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Bucci P, Mucci A, Giordano GM, Caporusso E, Giuliani L, Gibertoni D, Rossi A, Rocca P, Bertolino A, Galderisi S. Insight in cognitive impairment assessed with the Cognitive Assessment Interview in a large sample of patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2024; 274:1343-1354. [PMID: 37380743 PMCID: PMC11362188 DOI: 10.1007/s00406-023-01641-7] [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: 02/06/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). The present study aimed at assessing, in a large sample of SCZ (n = 601), the agreement between patients and their informants on CAI ratings, to explore patients' insight in their cognitive deficits and its relationships with clinical and functional indices. Agreement between patient- and informant-based ratings was assessed by the Gwet's agreement coefficient. Predictors of insight in cognitive deficits were explored by stepwise multiple regression analyses. Patients reported lower severity of cognitive impairment vs. informants. A substantial to almost perfect agreement was observed between patients' and informants' ratings. Lower insight in cognitive deficits was associated to greater severity of neurocognitive impairment and positive symptoms, lower severity of depressive symptoms, and older age. Worse real-life functioning was associated to lower insight in cognitive deficit, worse neurocognitive performance, and worse functional capacity. Our findings indicate that the CAI is a valid co-primary measure with the interview to patients providing a reliable assessment of their cognitive deficits. In the absence of informants with good knowledge of the subject, the interview to the patient may represent a valid alternative.
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Affiliation(s)
- Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia M Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dino Gibertoni
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Larrauri CA, Harvey PD, Kane JM. A Patient-Clinician Discussion of Current Challenges in Schizophrenia Part 1: Addressing Daily Functioning and Cognitive Impairments Associated with Schizophrenia [Podcast]. Neuropsychiatr Dis Treat 2023; 19:1331-1338. [PMID: 37292181 PMCID: PMC10244615 DOI: 10.2147/ndt.s419177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 06/10/2023] Open
Abstract
Dr John M. Kane discusses cognitive impairments in schizophrenia with fellow expert Dr Philip D. Harvey and patient advocate and mental health clinician, Mr Carlos A. Larrauri, who was diagnosed with schizophrenia. The podcast aims to raise awareness of the unmet need to address cognitive impairments associated with schizophrenia (CIAS) as well as the challenges/opportunities faced by patients and clinicians regarding assessments and treatments. The authors emphasize the importance of a treatment focus on daily functioning, in parallel with cognitive symptoms, to mitigate impairments and improve overall outcomes. Mr Larrauri presents the patient perspective and shares his experiences of how psychosocial support and cognitive training can benefit recovery and help patients achieve their goals.
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Affiliation(s)
| | | | - John M Kane
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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3
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Sauvé G, Buck G, Lepage M, Corbière M. Minds@Work: A New Manualized Intervention to Improve Job Tenure in Psychosis Based on Scoping Review and Logic Model. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:515-528. [PMID: 34331191 DOI: 10.1007/s10926-021-09995-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
Introduction A significant proportion of people experiencing psychosis are unemployed, despite a strong desire to work. Current supported employment programs appear effective in helping them obtain employment, yet job tenure remains an arduous challenge. The objective of this study was to review the literature and model the results to inform the development of a new manualized group psychosocial intervention-'Minds@Work'-aimed specifically at improving job tenure in psychosis. Methods The study was registered on the Open Science Framework platform ( https://osf.io/he68z ). The literature was searched in Medline, Embase, PsycInfo and Cochrane Library databases for studies examining predictors of job tenure in psychosis and existing occupational psychosocial interventions. Data were extracted using a pre-established form and synthesized using logic models. Results A total of 94 studies were included and their findings were modeled using different categories: intervention typologies, mechanisms of action, predictors of job tenure, outcomes and contextual factors. The 'Minds@Work' program was built based on these modeled findings and aimed to target specific predictors of job tenure while addressing some of the limitations of existing interventions. The program uses evidence-based techniques and is divided into 9 modules covering 4 themes: positive psychology (motivation, character strengths, self-compassion), neurocognitive remediation (attention, memory, problem-solving), cognitive biases training (jumping to conclusions, defeatists beliefs, theory of mind, attributional styles) and socioemotional coping skills (emotion regulation, communication). Conclusions Once validated, this new program is meant to be used either as a stand-alone intervention or integrated in supported employment initiatives, by employment specialists or healthcare workers.
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Affiliation(s)
- Geneviève Sauvé
- Department of Psychology, Université du Québec À Montréal, 100 Sherbrooke West, Montreal, QC, H2X 3P2, Canada
| | - Gabriella Buck
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Marc Corbière
- Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada.
- Department of Education - Career Counselling, Université du Québec À Montréal, Pavilion N, 1205 Saint-Denis, Montreal, QC, H2X 3R9, Canada.
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Lynham AJ, Jones IR, Walters JTR. Web-Based Cognitive Testing in Psychiatric Research: Validation and Usability Study. J Med Internet Res 2022; 24:e28233. [PMID: 35142640 PMCID: PMC8874806 DOI: 10.2196/28233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/11/2021] [Accepted: 11/21/2021] [Indexed: 01/23/2023] Open
Abstract
Background Cognitive impairments are features of many psychiatric disorders and affect functioning. A barrier to cognitive research on psychiatric disorders is the lack of large cross-disorder data sets. However, the collection of cognitive data can be logistically challenging and expensive. Web-based collection may be an alternative; however, little is known about who does and does not complete web-based cognitive assessments for psychiatric research. Objective The aims of this study are to develop a web-based cognitive battery for use in psychiatric research, validate the battery against the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, and compare the characteristics of the participants who chose to take part with those of the individuals who did not participate. Methods Tasks were developed by The Many Brains Project and selected to measure the domains specified by the MATRICS initiative. We undertook a cross-validation study of 65 participants with schizophrenia, bipolar disorder, depression, or no history of psychiatric disorders to compare the web-based tasks with the MATRICS Consensus Cognitive Battery. Following validation, we invited participants from 2 large ongoing genetic studies, which recruited participants with psychiatric disorders to complete the battery and evaluated the demographic and clinical characteristics of those who took part. Results Correlations between web-based and MATRICS tasks ranged between 0.26 and 0.73. Of the 961 participants, 887 (92.3%) completed at least one web-based task, and 644 (67%) completed all tasks, indicating adequate completion rates. Predictors of web-based participation included being female (odds ratio [OR] 1.3, 95% CI 1.07-1.58), ethnicity other than White European (OR 0.66, 95% CI 0.46-0.96), higher levels of education (OR 1.19, 95% CI 1.11-1.29), diagnosis of an eating disorder (OR 2.17, 95% CI 1.17-4) or depression and anxiety (OR 5.12, 95% CI 3.38-7.83), and absence of a diagnosis of schizophrenia (OR 0.59, 95% CI 0.35-0.94). Lower performance on the battery was associated with poorer functioning (B=−1.76, SE 0.26; P<.001). Conclusions Our findings offer valuable insights into the advantages and disadvantages of testing cognitive function remotely for mental health research.
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Affiliation(s)
- Amy Joanne Lynham
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ian R Jones
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - James T R Walters
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Trace Amine-Associated Receptor 1 as a Target for the Development of New Antipsychotics: Current Status of Research and Future Directions. CNS Drugs 2021; 35:1153-1161. [PMID: 34655036 DOI: 10.1007/s40263-021-00864-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Schizophrenia is a mental illness associated with an array of symptoms that often result in disability. The primary treatments for schizophrenia are termed antipsychotics. Although antipsychotics modulate a number of different receptor types and subtypes, all currently regulatory agency-approved antipsychotics share in common direct or functional antagonism at the dopamine type 2 receptor (D2R). The majority of people with schizophrenia do not achieve full resolution of their symptoms with antipsychotics, suggesting the need for alternative or complementary approaches. The primary focus of this review is to assess the evidence for the role of the trace amine-associated receptor 1 (TAAR-1) in schizophrenia and the role of TAAR-1 modulators as novel-mechanism antipsychotics. Topics include an overview of TAAR-1 physiology and pathophysiology in schizophrenia, interaction with other neurotransmitter systems, including the dopaminergic, glutamatergic and serotonergic system, and finally, a review of investigational TAAR-1 compounds that have reached Phase II clinical studies in schizophrenia: SEP-363856 (ulotaront) and RO6889450 (ralmitaront). Thus far, results are publicly available only for ulotaront in a relatively young (18-40 years) and acutely exacerbated cohort. These results showed positive effects for overall schizophrenia symptoms without significant tolerability concerns. An ongoing study of ralmitaront will assess specific efficacy in patients with persistent negative symptoms. If trials of TAAR-1 modulators, and other novel-mechanism targets for schizophrenia that are under active study, continue to show positive results, the definition of an antipsychotic may need to be expanded beyond the D2R target in the near future.
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Dopamine, Cognitive Impairments and Second-Generation Antipsychotics: From Mechanistic Advances to More Personalized Treatments. Pharmaceuticals (Basel) 2020; 13:ph13110365. [PMID: 33167370 PMCID: PMC7694365 DOI: 10.3390/ph13110365] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
The pharmacological treatment of cognitive impairments associated with schizophrenia is still a major unmet clinical need. Indeed, treatments with available antipsychotics generate highly variable cognitive responses among patients with schizophrenia. This has led to the general assumption that antipsychotics are ineffective on cognitive impairment, although personalized medicine and drug repurposing approaches might scale down this clinical issue. In this scenario, evidence suggests that cognitive improvement exerted by old and new atypical antipsychotics depends on dopaminergic mechanisms. Moreover, the newer antipsychotics brexpiprazole and cariprazine, which might have superior clinical efficacy on cognitive deficits over older antipsychotics, mainly target dopamine receptors. It is thus reasonable to assume that despite more than 50 years of elusive efforts to develop novel non-dopaminergic antipsychotics, dopamine receptors remain the most attractive and promising pharmacological targets in this field. In the present review, we discuss preclinical and clinical findings showing dopaminergic mechanisms as key players in the cognitive improvement induced by both atypical antipsychotics and potential antipsychotics. We also emphasize the concept that these mechanistic advances, which help to understand the heterogeneity of cognitive responses to antipsychotics, may properly guide treatment decisions and address the unmet medical need for the management of cognitive impairment associated with schizophrenia.
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Kantrowitz JT, Javitt DC, Freedman R, Sehatpour P, Kegeles LS, Carlson M, Sobeih T, Wall MM, Choo TH, Vail B, Grinband J, Lieberman JA. Double blind, two dose, randomized, placebo-controlled, cross-over clinical trial of the positive allosteric modulator at the alpha7 nicotinic cholinergic receptor AVL-3288 in schizophrenia patients. Neuropsychopharmacology 2020; 45:1339-1345. [PMID: 32015461 PMCID: PMC7298033 DOI: 10.1038/s41386-020-0628-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/06/2020] [Accepted: 01/26/2020] [Indexed: 11/09/2022]
Abstract
Despite their theoretical rationale, nicotinic alpha-7 acetylcholine (nα7) receptor agonists, have largely failed to demonstrate efficacy in placebo-controlled trials in schizophrenia. AVL-3288 is a nα7 positive allosteric modulator (PAM), which is only active in the presence of the endogenous ligand (acetylcholine), and thus theoretically less likely to cause receptor desensitization. We evaluated the efficacy of AVL-3288 in a Phase 1b, randomized, double-blind, placebo-controlled, triple cross-over study. Twenty-four non-smoking, medicated, outpatients with schizophrenia or schizoaffective disorder and a Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) ≥62 were randomized. Each subject received 5 days of AVL-3288 (10, 30 mg) and placebo across three separate treatment weeks. The primary outcome measure was the RBANS total scale score, with auditory P50 evoked potential suppression the key target engagement biomarker. Secondary outcome measures include task-based fMRI (RISE task), mismatch negativity, the Scale for the Assessment of Negative Symptoms of Schizophrenia (SANS) and the Brief Psychiatric Rating Scale (BPRS). Twenty-four subjects were randomized and treated without any clinically significant treatment emergent adverse effects. Baseline RBANS (82 ± 17) and BPRS (41 ± 13) scores were consistent with moderate impairment. Primary outcomes were negative, with non-significant worsening for both active groups vs. placebo in the P50 and minimal between group changes on the RBANS. In conclusion, the results did not indicate efficacy of the compound, consistent with most prior results for the nα7 target.
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Affiliation(s)
- Joshua T. Kantrowitz
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA ,0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | - Daniel C. Javitt
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA ,0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | | | - Pejman Sehatpour
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA ,0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | - Lawrence S. Kegeles
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Marlene Carlson
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Tarek Sobeih
- 0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | - Melanie M. Wall
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Tse-Hwei Choo
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Blair Vail
- 0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Jack Grinband
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Jeffrey A. Lieberman
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
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Maurus I, Röh A, Falkai P, Malchow B, Schmitt A, Hasan A. Nonpharmacological treatment of dyscognition in schizophrenia: effects
of aerobic exercise
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 21:261-269. [PMID: 31749650 PMCID: PMC6829165 DOI: 10.31887/dcns.2019.21.3/aschmitt] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive symptoms are a core feature of schizophrenia and are related to an
unfavorable disease outcome. So far, there are no satisfactory pharmacological
approaches to address cognitive symptoms. For some time now, aerobic exercise has been
demonstrated in various trials to be a promising candidate for this indication. The aim
of this brief qualitative review was to present the most recent meta-analyses regarding
the capacity of exercise to improve cognition in schizophrenia patients. Additionally,
we give a short overview of the effects in other conditions, like healthy subjects and
patients with major depression. We conducted a focused literature search using the
PubMed database, concentrating on meta-analyses which are based on a systematic search.
The most recent meta-analysis investigating the efficacy of aerobic exercise on
cognitive impairments in schizophrenia patients provides evidence that exercise has
positive effects on cognitive functioning in this population. However, the effect seems
not to be specific; there were positive findings regarding healthy subjects and patients
with depressive disorders as well, even if they were less consistent. As most available
trials have a small to modest sample size and have no consensus with regard to the
intervention regime, nor to the assessment of cognition, the findings are difficult to
generalize. In the future, standardized clinical trials focusing on the long-term
effects of exercise are needed to evaluate whether the improvements in cognition are
sustainable.
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Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Unversity Hopsital of Jena, Jena, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
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de la Garrigue N, Glasser J, Sehatpour P, Iosifescu DV, Dias E, Carlson M, Shope C, Sobeih T, Choo TH, Wall MM, Kegeles LS, Gangwisch J, Mayer M, Brazis S, De Baun HM, Wolfer S, Bermudez D, Arnold M, Rette D, Meftah AM, Conant M, Lieberman JA, Kantrowitz JT. Grant Report on d-Serine Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia †. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2020; 5:e200018. [PMID: 32856005 PMCID: PMC7448686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report on the rationale and design of an ongoing NIMH sponsored R61-R33 project in schizophrenia/schizoaffective disorder. This project studies augmenting the efficacy of auditory neuroplasticity cognitive remediation (AudRem) with d-serine, an N-methyl-d-aspartate-type glutamate receptor (NMDAR) glycine-site agonist. We operationalize improved (smaller) thresholds in pitch (frequency) between successive auditory stimuli after AudRem as improved plasticity, and mismatch negativity (MMN) and auditory θ as measures of functional target engagement of both NMDAR agonism and plasticity. Previous studies showed that AudRem alone produces significant, but small cognitive improvements, while d-serine alone improves symptoms and MMN. However, the strongest results for plasticity outcomes (improved pitch thresholds, auditory MMN and θ) were found when combining d-serine and AudRem. AudRem improvements correlated with reading and other auditory cognitive tasks, suggesting plasticity improvements are predictive of functionally relevant outcomes. While d-serine appears to be efficacious for acute AudRem enhancement, the optimal dose remains an open question, as does the ability of combined d-serine + AudRem to produce sustained improvement. In the ongoing R61, 45 schizophrenia patients will be randomized to receive three placebo-controlled, double-blind d-serine + AudRem sessions across three separate 15 subject dose cohorts (80/100/120 mg/kg). Successful completion of the R61 is defined by ≥moderate effect size changes in target engagement and correlation with function, without safety issues. During the three-year R33, we will assess the sustained effects of d-serine + AudRem. In addition to testing a potentially viable treatment, this project will develop a methodology to assess the efficacy of novel NMDAR modulators, using d-serine as a "gold-standard".
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Affiliation(s)
| | - Juliana Glasser
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Pejman Sehatpour
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Dan V. Iosifescu
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Elisa Dias
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Marlene Carlson
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | | | - Tarek Sobeih
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Tse-Hwei Choo
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Melanie M. Wall
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Lawrence S. Kegeles
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - James Gangwisch
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Megan Mayer
- New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | | | - Dalton Bermudez
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Molly Arnold
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | | | - Amir M. Meftah
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Melissa Conant
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Jeffrey A. Lieberman
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Joshua T. Kantrowitz
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA,Correspondence: Joshua T. Kantrowitz, ; Tel.: +1-646-774-6738
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Cotter J, Barnett JH, Granger K. The Use of Cognitive Screening in Pharmacotherapy Trials for Cognitive Impairment Associated With Schizophrenia. Front Psychiatry 2019; 10:648. [PMID: 31551837 PMCID: PMC6743013 DOI: 10.3389/fpsyt.2019.00648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/12/2019] [Indexed: 11/13/2022] Open
Abstract
There are currently no regulatory approved pharmacological treatments for cognitive impairment associated with schizophrenia (CIAS). One possibility is that trial methodology itself is hindering their development. Emerging evidence suggests that patients with schizophrenia may show limited benefit from pro-cognitive interventions if they already exhibit intact cognitive performance, relative to normative thresholds. The aim of this report was to examine the extent to which objectively assessed cognitive performance has been used as an eligibility and/or stratification criterion in CIAS pharmacotherapy trials. On 16th January 2019, we conducted a systematic search of studies listed on ClinicalTrials.gov to identify randomized, double-blind, placebo-controlled, add-on pharmacotherapy trials conducted in patients with a diagnosis of schizophrenia, in which a paper-and-pencil or computerized cognitive task (or battery) was specified as a primary outcome measure. Of the 87 trials that met our inclusion criteria, 10 (11.5%) required the presence of an objectively assessed cognitive deficit as part of their patient eligibility criteria. No studies reported stratifying patients according to the presence or degree of cognitive impairment they exhibited. These results suggest that the vast majority of CIAS trials may have been underpowered due to the inclusion of cognitively "normal" patients. Purposive screening for cognitive impairment could increase CIAS trial success.
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Affiliation(s)
- Jack Cotter
- Cambridge Cognition, Cambridge, United Kingdom
| | - Jennifer H Barnett
- Cambridge Cognition, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Caponnetto P, Maglia M, Auditore R, Bocchieri M, Caruso A, DiPiazza J, Polosa R. Improving neurocognitive functioning in schizophrenia by addition of cognitive remediation therapy to a standard treatment of metacognitive training. Ment Illn 2018; 10:7812. [PMID: 30746055 PMCID: PMC6342025 DOI: 10.4081/mi.2018.7812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Cognitive dysfunctions are a common clinical feature of schizophrenia and represent important indicators of outcome among patients who are affected. Therefore, a randomized, controlled, monocentric, singleblind trial was carried out to compare two different rehabilitation strategies adopted for the restoration and recovery of cognitive functioning of residential patients with schizophrenia. A sample of 110 residential patients were selected and, during the experimental period, a group of 55 patients was treated with sets of domain-specific exercises (SRT+CRT), whereas an equal control group was treated with sets of nondomain- specific exercises (SRT+PBO) belonging to the Cogpack® software. The effects on the scores (between T0 and T1) of the variables treatment and time and of the interaction time X treatment were analyzed: for the total BACS, the main effect of the between-factors variable treatment is statistically significant (F=201.562 P=0.000), as well as the effect of the within-factors variable “time” (F=496.68 P=0.000).The interaction of these two factors is also statistically significant (F=299.594 P=0.000). The addition of cognitive remediation therapy (CRT) to a standard treatment of metacognitive training (MCT) resulted in a significant improvement in global neurocognitive functioning and has reported positive effects with regard to the strengthening of verbal and working memory, selective and sustained attention at T1. A relevant result is the statistically significance of “time X treatment” for all the tests administered: we can assume that the domain-specific cognitive training amplifies the effects of SRT, as the primary and secondary goals of the present study were achieved.
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Affiliation(s)
- Pasquale Caponnetto
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Marilena Maglia
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Roberta Auditore
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Marta Bocchieri
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Antonio Caruso
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Jennifer DiPiazza
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Riccardo Polosa
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
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12
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Room to move: Plasticity in early auditory information processing and auditory learning in schizophrenia revealed by acute pharmacological challenge. Schizophr Res 2018; 199:285-291. [PMID: 29627173 PMCID: PMC6151271 DOI: 10.1016/j.schres.2018.03.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
Abstract
Many patients with chronic psychotic disorders including schizophrenia (SZ) maintain meaningful levels of plasticity (i.e., capacity for change) within neurocognition-relevant brain mechanisms, as evidenced by gains in neurocognition and function after interventions such as targeted cognitive training. However, like many clinical features of these disorders, therapeutic responses in SZ are heterogeneous, and prospectively identifying treatment-sensitive individuals and individualized treatment modalities remains an unmet challenge. We propose that available plasticity in neurocognition-relevant brain mechanisms in individual SZ patients can be detected by gains in laboratory measures of early auditory information processing (EAIP) and auditory learning after a single challenge-dose of a pharmacologic agent; here, we present supportive data for this strategy with the non-competitive NMDA antagonist, memantine, and the psychostimulant, amphetamine. We describe a novel therapeutic model where this "challenge dose" strategy is used to prospectively identify a sensitive cohort of patients, and in these patients, a therapeutic response is elicited by pairing drug-enhanced EAIP and auditory learning with auditory-based targeted cognitive training.
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13
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Gold M, Amatniek J, Carrillo MC, Cedarbaum JM, Hendrix JA, Miller BB, Robillard JM, Rice JJ, Soares H, Tome MB, Tarnanas I, Vargas G, Bain LJ, Czaja SJ. Digital technologies as biomarkers, clinical outcomes assessment, and recruitment tools in Alzheimer's disease clinical trials. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:234-242. [PMID: 29955666 PMCID: PMC6021547 DOI: 10.1016/j.trci.2018.04.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Digital technology is transforming the development of drugs for Alzheimer's disease and was the topic of the Alzheimer's Association's Research Roundtable on its May 23–24, 2017 meeting. Research indicates that wearable devices and unobtrusive passive sensors that enable the collection of frequent or continuous, objective, and multidimensional data during daily activities may capture subtle changes in cognition and functional capacity long before the onset of dementia. The potential to exploit these technologies to improve clinical trials as both recruitment and retention tools as well as for potential end points was discussed. The implications for the collection and use of large amounts of data, lessons learned from other related disease areas, ethical concerns raised by these new technologies, and regulatory issues were also covered in the meeting. Finally, the challenges and opportunities of these new technologies for future use were discussed.
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Affiliation(s)
| | - Joan Amatniek
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | | | | | | | | | - Julie M Robillard
- Division of Neurology, Department of Medicine, University of British Columbia and Children's and Women's Hospital and Health Centres, Vancouver, BC, Canada
| | - J Jeremy Rice
- Healthcare and Life Science Research, IBM T.J. Watson Research Center, New York, NY, USA
| | | | | | - Ioannis Tarnanas
- Altoida Inc., La Jolla, CA, USA.,Scripps Memorial Hospital, San Diego, CA, USA.,Atlantic Fellow for Equity in Brain Health with the Global Brain Health Institute (GBHI) at UCSF, San Francisco, CA, USA.,Trinity College Dublin, Dublin, Ireland
| | | | - Lisa J Bain
- Independent Science Writer, Elverson, PA, USA
| | - Sara J Czaja
- Department of Psychiatry and Behavioral Science, Miller School of Medicine, University of Miami, Miami, FL, USA
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14
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Hopkins SC, Ogirala A, Loebel A, Koblan KS. Transformed PANSS Factors Intended to Reduce Pseudospecificity Among Symptom Domains and Enhance Understanding of Symptom Change in Antipsychotic-Treated Patients With Schizophrenia. Schizophr Bull 2018; 44:593-602. [PMID: 28981857 PMCID: PMC5890480 DOI: 10.1093/schbul/sbx101] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Positive and Negative Syndrome Scale (PANSS) total score is the standard primary efficacy measure in acute treatment studies of schizophrenia. However, PANSS factors that have been derived from factor analytic approaches over the past several decades have uncertain clinical and regulatory status as they are, to varying degrees, intercorrelated. As a consequence of cross-factor correlations, the apparent improvement in key clinical domains (eg, negative symptoms, disorganized thinking/behavior) may largely be attributable to improvement in a related clinical domain, such as positive symptoms, a problem often referred to as pseudospecificity. Here, we analyzed correlations among PANSS items, at baseline and change post-baseline, in a pooled sample of 5 placebo-controlled clinical trials (N = 1710 patients), using clustering and factor analysis to identify an uncorrelated PANSS score matrix (UPSM) that minimized the degree of correlation between each resulting transformed PANSS factor. The transformed PANSS factors corresponded well with discrete symptom domains described by prior factor analyses, but between-factor change-scores correlations were markedly lower. We then used the UPSM to transform PANSS in data from 4657 unique schizophrenia patients included in 12 additional lurasidone clinical trials. The results confirmed that transformed PANSS factors retained a high degree of specificity, thus validating that low between-factor correlations are a reliable property of the USPM when transforming PANSS data from a variety of clinical trial data sets. These results provide a more robust understanding of the structure of symptom change in schizophrenia and suggest a means to evaluate the specificity of antipsychotic treatment effects.
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Affiliation(s)
- Seth C Hopkins
- Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA
| | - Ajay Ogirala
- Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA
| | - Antony Loebel
- Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA
| | - Kenneth S Koblan
- Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA,To whom correspondence should be addressed; tel: +1-508-357-7345, fax: +1-508-490-5454, e-mail:
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15
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Hopkins SC, Ogirala A, Loebel A, Koblan KS. Understanding Antipsychotic Drug Treatment Effects: A Novel Method to Reduce Pseudospecificity of the Positive and Negative Syndrome Scale (PANSS) Factors. INNOVATIONS IN CLINICAL NEUROSCIENCE 2017; 14:54-58. [PMID: 29410937 PMCID: PMC5788251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Positive and Negative Syndrome Scale (PANSS) is the most widely used efficacy measure in acute treatment studies of schizophrenia. However, interpretation of the efficacy of antipsychotics in improving specific symptom domains is confounded by moderate-to-high correlations among standard (Marder) PANSS factors. The authors review the results of an uncorrelated PANSS score matrix (UPSM) transform designed to reduce pseudospecificity in assessment of symptom change in patients with schizophrenia. Based on a factor analysis of five pooled, placebo-controlled lurasidone clinical trials (N=1,710 patients), a UPSM transform was identified that generated PANSS factors with high face validity (good correlation with standard Marder PANSS factors), and high specificity/orthogonality (low levels of between-factor correlation measuring change during treatment). Between-factor correlations were low at baseline for both standard (Marder) PANSS factors and transformed PANSS factors. However, when measured change in symptom severity was measured during treatment (in a pooled 5-study analysis), there was a notable difference for standard PANSS factors, where changes across factors were found to be highly correlated (factors exhibited pseudospecificity), compared to transformed PANSS factors, where factor change scores exhibited the same low levels of between-factor correlation observed at baseline. At Week 6-endpoint, correlations among PANSS factor severity scores were moderate-to-high for standard factors (0.34-0.68), but continued to be low for the transformed factors (-0.22-0.20). As an additional validity check, we analyzed data from one of the original five pooled clinical trials that included other well-validated assessment scales (MADRS, Negative Symptom Assessment scale [NSA]). In this baseline analysis, UPSM-transformed PANSS factor severity scores (negative and depression factors) were found to correlate well with the MADRS and NSA. The availability of transformed PANSS factors with a high degree of orthogonality/specificity, but which retain a high degree of concurrent and face validity, can reduce pseudospecificity as a measurement confound, and should facilitate the drug development process, permitting a more accurate characterization of the efficacy of putative new agents in targeting specific symptom domains in patients with psychotic illness.
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Affiliation(s)
- Seth C Hopkins
- Drs. Hopkins, Ogirala, Loebel, and Koblan are with Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
| | - Ajay Ogirala
- Drs. Hopkins, Ogirala, Loebel, and Koblan are with Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
| | - Antony Loebel
- Drs. Hopkins, Ogirala, Loebel, and Koblan are with Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
| | - Kenneth S Koblan
- Drs. Hopkins, Ogirala, Loebel, and Koblan are with Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
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16
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Lam M, Wang M, Huang W, Eng GK, Rapisarda A, Kraus M, Kang S, Keefe RSE, Lee J. Establishing the Brief Assessment of Cognition - Short form. J Psychiatr Res 2017; 93:1-11. [PMID: 28549241 DOI: 10.1016/j.jpsychires.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/30/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
The study aims to identify and validate a parsimonious subset of tests in the commonly used Brief Assessment of Cognition in Schizophrenia (BACS) that allows the evaluation of global cognitive ability. Several permutations of subtests from the BACS were examined to identify the best subset of tests to compose the short form measure. The Brief Assessment of Cognition-Short Form (BAC-SF) was evaluated for convergent validity in healthy and psychiatric samples (N = 3718). Verbal Memory, Digit Sequencing, and Symbol Coding subtests were found to best summarize the variance of composite scores in both Asian and US Norming samples (r = 0.91) indicating that BAC-SF is an appropriate approximation of cognitive deficits. Test re-test reliability of the BAC-SF was adequate (Intraclass Correlation Coefficient (ICC) = 0.73) and showed sufficient separation between healthy controls and schizophrenia (Average Predictive Accuracy = 79.9%; replication = 76.5%). Findings indicate that the BAC-SF an could be used as a cognitive screener for large-scale clinical and epidemiological studies. The short form does not replace the need for comprehensive neuropsychological batteries purposed for detailed neuropsychological and clinical investigation of cognitive function. Further replication of the construct might be necessary in other clinical populations.
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Affiliation(s)
- Max Lam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore.
| | - Mingyuan Wang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
| | - Wanping Huang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Goi Khia Eng
- Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
| | - Michael Kraus
- Psychiatry and Behavioral Sciences, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Sim Kang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore; General Psychiatry, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
| | - R S E Keefe
- Psychiatry and Behavioral Sciences, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore; General Psychiatry, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
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Davies G, Fowler D, Greenwood K. Metacognition as a Mediating Variable Between Neurocognition and Functional Outcome in First Episode Psychosis. Schizophr Bull 2017; 43:824-832. [PMID: 27590844 PMCID: PMC5472108 DOI: 10.1093/schbul/sbw128] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurocognitive and functional outcome deficits have long been acknowledged in schizophrenia and neurocognition has been found to account for functional disability to a greater extent than psychopathology. Much of the variance in functional outcome however still remains unexplained and metacognition may mediate the relationship between neurocognition, functional capacity, and self-reported social and occupational function. METHOD Eighty first episode psychosis participants were recruited and completed measures of neurocognition (memory, executive function, and intelligence quotient), metacognition (Beck Cognitive Insight Scale, Metacognitive Awareness Interview), psychopathology (PANSS), and both functional capacity (UPSA) and real-life social and occupational function (The Time Use Survey). Path analyses investigated the relationships between variables through structural equation modeling. RESULTS A series of path models demonstrated that metacognition partially mediates the relationship between neurocognition and functional capacity, and fully mediates the relationship between functional capacity and social and occupational function. CONCLUSION The present study findings identify that metacognition may be critical to translating cognitive and functional skills into real-world contexts, and this relationship is found at early stages of illness. Understanding how individuals translate cognitive and functional skills into the real-world (the competence-performance gap) may offer valuable guidance to intervention programs. This finding is important to models of recovery as it suggests that intervention programs that focus on enhancing metacognition abilities may have a greater impact than traditional rehabilitation programs focusing on cognitive abilities, on social and occupational outcomes.
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Affiliation(s)
- Geoff Davies
- Department of Psychology, University of Sussex, Falmer, Brighton BN1 9QH, UK;,R&D department, Sussex Partnership NHS Foundation Trust
| | - David Fowler
- Department of Psychology, University of Sussex, Falmer, Brighton BN1 9QH, UK;,R&D department, Sussex Partnership NHS Foundation Trust
| | - Kathryn Greenwood
- Department of Psychology, University of Sussex, Falmer, Brighton BN1 9QH, UK;,R&D department, Sussex Partnership NHS Foundation Trust
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EPICOG-SCH: A brief battery to screen cognitive impact of schizophrenia in stable outpatients. SCHIZOPHRENIA RESEARCH-COGNITION 2017; 8:7-20. [PMID: 28740826 PMCID: PMC5514304 DOI: 10.1016/j.scog.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 11/21/2022]
Abstract
Brief batteries in schizophrenia, are needed to screen for the cognitive impact of schizophrenia. We aimed to validate and co-norm the Epidemiological Study of Cognitive Impairment in Schizophrenia (EPICOG-SCH) derived brief cognitive battery. A cross-sectional outpatient evaluation was conducted of six-hundred-seventy-two patients recruited from 234 centers. The brief battery included well-known subtests available worldwide that cover cognitive domains related to functional outcomes: WAIS-III-Letter-Number-Sequencing-LNS, Category Fluency Test-CFT, Logical-Memory Immediate Recall-LM, and Digit-Symbol-Coding-DSC. CGI-SCH Severity and WHO-DAS-S were used to assess clinical severity and functional impairment, respectively. Unit Composite Score (UCS) and functional regression-weighted Composite Scores (FWCS) were obtained; discriminant properties of FWCS to identify patients with different levels of functional disability were analyzed using receiver-operating characteristic (ROC) technique. The battery showed good internal consistency, Cronbach's alpha = 0.78. The differences between cognitive performance across CGI-SCH severity level subscales ranged from 0.5 to 1 SD. Discriminant capacity of the battery in identifying patients with up to moderate disability levels showed fair discriminant accuracy with areas under the curve (AUC) > 0.70, p < 0.0001. An FWCS mean cut-off score ≥ 100 showed likelihood ratios (LR) up to 4.7, with an LR + of 2.3 and a LR - of 0.5. An FWCS cut-off ≥ 96 provided the best balance between sensitivity (0.74) and specificity (0.62). The EPICOG-SCH proved to be a useful brief tool to screen for the cognitive impact of schizophrenia, and its regression-weighted Composite Score was an efficient complement to clinical interviews for confirming patients' potential functional outcomes and can be useful for monitoring cognition during routine outpatient follow-up visits.
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Pu S, Nakagome K, Itakura M, Iwata M, Nagata I, Kaneko K. Association of fronto-temporal function with cognitive ability in schizophrenia. Sci Rep 2017; 7:42858. [PMID: 28205609 PMCID: PMC5311872 DOI: 10.1038/srep42858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/18/2017] [Indexed: 01/13/2023] Open
Abstract
Deficits in neuropsychological performance are common in schizophrenia, but their relationship with the fronto-temporal functional abnormalities associated with this condition remains unclear. We explored the relationship between neuropsychological performance as measured using the Brief Assessment of Cognition in Schizophrenia (BACS) and the Social Cognition Screening Questionnaire theory of mind (ToM) subscale and fronto-temporal function in 23 patients with schizophrenia and 23 age- and gender-matched healthy controls (HCs), using 52-channel near-infrared spectroscopy (NIRS). Regional hemodynamic changes were significantly smaller in the schizophrenia group than in the HCs group in the ventro-lateral prefrontal cortex and the anterior part of the temporal cortex (VLPFC/aTC) and dorso-lateral prefrontal cortex and frontopolar cortex (DLPFC/FPC) regions. To dissect the effect of variance in BACS cognitive domains from the relationship between ToM function and fronto-temporal function, we performed additional partial correlation analyses between ToM and NIRS data, using BACS composite score as a control variable. The correlation between ToM and NIRS data remained significant only in the DLPFC/FPC region. This finding is important to models of recovery, as it suggests that intervention programs focusing on enhancing fronto-temporal function may have a greater impact on social and occupational outcomes than traditional rehabilitation programs focusing on neuropsychological performance.
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Affiliation(s)
- Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Kazuyuki Nakagome
- National Center of Neurology and Psychiatry: 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551 Japan
| | - Masashi Itakura
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Masaaki Iwata
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Izumi Nagata
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
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21
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Garay RP, Citrome L, Samalin L, Liu CC, Thomsen MS, Correll CU, Hameg A, Llorca PM. Therapeutic improvements expected in the near future for schizophrenia and schizoaffective disorder: an appraisal of phase III clinical trials of schizophrenia-targeted therapies as found in US and EU clinical trial registries. Expert Opin Pharmacother 2016; 17:921-36. [DOI: 10.1517/14656566.2016.1149164] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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