMID: 31439493 DOI: 10.1016/j.bpsc.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/20/2022]
Abstract
The National Institutes of Health has established the PhenX Toolkit as a web-based resource containing consensus measures freely available to the research community. The National Institute of Mental Health (NIMH) has introduced the Mental Health Research Core Collection as part of the PhenX Toolkit and recently convened the PhenX Early Psychosis Working Group to generate the PhenX Early Psychosis Specialty Collection. The Working Group consisted of two complementary panels for clinical and translational research. We review the process, deliberations, and products of the translational research panel. The Early Psychosis Specialty Collection rationale for measure selection as well as additional information and protocols for obtaining each measure are available on the PhenX website (https://www.phenxtoolkit.org). The NIMH strongly encourages investigators to use instruments from the PhenX Mental Health Research Collections in NIMH-funded studies and discourages use of alternative measures to collect similar data without justification. We also discuss some of the potential advances that can be achieved by collecting common data elements across large-scale longitudinal studies of early psychosis.
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Affiliation(s)
- Dost Öngür
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, Davis, California
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Akira Sawa
- Department of Psychiatry, The Johns Hopkins University, Baltimore, Maryland
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Carol Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas
| | - Wayne Huggins
- RTI International, Research Triangle Park, North Carolina
| | - Carol Hamilton
- RTI International, Research Triangle Park, North Carolina
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19
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Biagianti B, Fisher M, Brandrett B, Schlosser D, Loewy R, Nahum M, Vinogradov S. Development and testing of a web-based battery to remotely assess cognitive health in individuals with schizophrenia. Schizophr Res 2019; 208:250-257. [PMID: 30733167 PMCID: PMC6544475 DOI: 10.1016/j.schres.2019.01.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/21/2019] [Accepted: 01/26/2019] [Indexed: 01/06/2023]
Abstract
Cognitive impairment in schizophrenia is often severe, enduring, and contributes significantly to chronic disability. A standardized platform for identifying cognitive impairments and measuring treatment effects in cognition is a critical aspect of comprehensive evaluation and treatment for individuals with schizophrenia. In this project, we developed and tested a suite of ten web-based, neuroscience-informed cognitive assessments that are designed to enable the interpretation of specific deficits that could signal that an individual is experiencing cognitive difficulties. The assessment suite assays speed of processing, sustained attention, executive functioning, learning and socio-affective processing in the auditory and visual modalities. We have obtained data from 283 healthy individuals who were recruited online and 104 individuals with schizophrenia who also completed formal neuropsychological testing. Our data show that the assessments 1) are acceptable and tolerable to users, with successful completion in an average of under 40 min; 2) reliably measure the distinct theoretical cognitive constructs they were designed to assess; 3) can discriminate schizophrenia patients from healthy controls with a fair degree of accuracy (AUROC > 0.70); and 4) have promising construct, convergent, and external validity. Further optimization and validation work is in progress to finalize the evaluation process prior to promoting the dissemination of these assessments in real-world settings.
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Affiliation(s)
| | | | | | - Danielle Schlosser
- Department of Psychiatry, University of California, San Francisco,Verily Life Sciences
| | - Rachel Loewy
- Department of Psychiatry, University of California, San Francisco
| | - Mor Nahum
- School of Occupational Therapy, Hebrew University of Jerusalem
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20
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Cognition, social cognition, and Self-assessment in schizophrenia: prediction of different elements of everyday functional outcomes. CNS Spectr 2019; 24:88-93. [PMID: 30683165 PMCID: PMC6414257 DOI: 10.1017/s1092852918001414] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A growing body of research has shown that two domains of cognition, neurocognition and social cognition, predict different domains of real-world outcomes in people with schizophrenia. Social cognition has been shown to predict social outcomes but not non-social outcomes (e.g. living independently), and neurocognition provides minimal prediction of social outcomes (e.g. interpersonal relationships). The differing predictive value of neurocognition and social cognition has led to an exploration of potential factors that interact with cognition to influence everyday outcomes. Functional skills, negative symptoms, and self-assessment have shown particularly promising relationships with cognitive ability. Several consensus studies have pinpointed valid performance-based assessments. High-contact informant ratings have additionally been shown to be highly accurate. The emerging understanding of divergent patterns of predicting outcomes and reliable assessments present an opportunity to improve treatment targets and real-world outcomes for individuals with schizophrenia. In particular, a recently defined component of metacognition has shown particular promise. Introspective accuracy (IA) addresses how well individuals evaluate their own abilities. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures of neurocognitive skills and has found that IA of social cognition accounts unique variance in real world disability above social cognitive abilities. Intriguingly, IA of neurocognition appears to preferentially predict non-social outcomes while IA of social cognition predicts social outcomes.
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21
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Bilder RM, Reise SP. Neuropsychological tests of the future: How do we get there from here? Clin Neuropsychol 2019; 33:220-245. [PMID: 30422045 PMCID: PMC6422683 DOI: 10.1080/13854046.2018.1521993] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This article reviews current approaches to neuropsychological assessment, identifies opportunities for development of new methods using modern psychometric theory and advances in technology, and suggests a transition path that promotes application of novel methods without sacrificing validity. METHODS Theoretical/state-of-the-art review. CONCLUSIONS Clinical neuropsychological assessment today does not reflect advances in neuroscience, modern psychometrics, or technology. Major opportunities for improving practice include both psychometric and technological strategies. Modern psychometric approaches including item response theory (IRT) enable linking procedures that can place different measures on common scales; adaptive testing algorithms that can dramatically increase efficiency of assessment; examination of differential item functioning (DIF) to detect measures that behave differently in different groups; and person fit statistics to detect aberrant patterns of responding of high value for performance validity testing. Opportunities to introduce novel technologies include computerized adaptive testing, Web-based assessment, healthcare- and bio-informatics strategies, mobile platforms, wearables, and the 'internet-of-things'. To overcome inertia in current practices, new methods must satisfy requirements for back-compatibility with legacy instrumentation, enabling us to leverage the wealth of validity data already accrued for classic procedures. A path to achieve these goals involves creation of a global network to aggregate item-level data into a shared repository that will enable modern psychometric analyses to refine existing methods, and serve as a platform to evolve novel assessment strategies, which over time can revolutionize neuropsychological assessment practices world-wide.
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Affiliation(s)
- Robert M Bilder
- a Departments of Psychiatry & Biobehavioral Science, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , California , USA
- b Department of Psychiatry & Biobehavioral Science , Los Angeles , California , USA
| | - Steven P Reise
- b Department of Psychiatry & Biobehavioral Science , Los Angeles , California , USA
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22
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Howieson D. Current limitations of neuropsychological tests and assessment procedures. Clin Neuropsychol 2019; 33:200-208. [DOI: 10.1080/13854046.2018.1552762] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Diane Howieson
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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23
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Silberstein J, Harvey PD. Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes. Cogn Neuropsychiatry 2019; 24:28-39. [PMID: 30477401 PMCID: PMC6370513 DOI: 10.1080/13546805.2018.1549985] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Individuals with schizophrenia present across a spectrum of symptomatology. Disability remains a debilitating reality across varying disease presentations and remains pervasive despite psychiatric medications. Cognition (neuro/social cognition) and negative symptoms have emerged as the strongest predictors of real-world disability, but account for <50% of the variance in outcomes. METHODS Our attempts to determine what accounts for the remaining 50% of variance has shown that poor introspective accuracy (IA) may be the most potent predictor of functional outcomes 25% of individuals with schizophrenia. We define IA as the adequacy of self-assessments of ability, skills, performance, or decisions. We suggest that IA is a progression of metacognition and can extend beyond cognition to include misestimation of prior and likely future performance in social or other adaptively relevant situations. RESULTS Additionally, IA is bidirectional and self-orientated. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures or neurocognitive skills and has found that IA of social cognition accounts unique variance in real-world disability above social cognitive performance. DISCUSSION We argue that impaired IA, affecting 25-50% of patients with schizophrenia, in the absence or minimal presence of other impairments might be the most powerful predictor of functional outcomes.
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Affiliation(s)
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA 33136,Research Service, Bruce W. Cater VA Medical Center, Miami VA Healthcare System. Miami, FL, USA
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24
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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25
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Jirsaraie RJ, Sheffield JM, Barch DM. Neural correlates of global and specific cognitive deficits in schizophrenia. Schizophr Res 2018; 201:237-242. [PMID: 29954699 PMCID: PMC6814153 DOI: 10.1016/j.schres.2018.06.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/14/2018] [Accepted: 06/09/2018] [Indexed: 12/12/2022]
Abstract
Cognitive deficits are a core feature of schizophrenia, but the neural mechanisms that contribute to these characteristics are not fully understood. This study investigated whether volume of the dorsal lateral prefrontal cortex (DLPFC), inferior frontal gyrus (IFG), hippocampus, and white matter were associated with impairment in specific cognitive domains, including executive functioning, working memory, verbal memory, verbal fluency, processing speed, versus global functioning. The multi-site data used in this study was collected from the Bipolar and Schizophrenia Network on Intermediate Phenotypes (B-SNIP), and consisted of 206 healthy controls and 247 individuals with either schizophrenia or schizoaffective disorder. The neuroimaging data was segmented based on the Destrieux atlas in FreeSurfer. Linear regression analyses revealed that global cognition, executive functioning, working memory, and processing speed were associated with all brain structures, except the DLPFC was only associated with executive fucntion. When controlling for the global cognitive deficit, executive function was trending significance with white matter, but continued to be associated with the DLPFC and IFG, as did the association between processing speed and the hippocampus. These findings suggest that volumes of the DLPFC, IFG, hippocampus, and white matter are associated with the global cognitive impairment seen in schizophrenia, but some brain structures may also be specifically related to domain-specific deficits (primarily executive function) over-and-beyond the global cognitive deficit.
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Affiliation(s)
- Robert J. Jirsaraie
- Department of Psychology, University of Colorado Denver, 1250 14th Street, Denver, CO, 80204, United States of America,Corresponding author. , (R.J. Jirsaraie)
| | - Julia M. Sheffield
- Department of Psychological&Brain Science, Washington University, Box 1125, One Brookings Drive, St. Louis, MO, 63130, United States of America
| | - Deanna M. Barch
- Department of Psychological&Brain Science, Washington University, Box 1125, One Brookings Drive, St. Louis, MO, 63130, United States of America,Department of Psychiatry, Washington University, Box 1125, One Brookings Drive, St Louis, MO, 63130, United States of America
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Sheffield JM, Karcher NR, Barch DM. Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective. Neuropsychol Rev 2018; 28:509-533. [PMID: 30343458 DOI: 10.1007/s11065-018-9388-2] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN, 37212, USA.
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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Computational Phenotyping: Using Models to Understand Individual Differences in Personality, Development, and Mental Illness. PERSONALITY NEUROSCIENCE 2018; 1:e18. [PMID: 32435735 PMCID: PMC7219680 DOI: 10.1017/pen.2018.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 12/19/2022]
Abstract
This paper reviews progress in the application of computational models to
personality, developmental, and clinical neuroscience. We first describe the
concept of a computational phenotype, a collection of parameters derived from
computational models fit to behavioral and neural data. This approach represents
individuals as points in a continuous parameter space, complementing traditional
trait and symptom measures. One key advantage of this representation is that it
is mechanistic: The parameters have interpretations in terms of cognitive
processes, which can be translated into quantitative predictions about future
behavior and brain activity. We illustrate with several examples how this
approach has led to new scientific insights into individual differences,
developmental trajectories, and psychopathology. We then survey some of the
challenges that lay ahead.
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28
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Silberstein J, Pinkham AE, Penn DL, Harvey PD. Self-assessment of social cognitive ability in schizophrenia: Association with social cognitive test performance, informant assessments of social cognitive ability, and everyday outcomes. Schizophr Res 2018; 199:75-82. [PMID: 29673732 PMCID: PMC6151277 DOI: 10.1016/j.schres.2018.04.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Impairments in self-assessment are common in people with schizophrenia and impairments in self-assessment of cognitive ability have been found to predict impaired functional outcome. In this study, we examined self-assessment of social cognitive ability and related them to assessments of social cognition provided by informants, to performance on tests of social cognition, and to everyday outcomes. The difference between self-reported social cognition and informant ratings was used to predict everyday functioning. METHODS People with schizophrenia (n=135) performed 8 different tests of social cognition. They were asked to rate their social cognitive abilities on the Observable Social Cognition Rating Scale (OSCARs). High contact informants also rated social cognitive ability and everyday outcomes, while unaware of the patients' social cognitive performance and self-assessments. Social competence was measured with a performance-based assessment and clinical ratings of negative symptoms were also performed. RESULTS Patient reports of their social cognitive abilities were uncorrelated with performance on social cognitive tests and with three of the four domains of functional outcomes. Differences between self-reported and informant rated social cognitive ability predicted impaired everyday functioning across all four functional domains. This difference score predicted disability even when the influences of social cognitive performance, social competence, and negative symptoms were considered. IMPLICATIONS Mis-estimation of social cognitive ability was an important predictor of social and nonsocial outcomes in schizophrenia compared to performance on social cognitive tests. These results suggest that consideration of self-assessment is critical when attempting to evaluate the causes of disability and when trying to implement interventions targeting disability reduction.
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Affiliation(s)
- Juliet Silberstein
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX
| | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC,Department of Psychology, Australian Catholic University, Melbourne, VIC
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL,Research Service, Miami VA Healthcare System
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Grove TB, Yao B, Mueller SA, McLaughlin M, Ellingrod VL, McInnis MG, Taylor SF, Deldin PJ, Tso IF. A Bayesian model comparison approach to test the specificity of visual integration impairment in schizophrenia or psychosis. Psychiatry Res 2018; 265:271-278. [PMID: 29768190 PMCID: PMC6448399 DOI: 10.1016/j.psychres.2018.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 02/23/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
Abstract
Impaired visual integration is well documented in schizophrenia and related to functional outcomes. However, it is unclear if this deficit is specific to schizophrenia, or characteristic of psychosis more broadly. To address this question, this study used a Bayesian model comparison approach to examine the evidence of three grouping models of visual integration performance in 116 individuals with schizophrenia (SZ), schizoaffective disorder (SA), bipolar disorder (BD) with or without a history of prominent psychosis (BDP+ and BDP-, respectively), or no psychiatric diagnosis (healthy controls; HC). We compared: (1) Psychosis Model (psychosis, non-psychosis), where the psychosis group included SZ, SA, and BDP+, and the non-psychosis group included BDP- and HC; (2) Schizophrenia Model (SZ, non-SZ); and (3) DSM Model (SZ, SA, BD, HC). The relationship between visual integration and general cognition was also explored. The Psychosis Model showed the strongest evidence, and visual integration was associated with general cognition in participants with psychosis. The results were consistent with the Research Domain Criteria (RDoC) framework, indicating that visual integration impairment is characteristic of psychosis and not specific to SZ or DSM categories, and may share similar disease pathways with observed neurocognitive deficits in psychotic disorders.
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Affiliation(s)
- Tyler B. Grove
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA,Correspondence concerning this article should be addressed to Tyler Grove, Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, Michigan 48109, USA. . Tel: 1-(734)-647-3872
| | - Beier Yao
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Savanna A. Mueller
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Vicki L. Ellingrod
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA,College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephan F. Taylor
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Patricia J. Deldin
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Ivy F. Tso
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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30
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MacQueen DA, Young JW, Cope ZA. Cognitive Phenotypes for Biomarker Identification in Mental Illness: Forward and Reverse Translation. Curr Top Behav Neurosci 2018; 40:111-166. [PMID: 29858983 DOI: 10.1007/7854_2018_50] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Psychiatric illness has been acknowledged for as long as people were able to describe behavioral abnormalities in the general population. In modern times, these descriptions have been codified and continuously updated into manuals by which clinicians can diagnose patients. None of these diagnostic manuals have attempted to tie abnormalities to neural dysfunction however, nor do they necessitate the quantification of cognitive function despite common knowledge of its ties to functional outcome. In fact, in recent years the National Institute of Mental Health released a novel transdiagnostic classification, the Research Domain Criteria (RDoC), which utilizes quantifiable behavioral abnormalities linked to neurophysiological processes. This reclassification highlights the utility of RDoC constructs as potential cognitive biomarkers of disease state. In addition, with RDoC and cognitive biomarkers, the onus of researchers utilizing animal models no longer necessitates the recreation of an entire disease state, but distinct processes. Here, we describe the utilization of constructs from the RDoC initiative to forward animal research on these cognitive and behavioral processes, agnostic of disease. By linking neural processes to these constructs, identifying putative abnormalities in diseased patients, more targeted therapeutics can be developed.
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Affiliation(s)
- David A MacQueen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Zackary A Cope
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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31
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Nguyen BN, Hew SA, Ly J, Shin HY, Wong JC, Yeung E, McKendrick AM. Acute caffeine ingestion affects surround suppression of perceived contrast. J Psychopharmacol 2018; 32:81-88. [PMID: 28879800 DOI: 10.1177/0269881117725684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Caffeine is a widely used psychostimulant that is associated with increased acetylcholine levels in mammalian brain and acetycholinesterase antagonism. Acetylcholine, a neuromodulator, plays an important role in the processing of visual information. One key example in human vision, thought to at least partly involve cholinergic neuromodulation, is perceptual surround suppression of contrast, whereby the perceived contrast of a pattern is altered by the presence of a neighbouring pattern. Perceptual surround suppression is weaker with pharmacological administration of donepezil (a centrally-acting acetylcholine enzyme inhibitor) in healthy human observers. Here, we test whether temporarily manipulating caffeine levels (from complete washout to a controlled dose of caffeine) has a similar effect on perceptual surround suppression in 21 healthy young adults (aged 20-24 years, 11 females). Neither ingestion of a caffeine pill nor placebo altered contrast judgments when the target pattern was presented on a uniform grey background ( p=0.54). With caffeine ingestion, perceptual surround suppression strength was reduced relative to baseline (prior to pill ingestion, p=0.003) and placebo ( p=0.029), irrespective of whether the surround was oriented parallel or orthogonal to the central target. While daily habitual caffeine consumption of low-to-moderate doses (<400 mg/day, estimated from a written questionnaire) is not predictive of performance, our study indicates that acute consumption of caffeine on the day of testing influences perceptual surround suppression strength. Perceptual surround suppression is predominantly attributed to inhibitory processes involving the major cortical inhibitory neurotransmitter, gamma-aminobutyric acid. Our results point to the involvement of other neuromodulators, possibly cholinergic, in perceptual surround suppression.
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Affiliation(s)
- Bao N Nguyen
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Sui-Ann Hew
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - John Ly
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Hee-Young Shin
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Jessica C Wong
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Yeung
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
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Assessing the Relationship between Performance on the University of California Performance Skills Assessment (UPSA) and Outcomes in Schizophrenia: A Systematic Review and Evidence Synthesis. SCHIZOPHRENIA RESEARCH AND TREATMENT 2018; 2018:9075174. [PMID: 30687553 PMCID: PMC6327277 DOI: 10.1155/2018/9075174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/12/2018] [Accepted: 12/05/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of the published literature to evaluate how functional capacity, as measured by the University of California at San Diego (UCSD) Performance-based Skills Assessment (UPSA), relates to other functional measures and real-world outcomes among individuals with schizophrenia. METHODS The MEDLINE® and Embase® databases were searched to identify joint evaluations with UPSA and key functional outcomes (functional scale measures; generic or disease-specific, health-related quality of life [HRQoL]; or real-world outcomes [residential status; employment status]) in patients with schizophrenia. Pearson correlations were estimated between UPSA scores, HRQoL, other functional scale measures, and real-world outcomes, for outcomes described in at least six studies. RESULTS The synthesis included 76 studies that provided 73 unique data sets. Quantitative assessment between the Specific Level of Function (SLOF) (n=18) scores and UPSA scores demonstrated a moderate borderline-significant correlation (0.45, p=0.06). Quantitative analysis of the relationship between the Global Assessment of Functioning (GAF) (n=11) and the Multidimensional Scale of Independent Functioning (MSIF) (n=6) scales revealed moderate and small nonsignificant Pearson correlations of -0.34 (p=0.31) and 0.12 (p=0.83), respectively. There was a small borderline-significant correlation between UPSA score and residential status (n=36; 0.31; p=0.08), while no correlation was found between UPSA score and employment status (n=19; 0.04; p=0.88). CONCLUSION The SLOF was the most often used functional measure and had the strongest observed correlation with the UPSA. Although knowledge gaps remain, evidence from this review indicates that there is a quantitative relationship between functional capacity and real-world outcomes in individuals with schizophrenia.
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Cella M, Stahl D, Morris S, Keefe RSE, Bell MD, Wykes T. Effects of cognitive remediation on negative symptoms dimensions: exploring the role of working memory. Psychol Med 2017; 47:2593-2601. [PMID: 28866985 PMCID: PMC5647678 DOI: 10.1017/s0033291717000757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent theories suggest that poor working memory (WM) may be the cognitive underpinning of negative symptoms in people with schizophrenia. In this study, we first explore the effect of cognitive remediation (CR) on two clusters of negative symptoms (i.e. expressive and social amotivation), and then assess the relevance of WM gains as a possible mediator of symptom improvement. METHOD Data were accessed for 309 people with schizophrenia from the NIMH Database of Cognitive Training and Remediation Studies and a separate study. Approximately half the participants received CR and the rest were allocated to a control condition. All participants were assessed before and after therapy and at follow-up. Expressive negative symptoms and social amotivation symptoms scores were calculated from the Positive and Negative Syndrome Scale. WM was assessed with digit span and letter-number span tests. RESULTS Participants who received CR had a significant improvement in WM scores (d = 0.27) compared with those in the control condition. Improvements in social amotivation levels approached statistical significance (d = -0.19), but change in expressive negative symptoms did not differ between groups. WM change did not mediate the effect of CR on social amotivation. CONCLUSIONS The results suggest that a course of CR may benefit behavioural negative symptoms. Despite hypotheses linking memory problems with negative symptoms, the current findings do not support the role of this cognitive domain as a significant mediator. The results indicate that WM improves independently from negative symptoms reduction.
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Affiliation(s)
- M. Cella
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - D. Stahl
- Department of Biostatistics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - S. Morris
- Division of Adult Translational Research, National Institute of Mental Health, North Bethesda, MD, USA
| | - R. S. E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - M. D. Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - T. Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Gratton G, Cooper P, Fabiani M, Carter CS, Karayanidis F. Dynamics of cognitive control: Theoretical bases, paradigms, and a view for the future. Psychophysiology 2017; 55. [DOI: 10.1111/psyp.13016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Gabriele Gratton
- Department of Psychology and Beckman InstituteUniversity of Illinois at Urbana‐ChampaignUrbana Illinois USA
| | - Patrick Cooper
- School of PsychologyUniversity of NewcastleNewcastle New South Wales Australia
| | - Monica Fabiani
- Department of Psychology and Beckman InstituteUniversity of Illinois at Urbana‐ChampaignUrbana Illinois USA
| | - Cameron S. Carter
- Departments of Psychiatry and PsychologyUniversity of California–DavisDavis California USA
| | - Frini Karayanidis
- School of PsychologyUniversity of NewcastleNewcastle New South Wales Australia
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35
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Cooper SR, Gonthier C, Barch DM, Braver TS. The Role of Psychometrics in Individual Differences Research in Cognition: A Case Study of the AX-CPT. Front Psychol 2017; 8:1482. [PMID: 28928690 PMCID: PMC5591582 DOI: 10.3389/fpsyg.2017.01482] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/17/2017] [Indexed: 11/13/2022] Open
Abstract
Investigating individual differences in cognition requires addressing questions not often thought about in standard experimental designs, especially regarding the psychometric properties of the task. Using the AX-CPT cognitive control task as a case study example, we address four concerns that one may encounter when researching the topic of individual differences in cognition. First, we demonstrate the importance of variability in task scores, which in turn directly impacts reliability, particularly when comparing correlations in different populations. Second, we demonstrate the importance of variability and reliability for evaluating potential failures to replicate predicted correlations, even within the same population. Third, we demonstrate how researchers can turn to evaluating psychometric properties as a way of evaluating the feasibility of utilizing the task in new settings (e.g., online administration). Lastly, we show how the examination of psychometric properties can help researchers make informed decisions when designing a study, such as determining the appropriate number of trials for a task.
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Affiliation(s)
- Shelly R. Cooper
- Cognitive Control and Psychopathology Laboratory, Department of Psychological & Brain Sciences, Washington University in St. Louis, St. LouisMO, United States
| | - Corentin Gonthier
- LP3C EA 1285, Department of Psychology, Université Rennes 2Rennes, France
| | - Deanna M. Barch
- Cognitive Control and Psychopathology Laboratory, Department of Psychological & Brain Sciences, Washington University in St. Louis, St. LouisMO, United States
| | - Todd S. Braver
- Cognitive Control and Psychopathology Laboratory, Department of Psychological & Brain Sciences, Washington University in St. Louis, St. LouisMO, United States
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36
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Barch DM, Carter CS, Gold JM, Johnson SL, Kring AM, MacDonald AW, Pizzagalli DA, Ragland JD, Silverstein SM, Strauss ME. Explicit and implicit reinforcement learning across the psychosis spectrum. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:694-711. [PMID: 28406662 PMCID: PMC5503766 DOI: 10.1037/abn0000259] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Motivational and hedonic impairments are core features of a variety of types of psychopathology. An important aspect of motivational function is reinforcement learning (RL), including implicit (i.e., outside of conscious awareness) and explicit (i.e., including explicit representations about potential reward associations) learning, as well as both positive reinforcement (learning about actions that lead to reward) and punishment (learning to avoid actions that lead to loss). Here we present data from paradigms designed to assess both positive and negative components of both implicit and explicit RL, examine performance on each of these tasks among individuals with schizophrenia, schizoaffective disorder, and bipolar disorder with psychosis, and examine their relative relationships to specific symptom domains transdiagnostically. None of the diagnostic groups differed significantly from controls on the implicit RL tasks in either bias toward a rewarded response or bias away from a punished response. However, on the explicit RL task, both the individuals with schizophrenia and schizoaffective disorder performed significantly worse than controls, but the individuals with bipolar did not. Worse performance on the explicit RL task, but not the implicit RL task, was related to worse motivation and pleasure symptoms across all diagnostic categories. Performance on explicit RL, but not implicit RL, was related to working memory, which accounted for some of the diagnostic group differences. However, working memory did not account for the relationship of explicit RL to motivation and pleasure symptoms. These findings suggest transdiagnostic relationships across the spectrum of psychotic disorders between motivation and pleasure impairments and explicit RL. (PsycINFO Database Record
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37
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Bilder RM. On the Hierarchical Organization of Psychopathology and Optimizing Symptom Assessments for Biological Psychiatry. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:300-302. [PMID: 29560916 PMCID: PMC6689418 DOI: 10.1016/j.bpsc.2017.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Robert M Bilder
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Psychology, University of California, Los Angeles, Los Angeles, California.
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Seidman LJ, Shapiro DI, Stone WS, Woodberry KA, Ronzio A, Cornblatt BA, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Mathalon DH, McGlashan TH, Perkins DO, Tsuang MT, Walker EF, Woods SW. Association of Neurocognition With Transition to Psychosis: Baseline Functioning in the Second Phase of the North American Prodrome Longitudinal Study. JAMA Psychiatry 2016; 73:1239-1248. [PMID: 27806157 PMCID: PMC5511703 DOI: 10.1001/jamapsychiatry.2016.2479] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Neurocognition is a central characteristic of schizophrenia and other psychotic disorders. Identifying the pattern and severity of neurocognitive functioning during the "near-psychotic," clinical high-risk (CHR) state of psychosis is necessary to develop accurate risk factors for psychosis and more effective and potentially preventive treatments. OBJECTIVES To identify core neurocognitive dysfunctions associated with the CHR phase, measure the ability of neurocognitive tests to predict transition to psychosis, and determine if neurocognitive deficits are robust or explained by potential confounders. DESIGN, SETTING, AND PARTICIPANTS In this case-control study across 8 sites, baseline neurocognitive data were collected from January 2009 to April 2013 in the second phase of the North American Prodrome Longitudinal Study (NAPLS 2). The dates of analysis were August 2015 to August 2016. The setting was a consortium of 8 university-based, outpatient programs studying the psychosis prodrome in North America. Participants were 264 healthy controls (HCs) and 689 CHR individuals, aged 12 to 35 years. MAIN OUTCOMES AND MEASURES Neurocognitive associations with transition to psychosis and effects of medication on neurocognition. Nineteen neuropsychological tests and 4 factors derived from factor analysis were used: executive and visuospatial abilities, verbal abilities, attention and working memory abilities, and declarative memory abilities. RESULTS This study included 264 HCs (137 male and 127 female) and 689 CHR participants (398 male and 291 female). In the HCs, 145 (54.9%) were white and 119 (45.1%) were not, whereas 397 CHR participants (57.6%) were white and 291 (42.3%) were not. In the HCs, 45 (17%) were of Hispanic origin, whereas 127 CHR participants (18.4%) were of Hispanic origin. The CHR individuals were significantly impaired compared with HCs on attention and working memory abilities and declarative memory abilities. The CHR converters had large deficits in attention and working memory abilities and declarative memory abilities (Cohen d, approximately 0.80) compared with controls and performed significantly worse on these dimensions than nonconverters (Cohen d, 0.28 and 0.48, respectively). These results were not accounted for by general cognitive ability or medications. In Cox proportional hazards regression, time to conversion in those who transitioned to psychosis was significantly predicted by high verbal (premorbid) abilities (β = 0.40; hazard ratio [HR], 1.48; 95% CI, 1.08-2.04; P = .02), impaired declarative memory abilities (β = -0.87; HR, 0.42; 95% CI, 0.31-0.56; P < .001), age (β = -0.10; HR, 0.90; 95% CI, 0.84-0.97; P = .003), site, and a combined score of unusual thought content or delusional ideas and suspiciousness or persecutory ideas items (β = 0.44; HR, 1.56; 95% CI, 1.36-1.78; P < .001). CONCLUSIONS AND RELEVANCE Neurocognitive impairment, especially in attention and working memory abilities and declarative memory abilities, is a robust characteristic of CHR participants, especially those who later develop psychosis. Interventions targeting the enhancement of neurocognitive functioning are warranted in this population.
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Affiliation(s)
- Larry J. Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston MA,Department of Psychiatry, Harvard Medical School at Massachusetts General Hospital, Boston MA,Corresponding Author: Larry J. Seidman, Ph.D., Massachusetts Mental Health Center, Commonwealth Research Center, Room 542, 75 Fenwood Road, Boston, MA 02115; Tel: 617-754-1238 Fax: 617-754-1240,
| | - Daniel I. Shapiro
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston MA
| | - William S. Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston MA
| | - Kristen A. Woodberry
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston MA
| | - Ashley Ronzio
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston MA
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles CA
| | | | - Tyrone D. Cannon
- Department of Psychology, Yale University, New Haven CT,Department of Psychiatry, Yale University, New Haven CT
| | - Daniel H. Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco CA
| | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill NC
| | | | - Elaine F. Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta GA
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Sterzer P, Mishara AL, Voss M, Heinz A. Thought Insertion as a Self-Disturbance: An Integration of Predictive Coding and Phenomenological Approaches. Front Hum Neurosci 2016; 10:502. [PMID: 27785123 PMCID: PMC5060939 DOI: 10.3389/fnhum.2016.00502] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/23/2016] [Indexed: 01/30/2023] Open
Abstract
Current theories in the framework of hierarchical predictive coding propose that positive symptoms of schizophrenia, such as delusions and hallucinations, arise from an alteration in Bayesian inference, the term inference referring to a process by which learned predictions are used to infer probable causes of sensory data. However, for one particularly striking and frequent symptom of schizophrenia, thought insertion, no plausible account has been proposed in terms of the predictive-coding framework. Here we propose that thought insertion is due to an altered experience of thoughts as coming from “nowhere”, as is already indicated by the early 20th century phenomenological accounts by the early Heidelberg School of psychiatry. These accounts identified thought insertion as one of the self-disturbances (from German: “Ichstörungen”) of schizophrenia and used mescaline as a model-psychosis in healthy individuals to explore the possible mechanisms. The early Heidelberg School (Gruhle, Mayer-Gross, Beringer) first named and defined the self-disturbances, and proposed that thought insertion involves a disruption of the inner connectedness of thoughts and experiences, and a “becoming sensory” of those thoughts experienced as inserted. This account offers a novel way to integrate the phenomenology of thought insertion with the predictive coding framework. We argue that the altered experience of thoughts may be caused by a reduced precision of context-dependent predictions, relative to sensory precision. According to the principles of Bayesian inference, this reduced precision leads to increased prediction-error signals evoked by the neural activity that encodes thoughts. Thus, in analogy with the prediction-error related aberrant salience of external events that has been proposed previously, “internal” events such as thoughts (including volitions, emotions and memories) can also be associated with increased prediction-error signaling and are thus imbued with aberrant salience. We suggest that the individual’s attempt to explain the aberrant salience of thoughts results in their interpretation as being inserted by an alien agent, similarly to the emergence of delusions in response to the aberrant salience of sensory stimuli.
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Affiliation(s)
- Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Aaron L Mishara
- Department of Clinical Psychology, Chicago School of Professional Psychology, Southern California Campus Los Angeles, CA, USA
| | - Martin Voss
- Department of Psychiatry and Psychotherapy, Charité University Hospital and St. Hedwig Hospital Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
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Poppe AB, Barch DM, Carter CS, Gold JM, Ragland JD, Silverstein SM, MacDonald AW. Reduced Frontoparietal Activity in Schizophrenia Is Linked to a Specific Deficit in Goal Maintenance: A Multisite Functional Imaging Study. Schizophr Bull 2016; 42:1149-57. [PMID: 27060129 PMCID: PMC4988742 DOI: 10.1093/schbul/sbw036] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with schizophrenia (SZ) previously demonstrated specific deficits in an executive function known as goal maintenance, associated with reduced middle frontal gyrus (MFG) activity. This study aimed to validate a new tool-the Dot Pattern Expectancy (DPX) task-developed to facilitate multisite imaging studies of goal maintenance deficits in SZ or other disorders. Additionally, it sought to arrive at recommendations for scan length for future studies using the DPX. Forty-seven SZ and 56 healthy controls (HC) performed the DPX in 3-Tesla functional magnetic resonance imaging (fMRI) scanners at 5 sites. Group differences in DPX-related activity were examined with whole brain voxelwise analyses. SZs showed the hypothesized specific performance deficits with as little as 1 block of data. Reduced activity in SZ compared with HC was observed in bilateral frontal pole/MFG, as well as left posterior parietal lobe. Efficiency analyses found significant group differences in activity using 18 minutes of scan data but not 12 minutes. Several behavioral and imaging findings from the goal maintenance literature were robustly replicated despite the use of different scanners at different sites. We did not replicate a previous correlation with disorganization symptoms among patients. Results were consistent with an executive/attention network dysfunction in the higher levels of a cascading executive system responsible for goal maintenance. Finally, efficiency analyses found that 18 minutes of scanning during the DPX task is sufficient to detect group differences with a similar sample size.
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Affiliation(s)
- Andrew B. Poppe
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Deanna M. Barch
- Departments of Psychology & Brain Science, Radiology, and Psychiatry, Washington University School of Medicine, St Louis, MO
| | - Cameron S. Carter
- Department of Psychiatry, University of California at Davis, Sacramento, CA;,Department of Psychology, University of California at Davis, Davis, CA, USA
| | - James M. Gold
- Maryland Psychiatric Research Center and University of Maryland School of Medicine, Baltimore, MD
| | | | - Steven M. Silverstein
- Department of Psychiatry, Rutgers–Robert Wood Johnson Medical School, Piscataway, NJ
| | - Angus W. MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN;,Department of Psychiatry, University of Minnesota, Minneapolis, MN,*To whom correspondence should be addressed; Department of Psychology, University of Minnesota, 75 E River Road, Minneapolis, MN 55455, US; tel: 612-624-3813; fax: 612-625-6668, e-mail:
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Johnson MK. Cognitive Neuroscience: Applied Cognitive Psychology. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2016. [DOI: 10.1016/j.jarmac.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Parikh V, Kutlu MG, Gould TJ. nAChR dysfunction as a common substrate for schizophrenia and comorbid nicotine addiction: Current trends and perspectives. Schizophr Res 2016; 171:1-15. [PMID: 26803692 PMCID: PMC4762752 DOI: 10.1016/j.schres.2016.01.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/07/2016] [Accepted: 01/10/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The prevalence of tobacco use in the population with schizophrenia is enormously high. Moreover, nicotine dependence is found to be associated with symptom severity and poor outcome in patients with schizophrenia. The neurobiological mechanisms that explain schizophrenia-nicotine dependence comorbidity are not known. This study systematically reviews the evidence highlighting the contribution of nicotinic acetylcholine receptors (nAChRs) to nicotine abuse in schizophrenia. METHODS Electronic data bases (Medline, Google Scholar, and Web of Science) were searched using the selected key words that match the aims set forth for this review. A total of 276 articles were used for the qualitative synthesis of this review. RESULTS Substantial evidence from preclinical and clinical studies indicated that dysregulation of α7 and β2-subunit containing nAChRs account for the cognitive and affective symptoms of schizophrenia and nicotine use may represent a strategy to remediate these symptoms. Additionally, recent meta-analyses proposed that early tobacco use may itself increase the risk of developing schizophrenia. Genetic studies demonstrating that nAChR dysfunction that may act as a shared vulnerability factor for comorbid tobacco dependence and schizophrenia were found to support this view. The development of nAChR modulators was considered an effective therapeutic strategy to ameliorate psychiatric symptoms and to promote smoking cessation in schizophrenia patients. CONCLUSIONS The relationship between schizophrenia and smoking is complex. While the debate for the self-medication versus addiction vulnerability hypothesis continues, it is widely accepted that a dysfunction in the central nAChRs represent a common substrate for various symptoms of schizophrenia and comorbid nicotine dependence.
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Affiliation(s)
- Vinay Parikh
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA 19112, United States.
| | - Munir Gunes Kutlu
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA 19112, United States
| | - Thomas J Gould
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA 19112, United States
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MacDonald III AW, Zick JL, Chafee MV, Netoff TI. Integrating Insults: Using Fault Tree Analysis to Guide Schizophrenia Research across Levels of Analysis. Front Hum Neurosci 2016; 9:698. [PMID: 26779007 PMCID: PMC4702292 DOI: 10.3389/fnhum.2015.00698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/11/2015] [Indexed: 12/13/2022] Open
Abstract
The grand challenges of schizophrenia research are linking the causes of the disorder to its symptoms and finding ways to overcome those symptoms. We argue that the field will be unable to address these challenges within psychiatry's standard neo-Kraepelinian (DSM) perspective. At the same time the current corrective, based in molecular genetics and cognitive neuroscience, is also likely to flounder due to its neglect for psychiatry's syndromal structure. We suggest adopting a new approach long used in reliability engineering, which also serves as a synthesis of these approaches. This approach, known as fault tree analysis, can be combined with extant neuroscientific data collection and computational modeling efforts to uncover the causal structures underlying the cognitive and affective failures in people with schizophrenia as well as other complex psychiatric phenomena. By making explicit how causes combine from basic faults to downstream failures, this approach makes affordances for: (1) causes that are neither necessary nor sufficient in and of themselves; (2) within-diagnosis heterogeneity; and (3) between diagnosis co-morbidity.
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Affiliation(s)
- Angus W. MacDonald III
- Department of Psychology, Translational Research in Cognitive and Affective Mechanisms, University of MinnesotaMinneapolis, MN, USA
| | - Jennifer L. Zick
- Department of Neuroscience, University of Minnesota School of MedicineMinneapolis, MN, USA
| | - Matthew V. Chafee
- Department of Neuroscience, University of Minnesota School of MedicineMinneapolis, MN, USA
- Veterans Affairs Medical CenterMinneapolis, MN, USA
| | - Theoden I. Netoff
- Department of Biomedical Engineering, University of MinnesotaMinneapolis, MN, USA
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Ragland JD, Ranganath C, Harms MP, Barch DM, Gold JM, Layher E, Lesh TA, MacDonald AW, Niendam TA, Phillips J, Silverstein SM, Yonelinas AP, Carter CS. Functional and Neuroanatomic Specificity of Episodic Memory Dysfunction in Schizophrenia: A Functional Magnetic Resonance Imaging Study of the Relational and Item-Specific Encoding Task. JAMA Psychiatry 2015; 72. [PMID: 26200928 PMCID: PMC4558363 DOI: 10.1001/jamapsychiatry.2015.0276] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Individuals with schizophrenia can encode item-specific information to support familiarity-based recognition but are disproportionately impaired encoding interitem relationships (relational encoding) and recollecting information. The Relational and Item-Specific Encoding (RiSE) paradigm has been used to disentangle these encoding and retrieval processes, which may depend on specific medial temporal lobe (MTL) and prefrontal cortex (PFC) subregions. Functional magnetic resonance (fMRI) imaging during RiSE task performance could help to specify dysfunctional neural circuits in schizophrenia that can be targeted for interventions to improve memory and functioning in the illness. OBJECTIVES To use fMRI to test the hypothesis that schizophrenia disproportionately affects MTL and PFC subregions during relational encoding and retrieval relative to item-specific memory processes, and to use fMRI results from healthy individuals serving as controls to establish neural construct validity for RiSE. DESIGN, SETTING, AND PARTICIPANTS This multisite, case-control, cross-sectional fMRI study was conducted between November 1, 2010, and May 30, 2012, at 5 Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia sites. The final sample included 52 outpatients with clinically stable schizophrenia and 57 demographically matched healthy control participants. Data analysis was performed between February 1, 2013, and May 30, 2014. MAIN OUTCOMES AND MEASURES Behavioral performance speed and accuracy (d') on item recognition and associative recognition tasks. Voxelwise statistical parametric maps for a priori MTL and PFC regions of interest to test activation differences between relational and item-specific memory during encoding and retrieval. RESULTS Item recognition was disproportionately impaired in patients with schizophrenia relative to healthy control participants following relational encoding (F1,107 = 4.7; P = .03). The differential deficit was accompanied by reduced dorsolateral PFC activation during relational encoding in patients with schizophrenia compared with healthy control participants (z > 2.3; P < .05 corrected). Retrieval success (hits > misses) was associated with hippocampal activation in healthy control participants during relational item recognition and associative recognition conditions, and hippocampal activation was specifically reduced in schizophrenia for recognition of relational but not item-specific information (z > 2.3; P < .05 corrected). CONCLUSIONS AND RELEVANCE In this unique, multisite fMRI study, results in the healthy control group supported RiSE construct validity by revealing expected memory effects in PFC and MTL subregions during encoding and retrieval. Comparison of schizophrenic and healthy control participants revealed disproportionate memory deficits in schizophrenia for relational vs item-specific information, accompanied by regionally and functionally specific deficits in dorsolateral PFC and hippocampal activation.
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Affiliation(s)
| | | | - Michael P. Harms
- Washington University School of Medicine, St Louis - Department of Psychiatry
| | - Deanna M. Barch
- Washington University School of Medicine, St Louis - Department of Psychiatry
| | - James M. Gold
- University of Maryland - Maryland Psychiatric Research Center
| | - Evan Layher
- University of California at Davis - Department of Psychiatry
| | - Tyler A. Lesh
- University of California at Davis - Department of Psychiatry
| | | | - Tara A. Niendam
- University of California at Davis - Department of Psychiatry
| | - Joshua Phillips
- University of California at Davis - Department of Psychiatry
| | | | | | - Cameron S. Carter
- University of California at Davis - Department of Psychiatry,University of California at Davis - Department of Psychology
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Tiberghien G, Martin C, Baudouin JY, Franck N, Guillaume F, Huron C. Face recognition in schizophrenia: do individual and average ROCs tell the same story? Cogn Neuropsychiatry 2015; 20:14-30. [PMID: 25223545 DOI: 10.1080/13546805.2014.955171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Many studies have shown that recollection process is impaired in patients with schizophrenia, whereas familiarity is generally spared. However, in these studies, the Receiver Operating Characteristic (ROC) presented is average ROC likely to mask individual differences. METHODS In the present study using a face-recognition task, we computed the individual ROC of patients with schizophrenia and control participants. Each group was divided into two subgroups on the basis of the type of recognition processes implemented: recognition based on familiarity only and recognition based on familiarity and recollection. RESULTS The recognition performance of the schizophrenia patients was below that of the control participants only when recognition was based solely on familiarity. For the familiarity-alone patients, the score obtained on the Scale for the Assessment of Positive Symptoms (SAPS) was correlated with the variance of the old-face familiarity. For the familiarity-recollection patients, the score obtained on the Scale for the Assessment of Negative Symptoms (SANS) was correlated with the decision criterion and with the old-face recollection probability. CONCLUSIONS These results show that one cannot ascribe the impaired recognition observed in patients with schizophrenia to a recollection deficit alone. These results show that individual ROC can be used to distinguish between subtypes of schizophrenia and could serve as a basis for setting up specific cognitive remediation therapy for individuals with schizophrenia.
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Affiliation(s)
- Guy Tiberghien
- a Laboratory Language, Brain and Cognition (CNRS) , Claude Bernard University , Lyon , France
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Abstract
The article by Lillienfeld in this issue comprises a thoughtful critique of the Research Domain Criteria (RDoC) project initiated by the National Institute of Mental Health, and includes four specific theoretical and methodological challenges along with recommendations to address each one. In this commentary, I briefly consider each of the four challenges in turn, noting points of agreement and also clarifying selected points from the NIMH RDoC perspective. Overall, Lillienfeld's paper represents a valuable contribution to the RDoC literature as research conducted with the new framework continues to accelerate.
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Affiliation(s)
- Bruce N Cuthbert
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
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English BA, Thomas K, Johnstone J, Bazih A, Gertsik L, Ereshefsky L. Use of translational pharmacodynamic biomarkers in early-phase clinical studies for schizophrenia. Biomark Med 2014; 8:29-49. [PMID: 24325223 DOI: 10.2217/bmm.13.135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Schizophrenia is a severe mental disorder characterized by cognitive deficits, and positive and negative symptoms. The development of effective pharmacological compounds for the treatment of schizophrenia has proven challenging and costly, with many compounds failing during clinical trials. Many failures occur due to disease heterogeneity and lack of predictive preclinical models and biomarkers that readily translate to humans during early characterization of novel antipsychotic compounds. Traditional early-phase trials consist of single- or multiple-dose designs aimed at determining the safety and tolerability of an investigational compound in healthy volunteers. However, by incorporating a translational approach employing methodologies derived from preclinical studies, such as EEG measures and imaging, into the traditional Phase I program, critical information regarding a compound's dose-response effects on pharmacodynamic biomarkers can be acquired. Furthermore, combined with the use of patients with stable schizophrenia in early-phase clinical trials, significant 'de-risking' and more confident 'go/no-go' decisions are possible.
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Strauss ME, McLouth CJ, Barch DM, Carter CS, Gold JM, Luck SJ, MacDonald AW, Ragland JD, Ranganath C, Keane BP, Silverstein SM. Temporal stability and moderating effects of age and sex on CNTRaCS task performance. Schizophr Bull 2014; 40:835-44. [PMID: 23817024 PMCID: PMC4059430 DOI: 10.1093/schbul/sbt089] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Research in schizophrenia has increasingly focused on incorporating measures from cognitive neuroscience, but little is known about their psychometric characteristics. Here, we extend prior research by reporting on temporal stability, as well as age and sex effects, for cognitive neuroscience paradigms optimized as part of the Cognitive Neuroscience Test Reliability and Clinical applications for Schizophrenia consortium. Ninety-nine outpatients with schizophrenia and 131 healthy controls performed 5 tasks assessing 4 constructs at 3 sessions. The constructs were (1) Goal maintenance (Dot Probe Expectancy [DPX] and AX continuous performance tasks [AX-CPT]); (2) Episodic memory (Relational and Item-Specific Encoding and Retrieval task [RiSE]); (3) Visual integration (Jittered Orientation Visual Integration task [JOVI]); and (4) Perceptual gain control (Contrast-Contrast Effect Task [CCE]). Patients performed worse than controls on all but the CCE, and the magnitude of these group differences was stable across sessions, with no sex differences observed. Improvements over sessions were seen for the AX-CPT, the DPX, and the JOVI though practice effects for the AX-CPT and the DPX were primarily present in older participants. For the AX-CPT and the JOVI, practice effects were larger for T1 to T2 than for T2 to T3. Age was associated with poor associative recognition on the RiSE and accuracy on the JOVI. Test-rest reliability ranged from poor for the JOVI threshold score to adequate to good for the DPX, AX-CPT, and JOVI accuracy measures, with RiSE and CCE measures in the moderate range. These results suggest that group differences in DPX, AX-CPT, RiSE, and JOVI are robust and consistent across repeated testing.
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Affiliation(s)
- Milton E Strauss
- Department of Psychology, University of New Mexico, Albuquerque, NM;
| | | | - Deanna M Barch
- Department of Psychology, Washington University, St Louis, MO
| | | | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD
| | - Steven J Luck
- Department of Psychology, University of California, Davis, CA
| | | | | | | | - Brian P Keane
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ; Center for Cognitive Science, Rutgers University, New Brunswick, NJ
| | - Steven M Silverstein
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ
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Reilly JL, Sweeney JA. Generalized and specific neurocognitive deficits in psychotic disorders: utility for evaluating pharmacological treatment effects and as intermediate phenotypes for gene discovery. Schizophr Bull 2014; 40:516-22. [PMID: 24574307 PMCID: PMC3984526 DOI: 10.1093/schbul/sbu013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A growing body of research suggests that schizophrenia and bipolar disorder share overlapping clinical, neurobiological, and genetic features, raising important questions about the boundaries and distinctiveness of these 2 major psychiatric disorders. A generalized cognitive impairment has long been understood to be a core feature of schizophrenia. More recently, it has become apparent that cognitive impairment also occurs in bipolar disorder, particularly in those patients with a history of psychotic symptoms. Whether a generalized deficit exists across a spectrum of psychotic disorders is less clearly established. Additionally, in the context of a broad impairment, it remains a significant challenge to identify deficits in specific cognitive processes that may have distinct neurochemical or regional brain substrates and linkages to particular risk-associated genetic factors. In this article, we review the findings from neuropsychological studies across a spectrum that includes schizophrenia, schizoaffective and bipolar disorders, and conclude the available evidence strongly supports that a generalized deficit is present across psychotic disorders that differs in severity more so than form. We then consider the implications of generalized and specific deficits in psychosis for 2 areas of research--the evaluation of pharmacological treatments targeting cognitive deficits, and the investigation of cognitive intermediate phenotypes in family genetic studies. Examples from the literature that touch on the relevance of the generalized deficit in these contexts are provided, as well as consideration for the continued need to identify specific impairments that are separable from the generalized deficit in order to advance drug and gene discovery.
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Affiliation(s)
- James L. Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL;,*To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Street Suite 7–100, Chicago, IL, US; tel: 312-503-4809, fax: 312-503-0527, e-mail:
| | - John A. Sweeney
- Departments of Psychiatry and Pediatrics, UT Southwestern Medical Center, Dallas, TX
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Tso IF, Carp J, Taylor SF, Deldin PJ. Role of visual integration in gaze perception and emotional intelligence in schizophrenia. Schizophr Bull 2014; 40:617-25. [PMID: 23666503 PMCID: PMC3984511 DOI: 10.1093/schbul/sbt058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Individuals with schizophrenia demonstrate a wide range of social cognitive deficits that significantly compromise functioning. Early visual processing is frequently disrupted in schizophrenia, and growing evidence suggests a role of perceptual dysfunctions in socioemotional functioning in the disorder. This study examined visual integration (the ability to effectively integrate individual, local visual features into a holistic representation), a target construct of basic perception identified by the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia initiative, and its relationship with eye- contact perception and emotional intelligence in schizophrenia. METHODS Twenty-nine participants with schizophrenia (SCZ) and 23 healthy controls (HC) completed tasks measuring visual integration (Coherent Motion Task, Contour Integration Task), an eye-contact perception task, and a measure of emotional intelligence. RESULTS SCZ participants showed compromised visual integration as suggested by poorer performance on the Contour Integration Task relative to HC. Visual integration was a significant predictor of eye-contact perception and emotional intelligence among SCZ. The amounts of variances in these 2 social cognitive areas accounted for by visual integration were comparable to and overlapped with those accounted for by the diagnosis of schizophrenia. CONCLUSIONS Individuals with schizophrenia showed compromised visual integration, and this may play a significant role in the observed deficits in higher level processing of social information in the disorder.
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Affiliation(s)
- Ivy F. Tso
- Department of Psychology, University of Michigan, Ann Arbor, MI;,Department of Psychiatry, University of Michigan, Ann Arbor, MI,*To whom correspondence should be addressed; 4250 Plymouth Road, Ann Arbor, MI 48109, US; tel: (734) 232-0373, fax: (734) 736-7868, e-mail:
| | - Joshua Carp
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | | | - Patricia J. Deldin
- Department of Psychology, University of Michigan, Ann Arbor, MI;,Department of Psychiatry, University of Michigan, Ann Arbor, MI
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