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Myin-Germeys I, Schick A, Ganslandt T, Hajdúk M, Heretik A, Van Hoyweghen I, Kiekens G, Koppe G, Marelli L, Nagyova I, Weermeijer J, Wensing M, Wolters M, Beames J, de Allegri M, di Folco S, Durstewitz D, Katreniaková Z, Lievevrouw E, Nguyen H, Pecenak J, Barne I, Bonnier R, Brenner M, Čavojská N, Dancik D, Kurilla A, Niebauer E, Sotomayor-Enriquez K, Schulte-Strathaus J, de Thurah L, Uyttebroek L, Schwannauer M, Reininghaus U. The experience sampling methodology as a digital clinical tool for more person-centered mental health care: an implementation research agenda. Psychol Med 2024:1-9. [PMID: 39247942 DOI: 10.1017/s0033291724001454] [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: 09/10/2024]
Abstract
This position paper by the international IMMERSE consortium reviews the evidence of a digital mental health solution based on Experience Sampling Methodology (ESM) for advancing person-centered mental health care and outlines a research agenda for implementing innovative digital mental health tools into routine clinical practice. ESM is a structured diary technique recording real-time self-report data about the current mental state using a mobile application. We will review how ESM may contribute to (1) service user engagement and empowerment, (2) self-management and recovery, (3) goal direction in clinical assessment and management of care, and (4) shared decision-making. However, despite the evidence demonstrating the value of ESM-based approaches in enhancing person-centered mental health care, it is hardly integrated into clinical practice. Therefore, we propose a global research agenda for implementing ESM in routine mental health care addressing six key challenges: (1) the motivation and ability of service users to adhere to the ESM monitoring, reporting and feedback, (2) the motivation and competence of clinicians in routine healthcare delivery settings to integrate ESM in the workflow, (3) the technical requirements and (4) governance requirements for integrating these data in the clinical workflow, (5) the financial and competence related resources related to IT-infrastructure and clinician time, and (6) implementation studies that build the evidence-base. While focused on ESM, the research agenda holds broader implications for implementing digital innovations in mental health. This paper calls for a shift in focus from developing new digital interventions to overcoming implementation barriers, essential for achieving a true transformation toward person-centered care in mental health.
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Affiliation(s)
- Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Ganslandt
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michal Hajdúk
- Department of Psychology, Faculty of Arts, Comenius University Bratislava, Bratislava, Slovakia
- Department of Psychiatry, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Anton Heretik
- Department of Psychology, Faculty of Arts, Comenius University Bratislava, Bratislava, Slovakia
| | - Ine Van Hoyweghen
- Life Sciences & Society Lab, Centre for Sociological Research, KU Leuven, Belgium
| | - Glenn Kiekens
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
- Research Group Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Georgia Koppe
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Clinic for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty, Heidelberg University, Mannheim, Germany
- Medical Faculty, Hector Institut for AI in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Luca Marelli
- Life Sciences & Society Lab, Centre for Sociological Research, KU Leuven, Belgium
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Italy
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, Pavol Jozef (PJ) Safarik University in Kosice, Kosice, Slovakia
| | - Jeroen Weermeijer
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Michel Wensing
- Heidelberg University, Heidelberg, Germany (Prof. Michel Wensing PhD), Department General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Maria Wolters
- OFFIS Institute for Information Technology, Oldenburg, Germany
| | - Joanne Beames
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Manuela de Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Simona di Folco
- Department of Clinical Psychology Doorway 6, University of Edinburgh, Elsie Inglis Quad, Teviot Place Edinburgh, Edinburgh, EH8 9AG, UK
| | - Daniel Durstewitz
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Interdisciplinary Center for Scientific Computing, Heidelberg University, Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Zuzana Katreniaková
- Department of Social and Behavioural Medicine, Faculty of Medicine, Pavol Jozef (PJ) Safarik University in Kosice, Kosice, Slovakia
| | - Elisa Lievevrouw
- Life Sciences & Society Lab, Centre for Sociological Research, KU Leuven, Belgium
- Meaningful Intereactions Lab (MintLab), Institute for Media Studies (IMS), KU Leuven, Belgium
| | - Hoa Nguyen
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jan Pecenak
- Department of Psychiatry, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Islay Barne
- Department of Clinical Psychology Doorway 6, University of Edinburgh, Elsie Inglis Quad, Teviot Place Edinburgh, Edinburgh, EH8 9AG, UK
| | - Rafael Bonnier
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Manuel Brenner
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Natália Čavojská
- Department of Psychiatry, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Daniel Dancik
- Department of Psychology, Faculty of Arts, Comenius University Bratislava, Bratislava, Slovakia
- Department of Psychiatry, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Adam Kurilla
- Department of Psychology, Faculty of Arts, Comenius University Bratislava, Bratislava, Slovakia
| | - Erica Niebauer
- Department of Clinical Psychology Doorway 6, University of Edinburgh, Elsie Inglis Quad, Teviot Place Edinburgh, Edinburgh, EH8 9AG, UK
| | - Koraima Sotomayor-Enriquez
- Department of Clinical Psychology Doorway 6, University of Edinburgh, Elsie Inglis Quad, Teviot Place Edinburgh, Edinburgh, EH8 9AG, UK
| | - Julia Schulte-Strathaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena de Thurah
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Lotte Uyttebroek
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Matthias Schwannauer
- Department of Clinical Psychology Doorway 6, University of Edinburgh, Elsie Inglis Quad, Teviot Place Edinburgh, Edinburgh, EH8 9AG, UK
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- German Center for Mental Health (DZPG), Partner Site Mannheim-Heidelberg-Ulm, Germany
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2
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Irwin L, Berry K, Bell T, Carter LA, Udachina A. Momentary displays of compassion and the relationship between psychosis, mood and risk incidents on inpatient wards: An experience sampling study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 39233367 DOI: 10.1111/bjc.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/23/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES Psychosis can be thought of as a threat-based experience. Compassion has been shown to be effective in reducing threat, although highly distressed individuals may struggle to be self-compassionate. This study explored the effects of compassionate interactions with staff on inpatients with psychosis. METHOD Experience Sampling Method (ESM) was used to investigate the relationships between compassion from staff and paranoia, voice hearing, distress related to psychosis experiences, affect and risk incidents in daily life. Twenty-two service users residing on inpatient mental health wards took part. Baseline measures of compassion, fears of compassion and affect were taken. Participants completed ESM assessments 10 times per day, over 6 days. RESULTS Compassion from staff was associated with a small increase in voice hearing, but was not associated with paranoia, paranoia-related distress, voice-related distress, negative affect, positive affect, or risk incidents in daily life. Baseline fears of compassion moderated the relationships between compassion from staff and some of the service user outcomes. For inpatients scoring low on fears of compassion, compassionate interactions were associated with increased positive affect and lower paranoia. However, for those scoring high on fears of compassion, this relationship was reversed, and compassionate interactions were associated with higher paranoia and lower positive affect. CONCLUSION People with psychosis who have fears of compassion may benefit from receiving support to address these fears in order to experience the benefit from the compassion of staff. The results should be interpreted with caution due to the low number of observations and limited statistical power.
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Affiliation(s)
- Leanne Irwin
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Tobyn Bell
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Gleeson JF, McGuckian TB, Fernandez DK, Fraser MI, Pepe A, Taskis R, Alvarez-Jimenez M, Farhall JF, Gumley A. Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders. Clin Psychol Rev 2024; 107:102357. [PMID: 38065010 DOI: 10.1016/j.cpr.2023.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade. METHOD We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms. RESULTS Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = -0.01, 1.63). CONCLUSIONS Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.
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Affiliation(s)
- J F Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia.
| | - T B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - D K Fernandez
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M I Fraser
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - A Pepe
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - R Taskis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - J F Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | - A Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Lüdtke T, Hedelt KS, Westermann S. Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies. J Behav Ther Exp Psychiatry 2023; 81:101885. [PMID: 37354896 DOI: 10.1016/j.jbtep.2023.101885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d). METHODS We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994. RESULTS Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data. LIMITATIONS The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations. CONCLUSIONS Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany.
| | | | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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5
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Fanti E, Di Sarno M, Di Pierro R. In search of hidden threats: A scoping review on paranoid presentations in personality disorders. Clin Psychol Psychother 2023; 30:1215-1233. [PMID: 37727949 DOI: 10.1002/cpp.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.
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Affiliation(s)
- Erika Fanti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
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Abel DB, Minor KS. Social pleasure in daily life: A meta-analysis of experience sampling studies in schizophrenia. Schizophr Res 2023; 260:56-64. [PMID: 37625224 DOI: 10.1016/j.schres.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/19/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
Social anhedonia is considered a key feature of schizophrenia that leads to impaired social functioning. Although traditional laboratory measures assess non-current social pleasure, researchers have begun using experience sampling methods (ESM) to measure current, or consummatory, experiences of social pleasure in daily life. A recent meta-analysis examined deficits in consummatory social pleasure in schizophrenia and found vast heterogeneity in effect sizes across ESM studies. Thus, this meta-analysis aimed to extend those results by testing moderators of this effect. Meta-analysis of 14 ESM studies suggests those with psychotic disorders exhibit a moderate deficit in consummatory social pleasure compared to healthy controls. Yet, this effect was significantly moderated by the type of measure used to assess social pleasure. Measures that directly assessed positive emotional experience during socialization yielded small effects that failed to reach significance; indirect measures of other social factors related to pleasure yielded large, significant effects. This suggests daily social anhedonia observed in psychotic disorders is not due to reduced experience of positive emotion. Instead, social anhedonia may be driven by other elements of social functioning. Most clinical variables did not influence effects, but there was a trend such that patient groups with lower cognitive functioning exhibited greater pleasure deficits. Inconsistent reporting across studies limited our ability to examine other real-world variables that may contribute to deficits in social pleasure. Yet, results show different ESM items used to measure social pleasure do not assess the same construct. Future research is needed to validate ESM measures and standardize protocols across studies.
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Affiliation(s)
- Danielle B Abel
- Indiana University-Purdue University Indianapolis, 402 N Blackford St, Indianapolis, IN 46202, United States.
| | - Kyle S Minor
- Indiana University-Purdue University Indianapolis, 402 N Blackford St, Indianapolis, IN 46202, United States
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Soyster PD, Song F, Fisher AJ. Clinician Opinions: Perceived Utility of and Barriers to Incorporating Pretreatment Ecological Momentary Assessment Into Clinical Care. Behav Ther 2023; 54:200-213. [PMID: 36858754 DOI: 10.1016/j.beth.2022.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Abstract
Increasingly, clinicians have the option of including technological components into clinical care. However, little research has assessed clinicians' interest in utilizing technology in their clinical work. Here, clinicians reported their opinions related to using a mobile assessment platform (MAP) to collect ecological data from clients before providing clinical care. Practicing and training mental health clinicians (N = 221) reported demographics, characteristics of their clinical work, and confidence in their clinical skill. Participants then read a description of MAP and responded to questions about their perceived benefits of and barriers to its use. Last, participants rated their interest in using MAP in their clinical work. These perceptions were then factor-analyzed and the resulting factor scores were regressed onto clinician characteristics. Interest in using MAP was significantly lower for the group that endorsed a psychodynamic/psychoanalytic orientation and those with greater confidence in their clinical skills. Across scales, we found a pattern that participants who did not identify as male, those with a psychodynamic/psychoanalytic orientation, and those with greater confidence in their clinical skills tended to have lower ratings of the benefits of and higher ratings for the barriers to using MAP. Results revealed that significant differences in opinions about incorporating technology into clinical work exist between different groups of clinicians. This information may be useful in future work that attempts to implement technological tools into clinical settings.
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Fan L, Bass E, Klein H, Springfield C, Pinkham A. A preliminary investigation of paranoia variability and its association with social functioning. Schizophr Res Cogn 2022; 29:100258. [PMID: 35620385 PMCID: PMC9126935 DOI: 10.1016/j.scog.2022.100258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/21/2022]
Abstract
Background Paranoid ideation is a core feature of psychosis and is associated with impaired social functioning. Severity of paranoia can fluctuate across time as symptoms wax and wane; however, no study has systematically investigated how this intra-individual variability in paranoia may relate to social impairments and social functioning. Methods Fifty-five patients with DSM-5 diagnoses and recent paranoia were followed for up to one year and completed the suspiciousness/persecution section (P6) of the Positive and Negative Symptom Scale (PANSS) on a monthly basis to monitor fluctuations in paranoia. Categorical changes between paranoid and non-paranoid status were monitored and tallied. Participants self-reported current paranoia and anxiety levels as well as social functioning when demonstrating paranoia changes. Results Most patients showed changes between paranoid categories (60%). Individuals with no paranoia change showed higher current paranoia and lower independence-competence subscores of the Birchwood Social Functioning Scale (SFS) compared with those with one change. Current paranoia and state anxiety explained significant variance in the prosocial activities subscore of SFS, and importantly, paranoia changes accounted for variance above and beyond these effects. Individuals with higher current paranoia participated less in prosocial activities, however those with higher paranoia variability were more involved in social activities. Similarly, individuals with more paranoia variability demonstrated better overall social functioning as measured by the averaged SFS total score. Conclusion Paranoia fluctuation is prevalent across time, and both paranoia severity and variability impact social functioning, in that lower levels of paranoia severity and higher levels of paranoia variability are associated with better interpersonal functioning.
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Affiliation(s)
- Linlin Fan
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Emily Bass
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Hans Klein
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Cassi Springfield
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Amy Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
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Stress and emotional arousal in urban environments: A biosocial study with persons having experienced a first-episode of psychosis and persons at risk. Health Place 2022; 75:102762. [PMID: 35286900 DOI: 10.1016/j.healthplace.2022.102762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
This article examines the entanglement between feelings of stress and discomfort, physiological arousal and urban experiences of persons living with early psychosis. It adopts a biosocial approach, using mixed methods combining ambulatory skin conductance monitoring, mobile interviews and contextual data, collected through GPS and video recordings. The study draws on and strives to cross-fertilize two recent strands of research. The first relates to the use of digital phenotyping in mental health research. The second explores stress and emotional arousal in cities using ambulatory physiological measures. Empirically, the paper is based on fieldwork in Basel, Switzerland, with nine participants recruited within the Basel Early Treatment Service (BEATS), and four controls. We focus on three salient elements in our results: visual perception of moving bodies, spatial transitions and openness and enclosure of the built environment. The analysis shows how these elements elicit physiological responses of arousal and expressed feelings of discomfort. In the concluding section we discuss the methodological implications of these results and suggest the notion of regime of attention as a focus for future biosocial research on urban mental health.
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10
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Hajdúk M, Pinkham AE, Penn DL, Harvey PD, Sasson NJ. Heterogeneity of social cognitive performance in autism and schizophrenia. Autism Res 2022; 15:1522-1534. [PMID: 35460541 DOI: 10.1002/aur.2730] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
Autistic adults and those with schizophrenia (SCZ) demonstrate similar levels of reduced social cognitive performance at the group level, but it is unclear whether these patterns are relatively consistent or highly variable within and between the two conditions. Seventy-two adults with SCZ (52 male, Mage = 28.2 years) and 94 with diagnoses on the autism spectrum (83 male, Mage = 24.2 years) without intellectual disability completed a comprehensive social cognitive battery. Latent profile analysis identified four homogeneous subgroups that were compared on their diagnosis, independent living skills, neurocognition, and symptomatology. Two groups showed normative performance across most social cognitive tasks but were differentiated by one having significantly higher hostility and blaming biases. Autistic participants were more likely to demonstrate fully normative performance (46.8%) than participants with SCZ, whereas normative performance in SCZ was more likely to co-occur with increased hostility and blaming biases (36.1%). Approximately 43% of participants in the full sample were classified into the remaining two groups showing low or very low performance. These participants tended to perform worse on neurocognitive tests and have lower IQ and fewer independent living skills. The prevalence of low performance on social cognitive tasks was comparable across clinical groups. However, nearly half of autistic participants demonstrated normative social cognitive performance, challenging assumptions that reduced social cognitive performance is inherent to the condition. Subgrouping also revealed a meaningful distinction between the clinical groups: participants with SCZ were more likely to demonstrate hostility biases than autistic participants, even when social cognitive performance was otherwise in the typical range. LAY SUMMARY: Social cognition refers to the perception and interpretation of social information. Previous research has shown that both autistic people and those with schizophrenia demonstrate reduced performance on traditional social cognitive tasks, which we replicate here at the group level. However, we also found that almost half of autistic participants performed in the normal range. Over a third of participants with schizophrenia did as well, but for them this performance was accompanied by a hostility bias not commonly found in the autistic sample. Taken together, findings challenge assumptions that difficulties in social cognition are a uniform characteristic of these clinical conditions in those without intellectual disability.
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Affiliation(s)
- Michal Hajdúk
- Department of Psychology, Faculty of Arts, Comenius University in Bratislava, Bratislava, Slovakia.,Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.,Science Park UK, Center for Psychiatric Disorders Research, Bratislava, Slovakia
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Research Service, Miami VA Healthcare System, Miami, Florida, USA
| | - Noah J Sasson
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA
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Raugh IM, James SH, Gonzalez CM, Chapman HC, Cohen AS, Kirkpatrick B, Strauss GP. Digital phenotyping adherence, feasibility, and tolerability in outpatients with schizophrenia. J Psychiatr Res 2021; 138:436-443. [PMID: 33964681 PMCID: PMC8192468 DOI: 10.1016/j.jpsychires.2021.04.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
Digital phenotyping has potential for use as an objective and ecologically valid form of symptom assessment in clinical trials for schizophrenia. However, there are critical methodological factors that must be addressed before digital phenotyping can be used for this purpose. The current study evaluated levels of adherence, feasibility, and tolerability for active (i.e., signal and event contingent ecological momentary assessment surveys) and passive (i.e., geolocation, accelerometry, and ambulatory psychophysiology) digital phenotyping methods recorded from smartphone and smartband devices. Participants included outpatients diagnosed with schizophrenia (SZ: n = 54) and demographically matched healthy controls (CN: n = 55), who completed 6 days of digital phenotyping. Adherence was significantly lower in SZ than CN for active recordings, but not markedly different for passive recordings. Some forms of passive recordings had lower adherence (ambulatory psychophysiology) than others (accelerometry and geolocation). Active digital phenotyping adherence was predicted by higher psychosocial functioning, whereas passive digital phenotyping adherence was predicted by education, positive symptoms, negative symptoms, and psychosocial functioning in people with SZ. Both groups found digital phenotyping methods tolerable and feasibility was supported by low frequency of invalid responding, brief survey completion times, and similar impediments to study completion. Digital phenotyping methods can be completed by individuals with SZ with good adherence, feasibility, and tolerability. Recommendations are provided for using digital phenotyping methods in clinical trials for SZ.
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Affiliation(s)
- Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Sydney H. James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | | | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA,Correspondence concerning this article should be addressed to Gregory P. Strauss, Ph.D., . Phone: +1-706-542-0307. Fax: +1-706-542-3275. University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602
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12
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Li H, Yang S, Chi H, Xu L, Zhang T, Singleton G, Tang Y, Stone WS, Wang J. Enhancing attention and memory of individuals at clinical high risk for psychosis with mHealth technology. Asian J Psychiatr 2021; 58:102587. [PMID: 33618070 DOI: 10.1016/j.ajp.2021.102587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive impairment has adverse impact on the social and role functions of those at clinical high risk for psychosis and it has become an important target for intervention. Mobile health applications are user-friendly, real-time, personalized and portable in administering cognitive training and have promising application prospects in the field of mental health. METHODS Eighty CHR subjects were randomized into an intervention group and a control group. CHR subjects of the intervention group performed attention and memory training via a Specific Memory Attention Resource and Training (SMART) application in their smart phones for 10 min per day, five days per week for three months. Both groups were followed up for three months. At baseline and follow-up phases, cognitive function was measured using the MATRICS Consensus Cognitive Battery (MCCB). In the follow-up, the intervention group completed the Mobile Application Rating Scale (MARS) to provide feedback to improve SMART. RESULTS There is a significant group by time interaction effect in the Attention/Vigilance domain, which is significantly better in the intervention group than in the control group at 3- month follow-up. The improvement in Attention/Vigilance in the intervention group is significantly related to the amount of cognitive training time. Global Assessment of Function (GAF) reduction rate at baseline could predict the improvement of Attention/Vigilance. MARS results indicate that CHR subjects were receptive of SMART. CONCLUSION Mobile technology can be applied to improve cognitive function of CHR individuals, especially in the Attention/Vigilance domain.
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Affiliation(s)
- Huijun Li
- Florida A&M University, 501 Orr Drive, Psychology Department, United States.
| | - Shuwen Yang
- Shanghai Mental Health Center, 600 Wanping Nan Road, Shanghai, China.
| | - Hongmei Chi
- Florida A&M University, 501 Orr Drive, Psychology Department, United States.
| | - Lihua Xu
- Shanghai Mental Health Center, 600 Wanping Nan Road, Shanghai, China.
| | - Tianghong Zhang
- Shanghai Mental Health Center, 600 Wanping Nan Road, Shanghai, China.
| | - Gwendolyn Singleton
- Florida A&M University, 501 Orr Drive, Psychology Department, United States.
| | - Yingying Tang
- Shanghai Mental Health Center, 600 Wanping Nan Road, Shanghai, China.
| | - William S Stone
- Beth Israel Deaconess Medical Center, 75 Fenwood Road, Boston, 02115, United States.
| | - Jijun Wang
- Shanghai Mental Health Center, 600 Wanping Nan Road, Shanghai, China.
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Moitra E, Park HS, Ben-Zeev D, Gaudiano BA. Using ecological momentary assessment for patients with psychosis posthospitalization: Opportunities for mobilizing measurement-based care. Psychiatr Rehabil J 2021; 44:43-50. [PMID: 32297774 PMCID: PMC8415125 DOI: 10.1037/prj0000417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Ecological momentary assessment (EMA) via mobile devices offers a promising approach for collecting real-time data from psychiatric patients, potentially as an augment to traditional measurement-based care strategies. This study examined whether EMA had added value in collecting clinically important data from recently hospitalized adults with psychosis, relative to traditional assessments. METHOD In a sample of 24 adults with psychosis, EMA data regarding psychotic symptoms, affect, alcohol and drug use, functioning, quality of life, and social support were collected starting immediately posthospital discharge and extending for up to one month during their transition to outpatient care. EMA data were compared with traditional retrospective assessments of the same constructs, administered at a 1-month follow-up assessment. RESULTS Data from EMA and traditional retrospective assessments were correlated with each other in most cases. However, in some cases, participants were more likely to report drug use, medication nonadherence, and psychotic symptoms via EMA compared with traditional retrospective assessments. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Results suggest that the additional information obtained via frequent in-the-moment self-reports collected using smartphones can provide an expanded picture of individuals' symptomatic and functional experiences. Thus, monitoring patients' progress posthospitalization could be improved through the use of EMA. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912USA
| | - Hyun Seon Park
- Psychosocial Research Program, Butler Hospital, Providence, RI, 02906 USA
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA
| | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912USA
- Psychosocial Research Program, Butler Hospital, Providence, RI, 02906 USA
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14
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Opoka SM, Ludwig L, Mehl S, Lincoln TM. An experimental study on the effectiveness of emotion regulation in patients with acute delusions. Schizophr Res 2021; 228:206-217. [PMID: 33453692 DOI: 10.1016/j.schres.2020.11.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/28/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with psychotic disorders report to apply more maladaptive and less adaptive emotion-regulation (ER) strategies compared to healthy controls. However, few studies have used experimental designs to investigate the success in ER and the results of those at hand are equivocal. AIM This study investigated whether patients with delusions show problems in downregulating negative affect via cognitive ER-strategies. METHOD Patients with schizophrenia spectrum disorders and acute delusions (n = 78) and healthy controls (n = 41) took part in an ER-experiment, in which they were instructed to downregulate anxiety and sadness via three ER-strategies (reappraisal, distraction, acceptance) or not to regulate their emotions (control-condition). ER-success was measured as the change in subjective emotion-intensity and physiological indicators (skin conductance and heart rate) from before to after regulation and was analyzed with mixed-repeated-measures ANOVAs. RESULTS We found a significant effect of the ER-strategy in the sense that the subjective emotion-intensity was significantly lower after applying the reappraisal- and distraction-strategies than after the just view-condition (p's < .001). This effect was not found for the acceptance strategy (p = .060). There was no ER-strategy ∗ time ∗ group interaction-effect F(4.918, 575.416) = 0.778, p = .564, ƞ2partial = 0.007. In all conditions, skin conductance decreased from pre- to post regulation (p < .001). CONCLUSION Our results indicate that patients with acute delusions can successfully apply cognitive ER-strategies. Before pursuing the relevant clinical implications of this finding, further research is needed to explore the role that the type of instruction has on ER-success and the extent to which the findings can be generalized to real life settings.
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Affiliation(s)
- Sandra M Opoka
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany.
| | - Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (CMBB), Faculty of Medicine, Philipps-University of Marburg, 35039 Marburg, Germany; Faculty of Health and Social Work, Frankfurt University of Applied Sciences, 60318 Frankfurt am Main, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
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Harvey PD, Miller ML, Moore RC, Depp CA, Parrish EM, Pinkham AE. Capturing Clinical Symptoms with Ecological Momentary Assessment: Convergence of Momentary Reports of Psychotic and Mood Symptoms with Diagnoses and Standard Clinical Assessments. INNOVATIONS IN CLINICAL NEUROSCIENCE 2021; 18:24-30. [PMID: 34150360 PMCID: PMC8195558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: The development and deployment of technology-based assessments of clinical symptoms are increasing. This study used ecological momentary assessment (EMA) to examine clinical symptoms and relates these sampling results to structured clinical ratings. Methods: Three times a day for 30 days, participants with bipolar disorder (n=71; BPI) or schizophrenia (n=102; SCZ) completed surveys assessing five psychosis-related and five mood symptoms, in addition to reporting their location and who they were with at the time of survey completion. Participants also completed Positive and Negative Syndrome Scale (PANSS) interviews with trained raters. Mixed-model repeated-measures (MMRM) analyses examined diagnostic effects and the convergence between clinical ratings and EMA sampling. Results: In total, 12,406 EMA samples were collected, with 80-percent adherence to prompts. EMA-reported psychotic symptoms manifested substantial convergence with equivalent endpoint PANSS items. Patients with SCZ had more severe PANSS and EMA psychotic symptoms. There were no changes in symptom severity scores as a function of the number of previous assessments. Conclusions: EMA surveyed clinical symptoms converged substantially with commonly used clinical rating scales in a large sample, with high adherence. This suggested that remote assessment of clinical symptoms is valid and practical and was not associated with alterations in symptoms as a function of reassessment, with additional benefits of "in the moment" sampling, such as eliminating recall bias and the need for informant reports.
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Affiliation(s)
- Philip D Harvey
- Dr. Harvey is with the University of Miami Miller School of Medicine in Miami, Florida, and Research Service at Bruce W. Carter VA Medical Center in Miami, Florida
- Ms. Miller is with the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Moore is with the Department of Psychiatry at the University of California in La Jolla, California
- Dr. Depp is with the Department of Psychiatry at the University of California in La Jolla, California, and Veterans Affairs San Diego Healthcare System in La Jolla, California
- Ms. Parrish is with the Joint Doctoral Program in Clinical Psychology at San Diego State University /University of California, San Diego
- Dr. Pinkham is with the University of Texas at Dallas in Richardson, Texas, and the UT Southwestern Medical Center in Dallas, Texas
| | - Michelle L Miller
- Dr. Harvey is with the University of Miami Miller School of Medicine in Miami, Florida, and Research Service at Bruce W. Carter VA Medical Center in Miami, Florida
- Ms. Miller is with the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Moore is with the Department of Psychiatry at the University of California in La Jolla, California
- Dr. Depp is with the Department of Psychiatry at the University of California in La Jolla, California, and Veterans Affairs San Diego Healthcare System in La Jolla, California
- Ms. Parrish is with the Joint Doctoral Program in Clinical Psychology at San Diego State University /University of California, San Diego
- Dr. Pinkham is with the University of Texas at Dallas in Richardson, Texas, and the UT Southwestern Medical Center in Dallas, Texas
| | - Raeanne C Moore
- Dr. Harvey is with the University of Miami Miller School of Medicine in Miami, Florida, and Research Service at Bruce W. Carter VA Medical Center in Miami, Florida
- Ms. Miller is with the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Moore is with the Department of Psychiatry at the University of California in La Jolla, California
- Dr. Depp is with the Department of Psychiatry at the University of California in La Jolla, California, and Veterans Affairs San Diego Healthcare System in La Jolla, California
- Ms. Parrish is with the Joint Doctoral Program in Clinical Psychology at San Diego State University /University of California, San Diego
- Dr. Pinkham is with the University of Texas at Dallas in Richardson, Texas, and the UT Southwestern Medical Center in Dallas, Texas
| | - Colin A Depp
- Dr. Harvey is with the University of Miami Miller School of Medicine in Miami, Florida, and Research Service at Bruce W. Carter VA Medical Center in Miami, Florida
- Ms. Miller is with the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Moore is with the Department of Psychiatry at the University of California in La Jolla, California
- Dr. Depp is with the Department of Psychiatry at the University of California in La Jolla, California, and Veterans Affairs San Diego Healthcare System in La Jolla, California
- Ms. Parrish is with the Joint Doctoral Program in Clinical Psychology at San Diego State University /University of California, San Diego
- Dr. Pinkham is with the University of Texas at Dallas in Richardson, Texas, and the UT Southwestern Medical Center in Dallas, Texas
| | - Emma M Parrish
- Dr. Harvey is with the University of Miami Miller School of Medicine in Miami, Florida, and Research Service at Bruce W. Carter VA Medical Center in Miami, Florida
- Ms. Miller is with the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Moore is with the Department of Psychiatry at the University of California in La Jolla, California
- Dr. Depp is with the Department of Psychiatry at the University of California in La Jolla, California, and Veterans Affairs San Diego Healthcare System in La Jolla, California
- Ms. Parrish is with the Joint Doctoral Program in Clinical Psychology at San Diego State University /University of California, San Diego
- Dr. Pinkham is with the University of Texas at Dallas in Richardson, Texas, and the UT Southwestern Medical Center in Dallas, Texas
| | - Amy E Pinkham
- Dr. Harvey is with the University of Miami Miller School of Medicine in Miami, Florida, and Research Service at Bruce W. Carter VA Medical Center in Miami, Florida
- Ms. Miller is with the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Moore is with the Department of Psychiatry at the University of California in La Jolla, California
- Dr. Depp is with the Department of Psychiatry at the University of California in La Jolla, California, and Veterans Affairs San Diego Healthcare System in La Jolla, California
- Ms. Parrish is with the Joint Doctoral Program in Clinical Psychology at San Diego State University /University of California, San Diego
- Dr. Pinkham is with the University of Texas at Dallas in Richardson, Texas, and the UT Southwestern Medical Center in Dallas, Texas
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Klein SD, Olman CA, Sponheim SR. Perceptual Mechanisms of Visual Hallucinations and Illusions in Psychosis. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2020; 5:e200020. [PMID: 32944656 PMCID: PMC7494209 DOI: 10.20900/jpbs.20200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Psychosis has been associated with neural anomalies across a number of brain regions and cortical networks. Nevertheless, the exact pathophysiology of the disorder remains unclear. Aberrant visual perceptions such as hallucinations are evident in psychosis, while the occurrence of visual distortions is elevated in individuals with genetic liability for psychosis. The overall goals of this project are to: (1) use psychophysical tasks and neuroimaging to characterize deficits in visual perception; (2) acquire a mechanistic understanding of these deficits through development and validation of a computational model; and (3) determine if said mechanisms mark genetic liability for psychosis. Visual tasks tapping both low- and high-level visual processing are being completed as individuals with psychotic disorders (IPD), first-degree biological siblings of IPDs (SibIPDs) and healthy controls (HCs) undergo 248-channel magneto-encephalography (MEG) recordings followed by 7 Tesla functional magnetic resonance imaging (MRI). By deriving cortical source signals from MEG and MRI data, we will characterize the timing, location and coordination of neural processes. We hypothesize that IPDs prone to visual hallucinations will exhibit deviant functions within early visual cortex, and that aberrant contextual influences on visual perception will involve higher-level visual cortical regions and be associated with visual hallucinations. SibIPDs who experience visual distortions-but not hallucinations-are hypothesized to exhibit deficits in higher-order visual processing reflected in abnormal inter-regional neural synchronization. We hope the results lead to the development of targeted interventions for psychotic disorders, as well as identify useful biomarkers for aberrant neural functions that give rise to psychosis.
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Affiliation(s)
- Samuel D. Klein
- Clinical Science and Psychopathology Research Program, University of Minnesota-Twin Cities, 75 East River Road, Minneapolis, MN 55455, USA
| | - Cheryl A. Olman
- Department of Psychology, University of Minnesota-Twin Cities, 75 East River Road, Minneapolis, MN 55455, USA
- Center for Magnetic Resonance Research, University of Minnesota-Twin Cities, 2021 6th St SE, Minneapolis, MN 55455, USA
| | - Scott R. Sponheim
- Minneapolis Veterans Affairs Health Care System, 1 Veterans Dr, Minneapolis, MN 55417, USA
- Department of Psychiatry and Behavioral Science, University of Minnesota, 606 24th Ave S, Minneapolis, MN 55454, USA
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17
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A pilot digital intervention targeting loneliness in young people with psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:877-889. [PMID: 30874828 DOI: 10.1007/s00127-019-01681-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Loneliness has been identified as a significant challenge for people with psychosis. Interventions targeting loneliness are lacking but adopting a positive psychology approach may reduce loneliness, promote well-being, and support meaningful social interactions. Together with youth mental health consumers, we developed a digital smartphone application (app) called +Connect, which delivers positive psychology content daily for 6 weeks. MATERIALS AND METHODS Twelve participants diagnosed with a psychotic disorder were recruited from early psychosis services. Loneliness was assessed pre-intervention, post-intervention, and 3-month post-intervention. Acceptability, feasibility, and usability were measured post-intervention, including a semi-structured interview on the user's experience of +Connect. RESULTS We found evidence for the feasibility of +Connect. All but two participants completed the +Connect program, completing 95% (40.10 out of 42 days) of the program. Furthermore, 66.67% (8 out of the 12 participants) remained engaged with the program 3-months post-intervention. Our data indicates preliminary evidence that +Connect may reduce loneliness, with scores from pre-intervention (M = 50.00, SD = 8.47) to post-intervention (M = 48.10, SD = 10.38) and 3-months post-intervention (M = 42.89, SD = 7.04). We found that positive reinforcement of in-game rewards and evidence of positive mood changes added to the feasibility of the app. Regarding acceptability, while 10% (1/10 participants) reported not finding +Connect useful or enjoyable, 90% of participants agreed that +Connect helped them to increase their social confidence, enjoy life, look forward to being with other people, and feel more connected with others. Participant interviews supported these results, with participants highlighting the app's strengths in providing useful information, stimulating self-reflection, fostering positive affect, and encouraging transfer of skills into their social interactions. DISCUSSION While preliminary findings indicated that +Connect yielded high levels of acceptability and feasibility, it is important to consider that we recruited a small and selected sample of lonely young people. Further iterations of this proof of concept app, which can incorporate participant feedback such preferences for increased personalisation, in-app feedback, and gamification, may allow an opportunity to test an improved version in the future.
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18
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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19
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Granholm E, Holden JL, Mikhael T, Link PC, Swendsen J, Depp C, Moore RC, Harvey PD. What Do People With Schizophrenia Do All Day? Ecological Momentary Assessment of Real-World Functioning in Schizophrenia. Schizophr Bull 2020; 46:242-251. [PMID: 31504955 PMCID: PMC7442321 DOI: 10.1093/schbul/sbz070] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Schizophrenia is a major cause of disability worldwide. As new treatments for functioning are tested, the need grows to demonstrate real-world functioning gains. Ecological momentary assessment (EMA) may provide a more ecologically valid measure of functioning. In this study, smartphone-based EMA was used to signal participants with schizophrenia (N = 100) and controls (N = 71) 7 times a day for 7 days to respond to brief questionnaires about social interactions and functioning behaviors. Excellent adherence was found, with both groups completing an average of 85% of surveys and only 3% of participants with schizophrenia excluded for poor adherence. Four-week test-retest reliability was high (r = .83 for total productive behaviors). Relative to controls, participants with schizophrenia reported significantly less total productive activity (d = 1.2), fewer social interactions (d = 0.3), more nonproductive behaviors (d = 1.0; watching TV, resting), and more time at home (d = 0.8). Within the schizophrenia group, participants living independently showed better functioning on EMA relative to participants in supported housing (d = 0.8) and participants engaged in vocational activities showed better functioning than individuals not engaged in vocational activities (d = 0.55). Modest correlations were found between EMA and an in-lab self-report measure of functioning activities performed in the community, but not between EMA and measures of functional capacity or potential. This study demonstrated the feasibility, sensitivity reliability, and validity of EMA methods to assess functioning in schizophrenia. EMA provides a much-needed measure of what individuals with schizophrenia are actually doing in real-world contexts. These results also suggest that there may be important disjunctions between indices of abilities and actual real-world functioning.
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Affiliation(s)
- Eric Granholm
- University of California, San Diego
- VA San Diego Healthcare System, San Diego, CA
| | | | | | | | - Joel Swendsen
- University of Bordeaux, CNRS, EPHE PSL Research University
| | - Colin Depp
- University of California, San Diego
- VA San Diego Healthcare System, San Diego, CA
| | | | - Philip D Harvey
- University of Miami Miller School of Medicine
- Bruce W. Carter VA Medical Center, Miami, FL
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20
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Bell IH, Rossell SL, Farhall J, Hayward M, Lim MH, Fielding-Smith SF, Thomas N. Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): Feasibility, acceptability and preliminary clinical outcomes. Schizophr Res 2020; 216:479-487. [PMID: 31812327 DOI: 10.1016/j.schres.2019.10.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/25/2019] [Accepted: 10/10/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Voice-hearing experiences can be distressing and impairing, and existing psychological treatments show modest effectiveness. Ecological momentary assessment and intervention (EMA/I) are two promising approaches which may be used as digital tools to support and enhance existing psychological therapies. The aim of this study was to investigate the potential clinical utility of smartphone-based EMA/I in a blended, coping focused therapy for voice-hearing experiences. METHOD This pilot RCT focused on feasibility, acceptability and preliminary estimations of efficacy. Thirty-four participants with persisting and distressing voices were randomised to receive the four-session intervention along-side treatment-as-usual (TAU) or TAU-only. RESULTS Findings supported the feasibility and acceptability of the approach, with good engagement and satisfaction rates, and clinical outcomes showed the intervention holds promise for improving coping, overall severity of voices and to some degree their negative impact. CONCLUSION This is the first examination of the use of EMA/I in a blended therapy for psychotic experiences, with findings suggesting these technologies show promise as clinical tools.
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Affiliation(s)
- Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Australia.
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Australia; Department of Psychiatry, St. Vincent's Hospital, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia; NorthWestern Mental Health, Melbourne Health, Australia
| | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - Sarah F Fielding-Smith
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Australia.
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Jongeneel A, Aalbers G, Bell I, Fried EI, Delespaul P, Riper H, van der Gaag M, van den Berg D. A time-series network approach to auditory verbal hallucinations: Examining dynamic interactions using experience sampling methodology. Schizophr Res 2020; 215:148-156. [PMID: 31780345 DOI: 10.1016/j.schres.2019.10.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Identifying variables that influence daily-life fluctuations in auditory verbal hallucinations (AVHs) provides insight into potential mechanisms and targets for intervention. Network analysis, that uses time-series data collected by Experience Sampling Method (ESM), could be used to examine relations between multiple variables over time. METHODS 95 daily voice-hearing individuals filled in a short questionnaire ten times a day for six consecutive days at pseudo-random moments. Using multilevel vector auto-regression, relations between voice-hearing and negative affect, positive affect, uncontrollable thoughts, dissociation, and paranoia were analysed in three types of networks: between-subjects (between persons, undirected), contemporaneous (within persons, undirected), and temporal (within persons, directed) networks. Strength centrality was measured to identify the most interconnected variables in the models. RESULTS Voice-hearing co-occurred with all variables, while on a 6-day period voice-hearing was only related to uncontrollable thoughts. Voice-hearing was not predicted by any of the factors, but it did predict uncontrollable thoughts and paranoia. All variables showed large autoregressions, i.e. mainly predicted themselves in this severe voice-hearing sample. Uncontrollable thoughts was the most interconnected factor, though relatively uninfluential. DISCUSSION Severe voice-hearing might be mainly related to mental state factors on the short-term. Once activated, voice-hearing appears to maintain itself. It is important to assess possible reactivity of AVH to triggers at the start of therapy; if reactive, therapy should focus on the triggering factor. If not reactive, Cognitive Behavioural interventions could be used first to reduce the negative effects of the voices. Limitations are discussed.
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Affiliation(s)
- Alyssa Jongeneel
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, the Netherlands.
| | - George Aalbers
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, the Netherlands
| | - Imogen Bell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, the Netherlands
| | - Philippe Delespaul
- Maastricht University, PO Box 616, 6226 NB, Maastricht, the Netherlands; Mondriaan, PO Box 4436 6401, CX, Heerlen, the Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, the Netherlands
| | - David van den Berg
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, the Netherlands
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Gruber J, Villanueva C, Burr E, Purcell JR, Karoly H. Understanding and Taking Stock of Positive Emotion Disturbance. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2020; 14:e12515. [PMID: 37636238 PMCID: PMC10456988 DOI: 10.1111/spc3.12515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.
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Affiliation(s)
- June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Cynthia Villanueva
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Emily Burr
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - John R. Purcell
- Department of Psychological & Brain Sciences, Indiana University
| | - Hollis Karoly
- Department of Psychology and Neuroscience, University of Colorado Boulder
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Fowler JC, Cope N, Knights J, Phiri P, Makin A, Peters-Strickland T, Rathod S. Hummingbird Study: a study protocol for a multicentre exploratory trial to assess the acceptance and performance of a digital medicine system in adults with schizophrenia, schizoaffective disorder or first-episode psychosis. BMJ Open 2019; 9:e025952. [PMID: 31253613 PMCID: PMC6609081 DOI: 10.1136/bmjopen-2018-025952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION In patients with schizophrenia, medication adherence is important for relapse prevention, and effective adherence monitoring is essential for treatment planning. A digital medicine system (DMS) has been developed to objectively monitor patient adherence and support clinical decision making regarding treatment choices. This study assesses the acceptance and performance of the DMS in adults with schizophrenia, schizoaffective disorder or first-episode psychosis and in healthcare professionals (HCPs). METHODS/ANALYSIS This is a multicentre, 8-week, single-arm, open-label pragmatic trial designed using coproduction methodology. The study will be conducted at five National Health Service Foundation Trusts in the UK. Patients 18-65 years old with a diagnosis of schizophrenia, schizoaffective disorder or first-episode psychosis will be eligible. HCPs (psychiatrists, care coordinators, nurses, pharmacists), researchers, information governance personnel, clinical commissioning groups and patients participated in the study design and coproduction. Intervention employed will be the DMS, an integrated system comprising an oral sensor tablet coencapsulated with an antipsychotic, non-medicated wearable patch, mobile application (app) and web-based dashboard. The coencapsulation product contains aripiprazole, olanzapine, quetiapine or risperidone, as prescribed by the HCP, with a miniature ingestible event marker (IEM) in tablet. On ingestion, the IEM transmits a signal to the patch, which collects ingestion and physical activity data for processing on the patient's smartphone or tablet before transmission to a cloud-based server for viewing by patients, caregivers and HCPs on secure web portals or mobile apps. ETHICS AND DISSEMINATION Approval was granted by London - City and East Research Ethics Committee (REC ref no 18/LO/0128), and clinical trial authorisation was provided by the Medicines and Healthcare products Regulatory Agency. Written informed consent will be obtained from every participant. The trial will be compliant with the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use guidelines and the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT03568500; EudraCT2017-004602-17; Pre-results.
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Affiliation(s)
- J Corey Fowler
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA
| | | | - Jonathan Knights
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Andrew Makin
- Otsuka Europe Development and Commercialisation, Wexham, UK
| | - Tim Peters-Strickland
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA
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Mandryk RL, Birk MV. The Potential of Game-Based Digital Biomarkers for Modeling Mental Health. JMIR Ment Health 2019; 6:e13485. [PMID: 31012857 PMCID: PMC6658250 DOI: 10.2196/13485] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Assessment for mental health is performed by experts using interview techniques, questionnaires, and test batteries and following standardized manuals; however, there would be myriad benefits if behavioral correlates could predict mental health and be used for population screening or prevalence estimations. A variety of digital sources of data (eg, online search data and social media posts) have been previously proposed as candidates for digital biomarkers in the context of mental health. Playing games on computers, gaming consoles, or mobile devices (ie, digital gaming) has become a leading leisure activity of choice and yields rich data from a variety of sources. OBJECTIVE In this paper, we argue that game-based data from commercial off-the-shelf games have the potential to be used as a digital biomarker to assess and model mental health and health decline. Although there is great potential in games developed specifically for mental health assessment (eg, Sea Hero Quest), we focus on data gathered "in-the-wild" from playing commercial off-the-shelf games designed primarily for entertainment. METHODS We argue that the activity traces left behind by natural interactions with digital games can be modeled using computational approaches for big data. To support our argument, we present an investigation of existing data sources, a categorization of observable traits from game data, and examples of potentially useful game-based digital biomarkers derived from activity traces. RESULTS Our investigation reveals different types of data that are generated from play and the sources from which these data can be accessed. Based on these insights, we describe five categories of digital biomarkers that can be derived from game-based data, including behavior, cognitive performance, motor performance, social behavior, and affect. For each type of biomarker, we describe the data type, the game-based sources from which it can be derived, its importance for mental health modeling, and any existing statistical associations with mental health that have been demonstrated in prior work. We end with a discussion on the limitations and potential of data from commercial off-the-shelf games for use as a digital biomarker of mental health. CONCLUSIONS When people play commercial digital games, they produce significant volumes of high-resolution data that are not only related to play frequency, but also include performance data reflecting low-level cognitive and motor processing; text-based data that are indicative of the affective state; social data that reveal networks of relationships; content choice data that imply preferred genres; and contextual data that divulge where, when, and with whom the players are playing. These data provide a source for digital biomarkers that may indicate mental health. Produced by engaged human behavior, game data have the potential to be leveraged for population screening or prevalence estimations, leading to at-scale, nonintrusive assessment of mental health.
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Affiliation(s)
- Regan Lee Mandryk
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Max Valentin Birk
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
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25
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Bell IH, Fielding-Smith SF, Hayward M, Rossell SL, Lim MH, Farhall J, Thomas N. Smartphone-based ecological momentary assessment and intervention in a blended coping-focused therapy for distressing voices: Development and case illustration. Internet Interv 2018; 14:18-25. [PMID: 30510910 PMCID: PMC6258111 DOI: 10.1016/j.invent.2018.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
Common approaches to the psychological treatment of distressing voice hearing experiences, such as cognitive behavioural therapy, aim to promote more adaptive cognitive, emotional and behavioural responses to these experiences. Digital technologies such as smartphones show promise for supporting and enhancing these treatments by linking immediate therapeutic settings to the context of daily life. Two promising technologies include ecological momentary assessment and intervention (EMA/I), which may offer a means of advanced assessment and support in daily life, and inform the tailoring of interventions to suit individual needs. In this study, a highly novel intervention approach was developed involving four face-to-face sessions with a psychologist blended with EMA/I between sessions in order to improve coping with distressing voice hearing experiences. The authors describe the background and development of this approach along-side a single case illustration, which supported feasibility and acceptability. This study details how digital technologies such as EMA/I may be used in future as clinical tools to enhance standard psychological treatments and clinical care of people with persisting and distressing experiences.
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Affiliation(s)
- Imogen H. Bell
- Centre for Mental Health, Swinburne University of Technology, Australia
| | | | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, UK
- School of Psychology, University of Sussex, UK
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Australia
- Department of Psychiatry, St. Vincent's Hospital, Australia
| | - Michelle H. Lim
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia
- North Western Mental Health, Melbourne Health, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Australia
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26
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Social anhedonia and asociality in psychosis revisited. An experience sampling study. Psychiatry Res 2018; 270:375-381. [PMID: 30300867 DOI: 10.1016/j.psychres.2018.09.057] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 12/28/2022]
Abstract
The DSM-5 appended the conceptualization of asociality in psychotic disorders as the manifestation of diminished interest in social interactions, but it also admitted that it might merely be the result of limited opportunities for social interactions. In an effort to investigate this apparent dichotomy, we used experience sampling data from 149 patients with psychotic disorder and 143 controls, and divided their social interactions into those occurring in the context of work and other structured activities that patients have limited access to, and those occurring in the context of unstructured activities such as visits and conversations that both groups can choose relatively more freely. Patients spent significantly smaller proportion of their time in structured social context, but matched the controls in the time spent in unstructured social contexts, and endorsed intact hedonic experience of both social contexts. Moreover, employment and living situation, in addition to the severity of symptoms of avolition, predicted the proportion of time patients spent in structured and unstructured social contexts, supporting the notion that both lifestyle as well as disease-specific factors contribute to real-life social behavior in psychosis.
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27
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van Knippenberg RJM, de Vugt ME, Smeets CMJ, Myin-Germeys I, Verhey FRJ, Ponds RW. Dealing with daily challenges in dementia (deal-id study): process evaluation of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia. Aging Ment Health 2018; 22:1199-1206. [PMID: 28714738 DOI: 10.1080/13607863.2017.1348466] [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] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study describes the process evaluation of the experience sampling method (ESM) intervention 'Partner in Sight' for spousal caregivers of people with dementia. The aim was to determine internal and external validity of the intervention and provide information for future implementation in clinical practice. METHOD Qualitative and quantitative data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, adherence to protocol) were evaluated using descriptive statistics and conventional content analysis. RESULTS The participation rate included 31.4%. Due to recruitment difficulties and time constraints the original goal to include 90 caregivers was not met. The intervention was largely performed according to protocol and well received by the participants. Overall, the ESM-derived feedback was considered supportive and increased participants' awareness of their feelings and behavior. A large variance was found in the extent to which caregivers applied the feedback into their daily lives. The importance of the personal coach to provide face-to-face feedback and stimulate caregivers to implement new insights into their daily lives was emphasized. Suggestions for improvement were to reduce the time intensity of the program, to better tailor the program content to one's personal situation, and to improve the ESM device. CONCLUSION Although recruitment barriers were encountered, results indicate that future implementation of the ESM intervention 'Partner in Sight' is likely to be feasible in regular health care. If the intervention turns out to be (cost-) effective, a fine-tuned version of the program could be a valuable addition to the current health care system.
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Affiliation(s)
- Rosalia J M van Knippenberg
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Marjolein E de Vugt
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Claudia M J Smeets
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Inez Myin-Germeys
- b Department of Neurosciences, Center for Contextual Psychiatry , KU Leuven , Leuven , Belgium
| | - Frans R J Verhey
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Rudolf W Ponds
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
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28
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Myin-Germeys I, Kasanova Z, Vaessen T, Vachon H, Kirtley O, Viechtbauer W, Reininghaus U. Experience sampling methodology in mental health research: new insights and technical developments. World Psychiatry 2018; 17:123-132. [PMID: 29856567 PMCID: PMC5980621 DOI: 10.1002/wps.20513] [Citation(s) in RCA: 274] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the mental health field, there is a growing awareness that the study of psychiatric symptoms in the context of everyday life, using experience sampling methodology (ESM), may provide a powerful and necessary addition to more conventional research approaches. ESM, a structured self-report diary technique, allows the investigation of experiences within, and in interaction with, the real-world context. This paper provides an overview of how zooming in on the micro-level of experience and behaviour using ESM adds new insights and additional perspectives to standard approaches. More specifically, it discusses how ESM: a) contributes to a deeper understanding of psychopathological phenomena, b) allows to capture variability over time, c) aids in identifying internal and situational determinants of variability in symptomatology, and d) enables a thorough investigation of the interaction between the person and his/her environment and of real-life social interactions. Next to improving assessment of psychopathology and its underlying mechanisms, ESM contributes to advancing and changing clinical practice by allowing a more fine-grained evaluation of treatment effects as well as by providing the opportunity for extending treatment beyond the clinical setting into real life with the development of ecological momentary interventions. Furthermore, this paper provides an overview of the technical details of setting up an ESM study in terms of design, questionnaire development and statistical approaches. Overall, although a number of considerations and challenges remain, ESM offers one of the best opportunities for personalized medicine in psychiatry, from both a research and a clinical perspective.
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Affiliation(s)
- Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Hugo Vachon
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Olivia Kirtley
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Reininghaus
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Bell IH, Fielding-Smith SF, Hayward M, Rossell SL, Lim MH, Farhall J, Thomas N. Smartphone-based ecological momentary assessment and intervention in a coping-focused intervention for hearing voices (SAVVy): study protocol for a pilot randomised controlled trial. Trials 2018; 19:262. [PMID: 29720208 PMCID: PMC5930938 DOI: 10.1186/s13063-018-2607-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Background Smartphone-based ecological momentary assessment and intervention (EMA/I) show promise for enhancing psychological treatments for psychosis. EMA has the potential to improve assessment and formulation of experiences which fluctuate day-to-day, and EMI may be used to prompt use of therapeutic strategies in daily life. The current study is an examination of these capabilities in the context of a brief, coping-focused intervention for distressing voice hearing experiences. Methods/design This is a rater-blinded, pilot randomised controlled trial comparing a four-session intervention in conjunction with use of smartphone EMA/I between sessions, versus treatment-as-usual. The recruitment target is 34 participants with persisting and distressing voice hearing experiences, recruited through a Voices Clinic based in Melbourne, Australia, and via wider advertising. Allocation will be made using minimisation procedure, balancing of the frequency of voices between groups. Assessments are completed at baseline and 8 weeks post-baseline. The primary outcomes of this trial will focus on feasibility and acceptability of the intervention and trial methodology, with secondary outcomes examining preliminary clinical effects related to overall voice severity, the emotional and functional impact of the voices, and emotional distress. Discussion This study offers a highly novel examination of specific smartphone capabilities and their integration with traditional psychological treatment for distressing voices. Such technology has potential to enhance psychological interventions and promote adaptation to distressing experiences. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN12617000348358. Registered on 7 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2607-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia. .,Monash Alfred Psychiatry Research Centre, Melbourne, Australia.
| | - Sarah F Fielding-Smith
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia.,Monash Alfred Psychiatry Research Centre, Melbourne, Australia.,Department of Psychiatry, St. Vincent's Hospital, Melbourne, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia.,Monash Alfred Psychiatry Research Centre, Melbourne, Australia
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30
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Kluge A, Kirschner M, Hager OM, Bischof M, Habermeyer B, Seifritz E, Walther S, Kaiser S. Combining actigraphy, ecological momentary assessment and neuroimaging to study apathy in patients with schizophrenia. Schizophr Res 2018; 195:176-182. [PMID: 29030262 DOI: 10.1016/j.schres.2017.09.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/10/2017] [Accepted: 09/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Apathy can be defined as a reduction of goal-directed behavior and is a strong predictor for poor functional outcome in schizophrenia. However, no objective measure of apathy has been identified and assessment is limited to retrospective interview-based ratings. Here we aimed to identify more precise objective readouts of apathy for translational research and clinical practice. METHODS We employed a combined approach including interview-based ratings of the two negative symptom factors apathy and diminished expression, actigraphy based measures of spontaneous motor activity and the evaluation of daily activities using ecological momentary assessment. Furthermore, a functional magnetic resonance imaging task for reward anticipation was applied to investigate shared and divergent neural correlates of interview-based and behaviorally measured apathy. RESULTS We found in 18 schizophrenia patients with high interview-based apathy levels that motor activity was negatively correlated with apathy but not with diminished expression. In contrast, measures of daily activities were not associated with apathy. Neural activation during reward anticipation revealed an association between hypoactivation of the ventral striatum and interview-based apathy as well as hypoactivation of the inferior frontal gyrus and motor activity level. CONCLUSIONS Spontaneous motor activity is an objective readout of apathy, which was specific and not present for diminished expression. On a neural level, interview-based and objective measures of apathy showed divergent neural correlates in the cortical-striatal network, which suggests dissociable neural processes. Finally, motor activity provides a promising readout for quantifying apathy in both translational research and clinical practice.
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Affiliation(s)
- Agne Kluge
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Oliver M Hager
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Martin Bischof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Benedikt Habermeyer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, 3008 Bern, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Mental Health and Psychiatry, Geneva University Hospitals, Chemin du Petit-Bel-Air, 1225 Chêne-Bourg, Switzerland
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31
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Groen RN, de Clercq NC, Nieuwdorp M, Hoenders HJR, Groen AK. Gut microbiota, metabolism and psychopathology: A critical review and novel perspectives. Crit Rev Clin Lab Sci 2018; 55:283-293. [PMID: 29673295 DOI: 10.1080/10408363.2018.1463507] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychiatric disorders are often associated with metabolic comorbidities. However, the mechanisms through which metabolic and psychiatric disorders are connected remain unclear. Pre-clinical studies in rodents indicate that the bidirectional signaling between the intestine and the brain, the so-called microbiome-gut-brain axis, plays an important role in the regulation of both metabolism and behavior. The gut microbiome produces a vast number of metabolites that may be transported into the host and play a part in homeostatic control of metabolism as well as brain function. In addition to short chain fatty acids, many of these metabolites have been identified in recent years. To what extent both microbiota and their products control human metabolism and behavior is a subject of intense investigation. In this review, we will discuss the most recent findings concerning alterations in the gut microbiota as a possible pathophysiological factor for the co-occurrence of metabolic comorbidities in psychiatric disorders.
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Affiliation(s)
- Robin N Groen
- a Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Nicolien C de Clercq
- b Department of Internal and Vascular Medicine , Academic Medical Center , Amsterdam , The Netherlands
| | - Max Nieuwdorp
- b Department of Internal and Vascular Medicine , Academic Medical Center , Amsterdam , The Netherlands.,c Department of Internal Medicine, VUmc Diabetes Center , Free University Medical Center , Amsterdam , The Netherlands.,d Wallenberg Laboratory , University of Gothenburg , Gothenburg , Sweden
| | | | - Albert K Groen
- b Department of Internal and Vascular Medicine , Academic Medical Center , Amsterdam , The Netherlands.,c Department of Internal Medicine, VUmc Diabetes Center , Free University Medical Center , Amsterdam , The Netherlands.,f Department of Pediatrics , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Emotional reactivity to daily life stress in spousal caregivers of people with dementia: An experience sampling study. PLoS One 2018; 13:e0194118. [PMID: 29617373 PMCID: PMC5884477 DOI: 10.1371/journal.pone.0194118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/09/2018] [Indexed: 01/06/2023] Open
Abstract
Introduction Caregivers differ in their emotional response when facing difficult situations during the caregiving process. Individual differences in vulnerabilities and resources could play an exacerbating or buffering role in caregivers’ reactivity to daily life stress. This study examines which caregiver characteristics modify emotional stress reactivity in dementia caregivers. Methods Thirty caregivers collected momentary data, as based on the experience sampling methodology, to assess (1) appraised subjective stress related to events and minor disturbances in daily life, and (2) emotional reactivity to these daily life stressors, conceptualized as changes in negative affect. Caregiver characteristics (i.e. vulnerabilities and resources) were administered retrospectively. Results Caregivers who more frequently used the coping strategies ‘seeking distraction’, ‘seeking social support’, and ‘fostering reassuring thoughts’ experienced less emotional reactivity towards stressful daily events. A higher educational level and a higher sense of competence and mastery lowered emotional reactivity towards minor disturbances in daily life. No effects were found for age, gender, and hours of care and contact with the person with dementia. Discussion Caregiver resources can impact emotional reactivity to daily life stress. Interventions aimed at empowerment of caregiver resources, such as sense of competence, mastery, and coping, could help to reduce stress reactivity in dementia caregivers.
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Klippel A, Viechtbauer W, Reininghaus U, Wigman J, van Borkulo C, Myin-Germeys I, Wichers M. The Cascade of Stress: A Network Approach to Explore Differential Dynamics in Populations Varying in Risk for Psychosis. Schizophr Bull 2018; 44:328-337. [PMID: 28338969 PMCID: PMC5815145 DOI: 10.1093/schbul/sbx037] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Stress plays a central role in the development and persistence of psychosis. Network analysis may help to reveal mechanisms at the level of the micro-dynamic effects between stress, other daily experiences and symptomatology. This is the first study to examine time-lagged networks of the relations between minor daily stress, momentary affect/thoughts, psychotic experiences, and other potentially relevant daily life contexts in individuals varying in risk for psychosis. Intensive longitudinal data were obtained through 6 studies. The combined sample consisted of 654 individuals varying in risk for psychosis: healthy control subjects (n = 244), first-degree relatives of psychotic patients (n = 165), and psychotic patients (n = 245). Using multilevel models combined with permutation testing, group-specific time-lagged network connections between daily experiences were compared between groups. Specifically, the role of stress was examined. Risk for psychosis was related to a higher number of significant network connections. In all populations, stress had a central position in the network and showed direct and significant connections with subsequent psychotic experiences. Furthermore, the higher the risk for psychosis, the more variables "loss of control" and "suspicious" were susceptible to influences by other network nodes. These findings support the idea that minor daily stress may play an important role in inducing a cascade of effects that may lead to psychotic experiences.
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Affiliation(s)
- Annelie Klippel
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Johanna Wigman
- University of Groningen, University Medical Center Groningen (UMCG), University Center Psychiatry (UCP), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Claudia van Borkulo
- University of Groningen, University Medical Center Groningen (UMCG), University Center Psychiatry (UCP), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
- Department of Psychology, Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), KU Leuven, Leuven, Belgium
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen (UMCG), University Center Psychiatry (UCP), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
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van Knippenberg RJM, de Vugt ME, Ponds RW, Myin-Germeys I, van Twillert B, Verhey FRJ. Dealing with daily challenges in dementia (deal-id study): an experience sampling study to assess caregiver functioning in the flow of daily life. Int J Geriatr Psychiatry 2017; 32:949-958. [PMID: 27464472 DOI: 10.1002/gps.4552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Accurate assessment of caregiver functioning is of great importance to gain better insight into daily caregiver functioning and to prevent high levels of burden. The experience sampling methodology (ESM) is an innovative approach to assess subjective experiences and behavior within daily life. In this study, the feasibility of the ESM in spousal caregivers of people with dementia was examined, and the usability of ESM data for clinical and scientific practice was demonstrated. METHODS Thirty-one caregivers collected ESM data for six consecutive days using an electronic ESM device that generated ten random alerts per day. After each alert, short reports of the caregiver's current mood state and context were collected. Feasibility was assessed by examining compliance and subjective experiences with the ESM. Usability was described using group and individual ESM data. RESULTS Participants on average completed 78.8% of the reports. One participant completed less than 33% of the reports and was excluded from data analyses. Participants considered the ESM device to be a user-friendly device in which they could accurately describe their feelings and experiences. The ESM was not experienced as too burdensome. Zooming in on the ESM data, personalized patterns of mood and contextual factors were revealed. CONCLUSIONS The ESM is a feasible method to assess caregiver functioning. In addition to standard retrospective measurements, it offers new opportunities to gain more insight into the daily lives of people with dementia and their caregivers. It also provides new possibilities to tailor caregiver support interventions to the specific needs of the caregiver. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- R J M van Knippenberg
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - M E de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - R W Ponds
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - I Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - B van Twillert
- Department of Clinical and Medical Psychology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - F R J Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
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Moitra E, Gaudiano BA, Davis CH, Ben-Zeev D. Feasibility and acceptability of post-hospitalization ecological momentary assessment in patients with psychotic-spectrum disorders. Compr Psychiatry 2017; 74:204-213. [PMID: 28231480 PMCID: PMC5369417 DOI: 10.1016/j.comppsych.2017.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/12/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Up to 50% of patients with psychotic-spectrum disorders are medication nonadherent. The use of real-time assessment via ecological momentary assessment (EMA) on mobile devices might offer important insights into adherence behaviors that cannot be measured in the clinic. However, existing EMA studies have only studied acutely ill patients during hospitalization or more stable patients in the community. METHODS Feasibility and acceptability of EMA in 65 patients with psychotic-spectrum disorders who were recently discharged from the hospital were assessed. EMA was administered for four weeks via study-provided mobile devices. Feasibility was measured by study recruitment/retention rates, patients' connectivity, and completion rates. Quantitative and qualitative acceptability data were collected. RESULTS Participants completed 28-31% of offered EMA assessments. The only significant predictor of reduced EMA completion was recent cannabis use. EMA completion was maintained from weeks 1 to 3 but significantly dropped at the fourth week. Patient acceptability feedback was generally positive; negative comments related primarily to technological problems. CONCLUSIONS This was the first study to use EMA in recently discharged patients with psychotic-spectrum disorders. EMA is feasible and acceptable in this population, but completion rates were lower than in more stable samples. Future research should consider limiting the assessment period, screening for substance use, and integrating assessment with intervention elements to increase EMA engagement.
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Affiliation(s)
- Ethan Moitra
- Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
| | - Brandon A Gaudiano
- Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; Butler Hospital, Providence, RI 02906, USA
| | | | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences. University of Washington, Seattle, WA 98195 USA
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On the Interconnectedness and Prognostic Value of Visual and Auditory Hallucinations in First-Episode Psychosis. Eur Psychiatry 2017; 41:122-128. [DOI: 10.1016/j.eurpsy.2016.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 01/29/2023] Open
Abstract
AbstractBackgroundVisual hallucinations (VH) are common symptoms in schizophrenia and other psychoses. An understanding of their cross-sectional and longitudinal patterns of association with auditory hallucinations (AH) is essential for developing accurate models of hallucinatory phenomena.ObjectiveThis study presents the most comprehensive examination of the association between VH and AH, and its change over time, in 1303 individuals with first-episode psychosis (FEP) and 469 individuals with chronic schizophrenia.MethodThe samples included data from the WHO multicentre study on the Determinants of Outcome of Severe Mental Disorders and the Western Australian Family Study of Schizophrenia (WAFSS). Standardized assessment of symptoms and functioning were used to examine the clinical profile and symptom co-occurrence of hallucinations over time.ResultsVH were approximately half as frequent as AH, almost always co-occurred with AH, and tended to be linked to a more severe psychopathological profile. AH and VH at baseline also predicted higher disability, risk of relapse and duration of psychosis after 1 and 2 years, especially when occurring in combination.ConclusionsThe findings point to three hallucination ‘subtypes’ with different symptom profile. The VH + AH combination signals greater psychopathology and a less favourable prognosis, than hallucinations occurring in isolation, and no hallucinations. This conclusion points to one common mechanism for all hallucinations, which can separate into distinct pathways and modalities. For a more complete clinical picture, clinicians should carefully probe for both auditory and VHs in presenting patients.
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Vasconcelos E Sa D, Wearden A, Hartley S, Emsley R, Barrowclough C. Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis. Psychiatry Res 2016; 245:406-413. [PMID: 27611070 DOI: 10.1016/j.psychres.2016.08.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/23/2016] [Accepted: 08/26/2016] [Indexed: 01/11/2023]
Abstract
While research using Experience Sampling Methodology (ESM) suggests that, in general, contact with relatives or friends may be protective for psychotic experiences, contact with high-Expressed Emotion (high-EE) relatives can have adverse consequences for patients. This study investigated whether contact with high-EE relatives, and relatives' behaviourally controlling interactions (BCI) are related to patients' symptoms and to both patients' and relatives' affect when measured using structured diary assessments in the course of everyday life. Twenty-one patients experiencing psychosis and their closest relatives provided synchronized self-reports of symptoms (patients only), affect, dyadic contact and BCI over a 6-days period. Relatives' EE was obtained from Camberwell Family Interviews. Multi-level modeling showed that patients' reports of relatives taking control of them and helping them were associated with increased patient negative affect and symptoms. Relatives' self-reports of nagging, taking control and keeping an eye on the patient were related to fluctuations in relatives' affect. No evidence was found for the moderating effect of EE status on the association between dyadic contact and affect or, in the case of patients, symptoms. When measured using an ecologically valid methodology, momentary behaviourally controlling interactions within dyads experiencing psychosis can impact on patients' affect and symptoms.
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Affiliation(s)
| | - Alison Wearden
- School of Psychological Sciences & Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Samantha Hartley
- School of Psychological Sciences, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Centre for Biostatistics, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
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Edwards CJ, Cella M, Tarrier N, Wykes T. The optimisation of experience sampling protocols in people with schizophrenia. Psychiatry Res 2016; 244:289-93. [PMID: 27512917 DOI: 10.1016/j.psychres.2016.07.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/19/2016] [Accepted: 07/24/2016] [Indexed: 11/19/2022]
Abstract
Experience sampling methodology (ESM) involves completing questionnaires during daily life and has been used extensively in people with schizophrenia to assess symptoms and behaviours. Despite considerable advantages over interview measures, there is limited information about its external validity. Our aim is to investigate whether ESM protocol implementation is affected differentially in people with schizophrenia and healthy individuals by factors such as mood, medication and symptoms which would have implications for validity. Fifty-three people with schizophrenia and fifty-eight controls from the general population completed seven ESM questionnaires per day for six consecutive days. Compliance and acceptability, including overall experience, training and disruption of normal routines, were recorded. Overall questionnaire completion rate in people with schizophrenia was comparable to controls (i.e. over 70%). People with schizophrenia completed significantly fewer questionnaires in the morning but did not show fatigue effects over the experience sampling period. Excluding questionnaires in the morning did not significantly alter the findings. In the schizophrenia group medication level and symptoms did not influence adherence. However, higher disruption was associated with reduced questionnaire completion in this group. These findings suggest that minimising disruption may enhance validity and completion rates. ESM is a valid methodology to use with people with schizophrenia.
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Affiliation(s)
- Clementine J Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, SE5 8AF, UK.
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, SE5 8AF, UK.
| | - Nicholas Tarrier
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, SE5 8AF, UK.
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, SE5 8AF, UK.
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Treisman GJ, Jayaram G, Margolis RL, Pearlson GD, Schmidt CW, Mihelish GL, Kennedy A, Howson A, Rasulnia M, Misiuta IE. Perspectives on the Use of eHealth in the Management of Patients With Schizophrenia. J Nerv Ment Dis 2016; 204:620-9. [PMID: 26828911 PMCID: PMC4972482 DOI: 10.1097/nmd.0000000000000471] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mobile devices, digital technologies, and web-based applications-known collectively as eHealth (electronic health)-could improve health care delivery for costly, chronic diseases such as schizophrenia. Pharmacologic and psychosocial therapies represent the primary treatment for individuals with schizophrenia; however, extensive resources are required to support adherence, facilitate continuity of care, and prevent relapse and its sequelae. This paper addresses the use of eHealth in the management of schizophrenia based on a roundtable discussion with a panel of experts, which included psychiatrists, a medical technology innovator, a mental health advocate, a family caregiver, a health policy maker, and a third-party payor. The expert panel discussed the uses, benefits, and limitations of emerging eHealth with the capability to integrate care and extend service accessibility, monitor patient status in real time, enhance medication adherence, and empower patients to take a more active role in managing their disease. In summary, to support this technological future, eHealth requires significant research regarding implementation, patient barriers, policy, and funding.
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Affiliation(s)
- Glenn J. Treisman
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Geetha Jayaram
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Russell L. Margolis
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Godfrey D. Pearlson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Chester W. Schmidt
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Gary L. Mihelish
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Adrienne Kennedy
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Alexandra Howson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Maziar Rasulnia
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Iwona E. Misiuta
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
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Abstract
PURPOSE OF REVIEW In this review, we discuss feasibility, content, and where possible efficacy of ecological momentary interventions (EMIs) in psychiatry. EMIs adopt mobile devices, such as personal digital assistants or smartphones, for the delivery of treatments in the daily life of patients. We will discuss EMIs in the field of schizophrenia, bipolar disorder and major depression disorder, as well as one generic, transdiagnostic EMI. RECENT FINDINGS The few studies that are available all underscore feasibility and acceptability of mobile health approaches in patients with severe mental illness. In terms of content, there is a huge variety in approaches ranging from a mixture of face-to-face contacts augmented with EMI components to a fully automated EMI. With regard to efficacy, only two randomized clinical trials have been conducted, supporting the efficacy of EMIs in mental health. Evidence seems to point toward greater efficacy when EMI is integrated with real-life assessment using experience sampling methodology, preferentially tailoring the intervention toward the specific needs of the individual as well as toward those moments when intervention is needed. SUMMARY The review demonstrates that mobile health may be an important asset to the mental health field but underscores that it still is in its very early ages. In the discussion, we point toward ways of improving EMIs for severe mental illness, changing our perspective from testing feasibility to testing efficacy and ultimately implementing EMIs in routine mental health services.
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van Knippenberg RJM, de Vugt ME, Ponds RW, Myin-Germeys I, Verhey FRJ. Dealing with daily challenges in dementia (deal-id study): effectiveness of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry 2016; 16:136. [PMID: 27169811 PMCID: PMC4865019 DOI: 10.1186/s12888-016-0834-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is an urgent need for psychosocial interventions that effectively support dementia caregivers in daily life. The Experience Sampling Methodology (ESM) offers the possibility to provide a more dynamic view of caregiver functioning. ESM-derived feedback may help to redirect caregivers' behavior towards situations that elicit positive emotions and to increase their feelings of competence in the caretaking process. This paper presents the design of a study that evaluates the process characteristics and effects of the ESM-based intervention 'Partner in Sight'. METHODS/DESIGN A randomized controlled trial with 90 spousal caregivers of people with dementia will be conducted. Participants will be randomly assigned to the experimental (6-week ESM intervention including feedback), pseudo-experimental (6-week ESM intervention without feedback), or control group (care as usual). Assessments will be performed pre- and post-intervention and at 2-, and 6-month follow-up. Main outcomes will be sense of competence, perceived control, momentary positive affect, and psychological complaints (depressive symptoms, perceived stress, anxiety, momentary negative affect). In addition to the effect evaluation, a process and economic evaluation will be conducted to investigate the credibility and generalizability of the intervention, and its cost-effectiveness. DISCUSSION The potential effects of the ESM intervention may help caregivers to endure their care responsibilities and prevent them from becoming overburdened. This is the first ESM intervention for caregivers of people with dementia. The results of this study, therefore, provide a valuable contribution to the growing knowledge on m-health interventions for dementia caregivers. TRIAL REGISTRATION Dutch Trial Register NTR4847 ; date registered Oct 9, 2014.
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Affiliation(s)
- Rosalia J. M. van Knippenberg
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Rudolf W. Ponds
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
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Emerencia AC, van der Krieke L, Bos EH, de Jonge P, Petkov N, Aiello M. Automating Vector Autoregression on Electronic Patient Diary Data. IEEE J Biomed Health Inform 2016; 20:631-43. [DOI: 10.1109/jbhi.2015.2402280] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gaudiano BA, Moitra E, Ellenberg S, Armey MF. The Promises and Challenges of Ecological Momentary Assessment in Schizophrenia: Development of an Initial Experimental Protocol. Healthcare (Basel) 2015; 3:556-73. [PMID: 26689969 PMCID: PMC4683929 DOI: 10.3390/healthcare3030556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/09/2015] [Indexed: 12/15/2022] Open
Abstract
Severe mental illnesses, including schizophrenia and other psychotic-spectrum disorders, are a major cause of disability worldwide. Although efficacious pharmacological and psychosocial interventions have been developed for treating patients with schizophrenia, relapse rates are high and long-term recovery remains elusive for many individuals. Furthermore, little is still known about the underlying mechanisms of these illnesses. Thus, there is an urgent need to better understand the contextual factors that contribute to psychosis so that they can be better targeted in future interventions. Ecological Momentary Assessment (EMA) is a dynamic procedure that permits the measurement of variables in natural settings in real-time through the use of brief assessments delivered via mobile electronic devices (i.e., smart phones). One advantage of EMA is that it is less subject to retrospective memory biases and highly sensitive to fluctuating environmental factors. In the current article, we describe the research-to-date using EMA to better understand fluctuating symptoms and functioning in patients with schizophrenia and other psychotic disorders and potential applications to treatment. In addition, we describe a novel EMA protocol that we have been employing to study the outcomes of patients with schizophrenia following a hospital discharge. We also report the lessons we have learned thus far using EMA methods in this challenging clinical population.
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Affiliation(s)
- Brandon A. Gaudiano
- Butler Hospital and Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA; E-Mails: (S.E.); (M.F.A.)
| | - Ethan Moitra
- Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; E-Mail:
| | - Stacy Ellenberg
- Butler Hospital and Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA; E-Mails: (S.E.); (M.F.A.)
| | - Michael F. Armey
- Butler Hospital and Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA; E-Mails: (S.E.); (M.F.A.)
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From Affective Experience to Motivated Action: Tracking Reward-Seeking and Punishment-Avoidant Behaviour in Real-Life. PLoS One 2015; 10:e0129722. [PMID: 26087323 PMCID: PMC4472779 DOI: 10.1371/journal.pone.0129722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/12/2015] [Indexed: 01/08/2023] Open
Abstract
Many of the decisions and actions in everyday life result from implicit learning processes. Important to psychopathology are, for example, implicit reward-seeking and punishment-avoidant learning processes. It is known that when specific actions get associated with a rewarding experience, such as positive emotions, that this will increase the likelihood that an organism will engage in similar actions in the future. Similarly, when actions get associated with punishing experiences, such as negative emotions, this may reduce the likelihood that the organism will engage in similar actions in the future. This study examines whether we can observe these implicit processes prospectively in the flow of daily life. If such processes take place then we expect that current behaviour can be predicted by how similar behaviour was experienced (in terms of positive and negative affect) at previous measurement moments. This was examined in a sample of 621 female individuals that had participated in an Experience Sampling data collection. Measures of affect and behaviour were collected at 10 semi-random moments of the day for 5 consecutive days. It was examined whether affective experience that was paired with certain behaviours (physical activity and social context) at previous measurements modified the likelihood to show similar behaviours at next measurement moments. Analyses were performed both at the level of observations (a time scale with units of ± 90 min) and at day level (a time scale with units of 24 h). As expected, we found that affect indeed moderated the extent to which previous behaviour predicted similar behaviour later in time, at both beep- and day-level. This study showed that it is feasible to track reward-seeking and punishment-avoidant behaviour prospectively in humans in the flow of daily life. This opens up a new toolbox to examine processes determining goal-oriented behaviour in relation to psychopathology in humans.
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Demeulemeester M, Kochman F, Fligans B, Tabet AJ, Thomas P, Jardri R. Assessing early-onset hallucinations in the touch-screen generation. Br J Psychiatry 2015; 206:181-3. [PMID: 25733569 DOI: 10.1192/bjp.bp.114.154153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The increasing development of apps for digital devices provides an opportunity for new instruments to assess hallucinations in young individuals. Here we present the Multisensory HAllucinations Scale for Children (MHASC), dedicated to assessing complex early-onset hallucinations. The MHASC will soon be translated into multilanguage versions with the support of the International Consortium of Hallucination Research.
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Affiliation(s)
- Morgane Demeulemeester
- Morgane Demeulemeester, Université de Lille, SCA-Lab, PSYChiC team, Lille and Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Fréderic Kochman, MD, Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Benjamin Fligans, Université de Lille, SCA-Lab, PSYChiC team, Lille; Ahmed J. Tabet, Université de Lille, PolyTech, Lille; Pierre Thomas, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Adult Psychiatry Department, Lille; Renaud Jardri, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Child & Adolescent Psychiatry Department, Lille, France
| | - Fréderic Kochman
- Morgane Demeulemeester, Université de Lille, SCA-Lab, PSYChiC team, Lille and Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Fréderic Kochman, MD, Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Benjamin Fligans, Université de Lille, SCA-Lab, PSYChiC team, Lille; Ahmed J. Tabet, Université de Lille, PolyTech, Lille; Pierre Thomas, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Adult Psychiatry Department, Lille; Renaud Jardri, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Child & Adolescent Psychiatry Department, Lille, France
| | - Benjamin Fligans
- Morgane Demeulemeester, Université de Lille, SCA-Lab, PSYChiC team, Lille and Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Fréderic Kochman, MD, Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Benjamin Fligans, Université de Lille, SCA-Lab, PSYChiC team, Lille; Ahmed J. Tabet, Université de Lille, PolyTech, Lille; Pierre Thomas, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Adult Psychiatry Department, Lille; Renaud Jardri, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Child & Adolescent Psychiatry Department, Lille, France
| | - Ahmed J Tabet
- Morgane Demeulemeester, Université de Lille, SCA-Lab, PSYChiC team, Lille and Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Fréderic Kochman, MD, Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Benjamin Fligans, Université de Lille, SCA-Lab, PSYChiC team, Lille; Ahmed J. Tabet, Université de Lille, PolyTech, Lille; Pierre Thomas, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Adult Psychiatry Department, Lille; Renaud Jardri, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Child & Adolescent Psychiatry Department, Lille, France
| | - Pierre Thomas
- Morgane Demeulemeester, Université de Lille, SCA-Lab, PSYChiC team, Lille and Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Fréderic Kochman, MD, Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Benjamin Fligans, Université de Lille, SCA-Lab, PSYChiC team, Lille; Ahmed J. Tabet, Université de Lille, PolyTech, Lille; Pierre Thomas, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Adult Psychiatry Department, Lille; Renaud Jardri, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Child & Adolescent Psychiatry Department, Lille, France
| | - Renaud Jardri
- Morgane Demeulemeester, Université de Lille, SCA-Lab, PSYChiC team, Lille and Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Fréderic Kochman, MD, Lautréamont Clinic, ORPEA-CLINEA Group, Loos; Benjamin Fligans, Université de Lille, SCA-Lab, PSYChiC team, Lille; Ahmed J. Tabet, Université de Lille, PolyTech, Lille; Pierre Thomas, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Adult Psychiatry Department, Lille; Renaud Jardri, MD, PhD, Université de Lille, SCA-Lab, PSYChiC team, and Centre Hospitalier Régional Universitaire (CHRU) de Lille, Child & Adolescent Psychiatry Department, Lille, France
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Veling W, Moritz S, van der Gaag M. Brave new worlds--review and update on virtual reality assessment and treatment in psychosis. Schizophr Bull 2014; 40:1194-7. [PMID: 25193975 PMCID: PMC4193729 DOI: 10.1093/schbul/sbu125] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In recent years, virtual reality (VR) research on psychotic disorders has been initiated. Several studies showed that VR can elicit paranoid thoughts about virtual characters (avatars), both in patients with psychotic disorders and healthy individuals. Real life symptoms and VR experiences were correlated, lending further support to its validity. Neurocognitive deficits and difficulties in social behavior were found in schizophrenia patients, not only in abstract tasks but also using naturalistic virtual environments that are more relevant to daily life, such as a city or encounters with avatars. VR treatments are conceivable for most dimensions of psychotic disorders. There is a small but expanding literature on interventions for delusions, hallucinations, neurocognition, social cognition, and social skills; preliminary results are promising. VR applications for assessment and treatment of psychotic disorders are in their infancy, but appear to have a great potential for increasing our understanding of psychosis and expanding the therapeutic toolbox.
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Affiliation(s)
- Wim Veling
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands;
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Brian RM, Ben-Zeev D. Mobile health (mHealth) for mental health in Asia: objectives, strategies, and limitations. Asian J Psychiatr 2014; 10:96-100. [PMID: 25042960 DOI: 10.1016/j.ajp.2014.04.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/15/2022]
Abstract
Mobile technologies are transforming the way in which we interact with one another, access resources, find information, and conduct business around the world. Harnessing the capabilities of mobile technologies to support health care initiatives worldwide has developed into a new interdisciplinary field called mobile health (mHealth). In the current paper, we review the penetration of mobile technology in Asia, and consider the integration of mobile technologies into the study, diagnoses, and treatment of mental disorders in the region. We outline how mHealth programs could improve mental health literacy, provide greater access to mental health services, extend community-based outreach and engagement, support self-management of illness, and regulate medication distribution. We end with a consideration of the potential barriers and limitations of mHealth for mental health, including funding, language and literacy barriers, power supply considerations, data security, and privacy issues.
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Affiliation(s)
- Rachel M Brian
- Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Dror Ben-Zeev
- Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Waters F, Collerton D, Ffytche DH, Jardri R, Pins D, Dudley R, Blom JD, Mosimann UP, Eperjesi F, Ford S, Larøi F. Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease. Schizophr Bull 2014; 40 Suppl 4:S233-45. [PMID: 24936084 PMCID: PMC4141306 DOI: 10.1093/schbul/sbu036] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 02/06/2023]
Abstract
Much of the research on visual hallucinations (VHs) has been conducted in the context of eye disease and neurodegenerative conditions, but little is known about these phenomena in psychiatric and nonclinical populations. The purpose of this article is to bring together current knowledge regarding VHs in the psychosis phenotype and contrast this data with the literature drawn from neurodegenerative disorders and eye disease. The evidence challenges the traditional views that VHs are atypical or uncommon in psychosis. The weighted mean for VHs is 27% in schizophrenia, 15% in affective psychosis, and 7.3% in the general community. VHs are linked to a more severe psychopathological profile and less favorable outcome in psychosis and neurodegenerative conditions. VHs typically co-occur with auditory hallucinations, suggesting a common etiological cause. VHs in psychosis are also remarkably complex, negative in content, and are interpreted to have personal relevance. The cognitive mechanisms of VHs in psychosis have rarely been investigated, but existing studies point to source-monitoring deficits and distortions in top-down mechanisms, although evidence for visual processing deficits, which feature strongly in the organic literature, is lacking. Brain imaging studies point to the activation of visual cortex during hallucinations on a background of structural and connectivity changes within wider brain networks. The relationship between VHs in psychosis, eye disease, and neurodegeneration remains unclear, although the pattern of similarities and differences described in this review suggests that comparative studies may have potentially important clinical and theoretical implications.
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Affiliation(s)
- Flavie Waters
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service Mental Health, Perth, Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Perth, Western Australia, Australia;
| | - Daniel Collerton
- Northumberland, Tyne and Wear NHS Foundation Trust, Bensham Hospital, Gateshead and Newcastle University, Newcastle Upon Tyne, UK
| | | | - Renaud Jardri
- Laboratoire de Neurosciences Fonctionnelles & Pathologies, Université Droit & Santé (UDSL), Univ Lille Nord de France and Centre Hospitalier Universitaire (CHU Lille), Hôpital Fontan, Lille, France
| | - Delphine Pins
- Laboratoire de Neurosciences Fonctionnelles & Pathologies, Université Droit & Santé (UDSL), Univ Lille Nord de France and Centre Hospitalier Universitaire (CHU Lille), Hôpital Fontan, Lille, France
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK; South of Tyne Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jan Dirk Blom
- Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Urs Peter Mosimann
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Frank Eperjesi
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Stephen Ford
- Department of Psychiatry, Sir Charles Gairdner Hospital, North Metropolitan Health Service Mental Health - Older Adult Program, Perth, Western Australia, Australia
| | - Frank Larøi
- Department of Psychology: Cognition and Behaviour, University of Liège, Liège, Belgium
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Hartley S, Haddock G, Vasconcelos E Sa D, Emsley R, Barrowclough C. An experience sampling study of worry and rumination in psychosis. Psychol Med 2014; 44:1605-1614. [PMID: 23953654 DOI: 10.1017/s0033291713002080] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Increasing research effort is being dedicated to investigating the links between emotional processes and psychosis, despite the traditional demarcation between the two. Particular focus has alighted upon two specific anxious and depressive processes, worry and rumination, given the potential for links with aspects of delusions and auditory hallucinations. This study rigorously explored the nature of these links in the context of the daily life of people currently experiencing psychosis. METHOD Experience sampling methodology (ESM) was used to assess the momentary links between worry and rumination on the one hand, and persecutory delusional ideation and auditory hallucinations on the other. Twenty-seven participants completed the 6-day experience sampling period, which required repeated self-reports on thought processes and experiences. Multilevel modelling was used to examine the links within the clustered data. RESULTS We found that antecedent worry and rumination predicted delusional and hallucinatory experience, and the distress they elicited. Using interaction terms, we have shown that the links with momentary symptom severity were moderated by participants' trait beliefs about worry/rumination, such that they were reduced when negative beliefs about worry/rumination (meta-cognitions) were high. CONCLUSIONS The current findings offer an ecologically valid insight into the influence of worry and rumination on the experience of psychotic symptoms, and highlight possible avenues for future intervention strategies.
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Affiliation(s)
- S Hartley
- Division of Clinical Psychology, University of Manchester, UK
| | - G Haddock
- Division of Clinical Psychology, University of Manchester, UK
| | | | - R Emsley
- Centre for Biostatistics, University of Manchester and Manchester Academic Health Sciences Centre, UK
| | - C Barrowclough
- Division of Clinical Psychology, University of Manchester, UK
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Wichers M. The dynamic nature of depression: a new micro-level perspective of mental disorder that meets current challenges. Psychol Med 2014; 44:1349-1360. [PMID: 23942140 DOI: 10.1017/s0033291713001979] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The examination of moment-to-moment, 'micro-level' patterns of experience and behaviour using experience sampling methodology has contributed to our understanding of the 'macro-level' development of full-blown symptoms and disorders. This paper argues that the micro-level perspective can be used to identify the smallest building blocks underlying the onset and course of mental ill-health. Psychopathology may be the result of the continuous dynamic interplay between micro-level moment-to-moment experiences and behavioural patterns over time. Reinforcing loops between momentary states may alter the course of mental health towards either a more or less healthy state. An example with observed data, from a population of individuals with depressive symptoms, supports the validity of a dynamic network model of psychopathology and shows that together and over time, this continuous interplay between momentary states may result in the cluster of symptoms we call major depressive disorder. This approach may help conceptualize the nature of mental disorders, and generate individualized insights useful for diagnosis and treatment in psychiatry.
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Affiliation(s)
- M Wichers
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
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