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Lin R, Li Q, Liu Z, Zhong S, Sun Q, Guo H, Cao H, Zhang X, Hu Y, Zhou J, Wang X. Abnormalities in electroencephalographic microstates among violent patients with schizophrenia. Front Psychiatry 2023; 14:1082481. [PMID: 36846235 PMCID: PMC9950110 DOI: 10.3389/fpsyt.2023.1082481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Schizophrenia is often associated with a remarkably increased risk of violence, which has become a public health concern and brought a great economic burden. Recent studies have reported changes in the electroencephalograms (EEG) of patients with schizophrenia. The evidence for an association between EEG and violence in patients with schizophrenia is not conclusive. This study aimed to investigate EEG microstates in violent patients with schizophrenia. Forty-three violent patients with schizophrenia (the VS group) and 51 non-violent patients with schizophrenia (the NVS group) were included, and their EEG microstates were recorded using 21-Channel EEG recordings. The two groups were compared for differences of four microstate classes (A-D) with regards to three microstate parameters (duration, occurrence, and coverage). Compared with the NVS group, the VS group exhibited increased duration, occurrence, and coverage of microstate class A and decreased occurrence of microstate class B. The VS group also had lower probabilities of transitions from "B to C" and from "C to B", as compared with the NVS group. In addition, the MOAS score was positively correlated with the duration, occurrence, and coverage of microstate A. The present study found an abnormal pattern of EEG microstates in violent patients with schizophrenia, which might help clinicians identify patients with schizophrenia who might engaged in violence as well as develop intervention strategies at an early stage.
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Affiliation(s)
- Ruoheng Lin
- National Center for Mental and Psychological Diseases Clinical Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiguang Li
- Xi'an Mental Health Center, Xi'an, China
| | - Ziwei Liu
- School of Medicine, Hunan Normal University, Changsha, China
| | - Shaoling Zhong
- Department of Community Mental Health, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiaoling Sun
- National Center for Mental and Psychological Diseases Clinical Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huijuan Guo
- National Center for Mental and Psychological Diseases Clinical Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Cao
- Department of Psychiatry, The Second People's Hospital of Hunan, Changsha, China
| | - Xiangbin Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuhang Hu
- Medicine School, Changsha Social Work College, Changsha, China
| | - Jiansong Zhou
- National Center for Mental and Psychological Diseases Clinical Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoping Wang
- National Center for Mental and Psychological Diseases Clinical Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
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Buizza C, Strozza C, Sbravati G, de Girolamo G, Ferrari C, Iozzino L, Macis A, Kennedy HG, Candini V. Positive and negative syndrome scale in forensic patients with schizophrenia spectrum disorders: a systematic review and meta-analysis. Ann Gen Psychiatry 2022; 21:36. [PMID: 36088451 PMCID: PMC9463849 DOI: 10.1186/s12991-022-00413-2] [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: 01/12/2022] [Accepted: 06/19/2022] [Indexed: 01/10/2023] Open
Abstract
Among forensic patients with schizophrenia spectrum disorders, the association between symptomatology and violence is still not entirely clear in literature, especially because symptoms shift both during the acute phase of the illness and after. The aims were to investigate the level of symptomatology in forensic patients and to evaluate if there are differences in the level of symptoms between forensic and non-forensic patients. According to PRISMA guidelines, a systematic search was performed in PubMed, Web of Science, and ProQuest, using the following key words: "forensic" AND "Positive and Negative Syndrome Scale" OR "PANSS". A total of 27 studies were included in the systematic review, while only 23 studies in the meta-analysis. The overall sample included a total of 1702 participants, most commonly male and inpatients in forensic settings. We found that studies with an entirely male sample had significantly lower Positive PANSS ratings than studies with mixed samples. Although both forensic and non-forensic patients were affected by mild psychopathological symptoms, forensic patients presented higher ratings in all four PANSS scales. This meta-analysis shows that forensic patients reported a mild level of symptomatology, as assessed with the PANSS, and therefore might be considered as patients in partial remission. Among patients with schizophrenia, the association between symptoms and violence is very complex: many factors might be considered as key mediators and thus should be taken into account to explain this association. Further studies are needed.Trial registration all materials and data can be found on the OSF framework: https://osf.io/5ceja (date of registration: 8 September 2021).
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Affiliation(s)
- Chiara Buizza
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Cosmo Strozza
- Interdisciplinary Centre On Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
| | - Giulio Sbravati
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy
| | - Laura Iozzino
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
| | - Ambra Macis
- Service of Statistics, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy
| | - Harry G Kennedy
- The National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.,Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Valentina Candini
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy.
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3
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Leshem R, Icht M, Ben-David BM. Processing of Spoken Emotions in Schizophrenia: Forensic and Non-forensic Patients Differ in Emotional Identification and Integration but Not in Selective Attention. Front Psychiatry 2022; 13:847455. [PMID: 35386523 PMCID: PMC8977511 DOI: 10.3389/fpsyt.2022.847455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with schizophrenia (PwS) typically demonstrate deficits in visual processing of emotions. Less is known about auditory processing of spoken-emotions, as conveyed by the prosodic (tone) and semantics (words) channels. In a previous study, forensic PwS (who committed violent offenses) identified spoken-emotions and integrated the emotional information from both channels similarly to controls. However, their performance indicated larger failures of selective-attention, and lower discrimination between spoken-emotions, than controls. Given that forensic schizophrenia represents a special subgroup, the current study compared forensic and non-forensic PwS. Forty-five PwS listened to sentences conveying four basic emotions presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Their performance was compared to that of 21 forensic PwS (previous study). The two groups did not differ in selective-attention. However, better emotional identification and discrimination, as well as better channel integration were found for the forensic PwS. Results have several clinical implications: difficulties in spoken-emotions processing might not necessarily relate to schizophrenia; attentional deficits might not be a risk factor for aggression in schizophrenia; and forensic schizophrenia might have unique characteristics as related to spoken-emotions processing (motivation, stimulation).
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Affiliation(s)
- Rotem Leshem
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Networks, Toronto, ON, Canada
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4
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Wiesenfeller J, Flasbeck V, Brown EC, Brüne M. Approach and Avoidance Behavior in Female Patients With Borderline Personality Disorder. Front Behav Neurosci 2020; 14:588874. [PMID: 33335479 PMCID: PMC7736178 DOI: 10.3389/fnbeh.2020.588874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/02/2020] [Indexed: 01/18/2023] Open
Abstract
Objectives Borderline personality disorder (BPD) is portrayed by unstable relationships, fears of abandonment and heightened sensitivity to social rejection. Research has shown that these characteristics may lead to inappropriate social behavior including altered approach-avoidance behavior. However, it has remained unclear how social exclusion may affect approach-avoidance behavior in patients with BPD. Design We assessed social approach-avoidance behavior and the impact of social exclusion in a sample of 38 patients with BPD and 40 healthy control participants. Methods We used an explicit joystick-based approach-avoidance task (AAT) after playing a virtual ball-tossing game (Cyberball), which simulates the exclusion of the participant by two other players. In the AAT, participants were required to push or pull emotional stimuli, more specifically happy and angry facial expressions, with either direct or averted gaze direction. Results Patients with BPD approached happy stimuli less and showed overall less differential approach-avoidance behavior toward individuals expressing positive or negative facial emotions compared to healthy participants, who showed more approach behavior for happy compared to angry facial expressions. Moreover, borderline symptom severity correlated inversely with the AAT score for happy facial expressions and positively with subjective unpleasantness during social exclusion as well as rejection sensitivity. However, social exclusion did not influence approach-avoidance tendencies. Conclusion Patients with BPD showed altered approach-avoidance behavior, which might affect social interactions in the patient’s everyday lives and may therefore impede social interaction.
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Affiliation(s)
- Jana Wiesenfeller
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Vera Flasbeck
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Elliot C Brown
- Department of Decision Neuroscience and Nutrition, German Institute of Human Nutrition, Nuthetal, Germany.,Neuroscience Research Center, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Brüne
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
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Bulgari V, Bava M, Gamba G, Bartoli F, Ornaghi A, Candini V, Ferla MT, Cricelli M, Bianconi G, Cavalera C, Conte G, Stefana A, Picchioni M, Iozzino L, Crocamo C, Carrà G. Facial emotion recognition in people with schizophrenia and a history of violence: a mediation analysis. Eur Arch Psychiatry Clin Neurosci 2020; 270:761-769. [PMID: 31106387 DOI: 10.1007/s00406-019-01027-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/15/2019] [Indexed: 11/26/2022]
Abstract
Evidence for an association between impaired facial emotion recognition and violence in people with schizophrenia is inconclusive. In particular, the role of misidentification patterns involving specific emotions such as anger and the influence of clinical characteristics on this association remain unclear. In this study, we compared facial emotion recognition performance in age- and gender-matched schizophrenia spectrum disorders subjects with (N = 52) and without (N = 52) a history of violence. Data on current symptom severity, Cluster B personality status, past victimization, and alcohol and substance misuse were also collected. Compared to those without, subjects with a history of violence showed worse facial emotion recognition performances, involving anger, fear, disgust, sadness, and happiness. When formally testing the reporting of angry faces, evidence of enhanced sensitivity to anger was not supported. Finally, when the impact of current symptoms was assessed, higher severity of activation symptoms, including motor hyperactivity, elevated mood, excitement and distractibility, mediated the relationship between history of violence and poor facial emotion recognition performance. As a whole, our findings seem to support the role of perceptual deficits involving different emotions as well as of a mediation played by activation symptoms. Facial emotion recognition deficits associated with the propensity to violence, as well certain symptoms mediating their relationship, should be targeted by specific treatment approaches.
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Affiliation(s)
- Viola Bulgari
- Psychiatric and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Mattia Bava
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulia Gamba
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandra Ornaghi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Valentina Candini
- Psychiatric and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Maria Teresa Ferla
- Department of Mental Health, ASST-Rhodense G.Salvini di Garbagnate, Milan, Italy
| | - Marta Cricelli
- Department of Mental Health, ASST-Rhodense G.Salvini di Garbagnate, Milan, Italy
| | | | - Cesare Cavalera
- Psychiatric and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Giovanni Conte
- Department of Mental Health, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Stefana
- Department of Mental Health, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Marco Picchioni
- St Magnus Hospital, Marley Lane, Haslemere, Surrey, UK
- GU and Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laura Iozzino
- Psychiatric and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Division of Psychiatry, University College of London, London, UK.
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6
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Leshem R, Icht M, Bentzur R, Ben-David BM. Processing of Emotions in Speech in Forensic Patients With Schizophrenia: Impairments in Identification, Selective Attention, and Integration of Speech Channels. Front Psychiatry 2020; 11:601763. [PMID: 33281649 PMCID: PMC7691229 DOI: 10.3389/fpsyt.2020.601763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
Individuals with schizophrenia show deficits in recognition of emotions which may increase the risk of violence. This study explored how forensic patients with schizophrenia process spoken emotion by: (a) identifying emotions expressed in prosodic and semantic content separately, (b) selectively attending to one speech channel while ignoring the other, and (c) integrating the prosodic and the semantic channels, compared to non-clinical controls. Twenty-one forensic patients with schizophrenia and 21 matched controls listened to sentences conveying four emotions (anger, happiness, sadness, and neutrality) presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Forensic patients with schizophrenia performed with intact identification and integration of spoken emotions, but their ratings indicated reduced discrimination, larger failures of selective attention, and under-ratings of negative emotions, compared to controls. This finding doesn't support previous reports of an inclination to interpret social situations in a negative way among individuals with schizophrenia. Finally, current results may guide rehabilitation approaches matched to the pattern of auditory emotional processing presented by forensic patients with schizophrenia, improving social interactions and quality of life.
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Affiliation(s)
- Rotem Leshem
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Roni Bentzur
- Psychiatric Division, Sheba Medical Center, Tel Hashomer, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, ON, Canada
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Lamsma J, Cahn W, Fazel S. Cognition and violent behavior in psychotic disorders: A nationwide case-control study. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100166. [PMID: 31832346 PMCID: PMC6890945 DOI: 10.1016/j.scog.2019.100166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022]
Abstract
Background The excess risk of violence in psychotic disorders may partly be explained by impairments in executive functions (EFs) and theory of mind (ToM). However, previous studies have been limited by composite measures of EFs and small samples of inpatients. Methods Data were collected for the research project Genetic Risk and Outcome of Psychosis (GROUP). Patients with psychotic disorders (N = 891) were recruited from various care settings in the Netherlands. The following neuropsychological tests were administered (targeted cognitive function in parentheses): (i) Continuous Performance Test-HQ (inhibition); (ii) Response Shifting Task (cognitive flexibility); (iii) Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) Block Design subtest (fluid intelligence); (iv) Neuropsychological Assessment Battery (NAB) Mazes Test (planning); (v) Degraded Facial Affect Recognition Task (affective ToM); and (vi) Hinting Task (cognitive ToM). Lifetime violence was ascertained from medical records and patient interviews. We used analysis of covariance to compare the mean scores of violent and nonviolent patients on each test, adjusting for age and sex. Results Violent patients performed significantly worse than nonviolent patients on the WAIS-III Block Design subtest (F [1, 847] = 5.12, p = .024), NAB Mazes Test (F [1, 499] = 5.32, p = .022) and Hinting Task (F [1, 839] = 9.38, p = .002). For the other tests, the between-group differences were nonsignificant. Violent behavior explained no more than 1% of the variance in performance on each test. Conclusion Impairments in EFs and ToM are unlikely to provide useful targets for risk assessment and interventions.
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Affiliation(s)
- Jelle Lamsma
- Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Event-Related Potentials in Response to Facial Affect Recognition in Patients with Schizophrenia. NEUROPHYSIOLOGY+ 2019. [DOI: 10.1007/s11062-019-09789-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Social cognition intervention in schizophrenia: Description of the training of affect recognition program - Indian version. Asian J Psychiatr 2018; 31:36-40. [PMID: 29358102 DOI: 10.1016/j.ajp.2017.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 12/08/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022]
Abstract
Social cognition refers to mental operations involved in processing of social cues and includes the domains of emotion processing, Theory of Mind (ToM), social perception, social knowledge and attributional bias. Significant deficits in ToM, emotion perception and social perception have been demonstrated in schizophrenia which can have an impact on socio-occupational functioning. Intervention modules for social cognition have demonstrated moderate effect sizes for improving emotion identification and discrimination. We describe the Indian version of the Training of Affect Recognition (TAR) program and a pilot study to demonstrate the feasibility of administering this intervention program in the Indian population. We also discuss the cultural sensibilities in adopting an intervention program for the Indian setting. To the best of our knowledge this is the first intervention program for social cognition for use in persons with schizophrenia in India.
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Sedgwick O, Young S, Baumeister D, Greer B, Das M, Kumari V. Neuropsychology and emotion processing in violent individuals with antisocial personality disorder or schizophrenia: The same or different? A systematic review and meta-analysis. Aust N Z J Psychiatry 2017; 51:1178-1197. [PMID: 28992741 DOI: 10.1177/0004867417731525] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess whether there are shared or divergent (a) cognitive and (b) emotion processing characteristics among violent individuals with antisocial personality disorder and/or schizophrenia, diagnoses which are commonly encountered at the interface of mental disorder and violence. Cognition and emotion processing are incorporated into models of violence, and thus an understanding of these characteristics within and between disorder groups may help inform future models and therapeutic targets. METHODS Relevant databases (OVID, Embase, PsycINFO) were searched to identify suitable literature. Meta-analyses comparing cognitive function in violent schizophrenia and antisocial personality disorder to healthy controls were conducted. Neuropsychological studies not comparing these groups to healthy controls, and emotion processing studies, were evaluated qualitatively. RESULTS Meta-analyses indicated lower IQ, memory and executive function in both violent schizophrenia and antisocial personality disorder groups compared to healthy controls. The degree of deficit was consistently larger in violent schizophrenia. Both antisocial personality disorder and violent schizophrenia groups had difficulties in aspects of facial affect recognition, although theory of mind results were less conclusive. Psychopathic traits related positively to experiential emotion deficits across the two disorders. Very few studies explored comorbid violent schizophrenia and antisocial personality disorder despite this being common in clinical practice. CONCLUSION There are qualitatively similar, but quantitatively different, neuropsychological and emotion processing deficits in violent individuals with schizophrenia and antisocial personality disorder which could be developed into transdiagnostic treatment targets for violent behaviour. Future research should aim to characterise specific subgroups of violent offenders, including those with comorbid diagnoses.
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Affiliation(s)
- Ottilie Sedgwick
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK
| | - Susan Young
- 2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK.,3 Centre for Mental Health, Department of Medicine, Imperial College London, London, UK
| | - David Baumeister
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Greer
- 2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK
| | - Mrigendra Das
- 2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK
| | - Veena Kumari
- 4 Research and Development, Sovereign Health Group, San Clemente, CA, USA
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Abstract
OBJECTIVES The association between schizophrenia and violence represents an important issue in psychiatry. Often highly publicized, violent acts raise the question of their detection, prevention, management and treatment. There is no single, direct and exclusive link between aggressiveness and the underlying psychiatric disorder. On the contrary, the processes underlying this violence are multiple and interlinked. In addition to static and dynamic risk factors, cognitive deficits play an important role in the genesis and maintenance of violent and aggressive behavior. METHODS Using recent data from the international literature and the main databases, we first clarify the role played by cognitive deficits in the violence of patients with schizophrenia. We then evaluate the place of psychosocial interventions such as cognitive remediation and social cognitive training in managing the violent and aggressive behavior of these patients. RESULTS Executive functions and working memory are the most studied neurocognitive functions in the field of violence in schizophrenia. Impulsivity, lack of cognitive flexibility, lack of adaptation and inhibition of automatic motor responses, and altered anger regulation may explain this relationship. Three main components of social cognition are associated with violent behaviors in schizophrenia: (1) the recognition of facial emotions through the inoperability of systems of "emotional monitoring", violent inhibition and recognition of informative facial zones; (2) the theory of the mind through the erroneous interpretation of the intentions of others; (3) the attributional style through the preferentially aggressive over interpretation of social situations and weak capacities of introspection. Overall, cognitive biases inhibit response in a socially acceptable manner and increase the risk of responding impulsively and aggressively to a stressful or provocative situation. In this context, we studied the place held by psychosocial interventions in the management of the violent and aggressive behaviors of these patients. Various cognitive remediation programs have shown their feasibility in people with schizophrenia and neurocognitive deficits with a history of violence as well as their effectiveness in reducing violence, mainly by reducing impulsivity. Similarly, specific programs dedicated to social cognitive training such as Social Cognition and Interaction Training (SCIT), Reasoning and Rehabilitation Mental Health Program (R&R2 MHP) and Metacognitive Training (MCT) have shown their positive impact on the control and reduction of global aggressive attitudes and on the numbers of physical and verbal aggressive incidents in schizophrenia. The improvement of social cognition would be achieved through the amendment of interpersonal relationships and social functioning. These interventions are effective at different stages of disease progression, in patients with varied profiles, on violent attitudes in general and on the number of verbal and physical attacks, whether for in-patients or out-patients. Beneficial effects can last up to 12months after termination of the study program. The interest of these interventions is preventive if the subject never entered in a violent register or curative in case of a personal history of violence. This type of care can be considered from a symptomatic point of view by limiting downstream the heavy consequences of such acts, but also etiologically by acting on one of the causes of violent behavior. Compliance with the eligibility criteria, carrying out a prior functional analysis and confirmation of the major impulsive part of the patient's violence are prerequisites for the use of these programs. Similarly, the early introduction of such therapies, their repetition over time and the integration of the patient into a comprehensive process of psychosocial rehabilitation will ensure the best chance of success. CONCLUSIONS Some cognitive impairments appear to have their place in the genesis, progression and maintenance of violent acts of individuals with schizophrenia. Their management thus opens new therapeutic perspectives such as cognitive remediation, still rarely used in this aim, to complement the action of the traditional care tools. However, further therapeutic trials are needed before considering cognitive remediation and social cognitive training as central care modalities in the therapeutic control of violence in schizophrenia.
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Affiliation(s)
- C Darmedru
- UMD, centre hospitalier Le Vinatier, 95, boulevard Pinel, 69500 Bron, France
| | - C Demily
- GenoPsy, centre hospitalier le Vinatier, 95, boulevard Pinel, 69500 Bron, France; Faculté de médecine Charles Mérieux Lyon Sud, université Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - N Franck
- Faculté de médecine Charles Mérieux Lyon Sud, université Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France; Centre ressource de réhabilitation psychosociale et de remédiation cognitive, 4, rue Jean-Sarrazin, 69008 Lyon, France.
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Bratton H, O'Rourke S, Tansey L, Hutton P. Social cognition and paranoia in forensic inpatients with schizophrenia: A cross-sectional study. Schizophr Res 2017; 184:96-102. [PMID: 27979698 DOI: 10.1016/j.schres.2016.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/25/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND People diagnosed with schizophrenia have difficulties in emotion recognition and theory of mind, and these may contribute to paranoia. The aim of this study was to determine whether this relationship is evident in patients residing in a secure forensic setting. METHOD Twenty-seven male participants with a diagnosis of schizophrenia and a history of offending behaviour were assessed using The Awareness of Social Inference Test (TASIT), The Ambiguous Intentions Hostility Questionnaire (AIHQ) and The Green et al. Paranoid Thought Scales (G-PTS). Individuals were recruited from two medium secure and one high secure forensic hospital in Scotland. RESULTS Correlation, logistic and multiple regression analyses did not find that emotion recognition and theory of mind were associated with indices of paranoid thinking. CONCLUSION Social cognition did not appear to be related to indices of paranoia in this forensic sample. Although participants reported low levels of paranoia overall, the results are consistent with recent conclusions that theory of mind impairments are not specifically linked to paranoia in people diagnosed with schizophrenia.
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Affiliation(s)
- Helen Bratton
- Forensic Clinical Psychology, Forensic Community Mental Health Service, Ward 17 Falkirk Community Hospital, Westburn Avenue, Falkirk FK1 5SU, United Kingdom.
| | - Suzanne O'Rourke
- Department of Clinical and Health Psychology, The School of Health in Social Science, University of Edinburgh, United Kingdom
| | - Louise Tansey
- The Orchard Clinic, NHS Lothian, Edinburgh, United Kingdom
| | - Paul Hutton
- Department of Clinical and Health Psychology, The School of Health in Social Science, University of Edinburgh, United Kingdom
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Darmedru C, Demily C, Franck N. Cognitive remediation and social cognitive training for violence in schizophrenia: a systematic review. Psychiatry Res 2017; 251:266-274. [PMID: 28219026 DOI: 10.1016/j.psychres.2016.12.062] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/03/2016] [Accepted: 12/31/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED A significant correlation exists between violence and schizophrenia (SCZ). Recent studies matched some cognitive deficits like strong risk factors for violence with interesting applications in terms of treatment. Our objective was to conduct a systematic review of the effectiveness of cognitive remediation (CR) and social cognitive training (SCT) in the management of violent and aggressive behaviors in SCZ. METHODS The electronic databases Pubmed, Web of Science, Cochrane Library and ScienceDirect were searched in, using combinations of terms relating to SCZ, CR and violence. Studies were selected and data were extracted using a PRISMA statement. Inclusion criteria were adults with SCZ and a documented collection of disruptive and violent behaviors, for whom researchers had used a CR or SCT program. RESULTS Eleven studies were identified, two related to non-specific CR intervention and nine to codified CR or SCT programs. Results showed that these programs had a positive impact on the control and reduction of global aggressive attitudes and physical assaults. Therapeutic targets were social cognition and executive functions through the improvement of interpersonal relationships and impulsivity feature respectively. Effectiveness was proved at various stages of the illness, in different types of patients and units, with effects persisting for up to 12 months after interruption of CR. Conclusions are limited by some methodological restrictions. CONCLUSION Although current evidences need to be completed with further randomized studies, CR and SCT appear to be promising approaches in the management of violence in SCZ.
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Affiliation(s)
- C Darmedru
- Rehabilitation Department (CRR & CL3R), Le Vinatier Hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - C Demily
- GénoPsy, Center for the Diagnosis and Management of Genetic Psychiatric Disorders, CH Le Vinatier, Bron, France; EDR-Psy, UMR 5229, Center for Cognitive Neuroscience, CNRS & Université Claude Bernard, Université de Lyon, Lyon, France
| | - N Franck
- Rehabilitation Department (CRR & CL3R), Le Vinatier Hospital, 4 rue Jean Sarrazin, 69008 Lyon, France; EDR-Psy, UMR 5229, Center for Cognitive Neuroscience, CNRS & Université Claude Bernard, Université de Lyon, Lyon, France.
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14
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Bilgi MM, Taspinar S, Aksoy B, Oguz K, Coburn K, Gonul AS. The relationship between childhood trauma, emotion recognition, and irritability in schizophrenia patients. Psychiatry Res 2017; 251:90-96. [PMID: 28192770 DOI: 10.1016/j.psychres.2017.01.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
Abstract
This study investigated the relationship between childhood trauma, irritability, and emotion recognition, in schizophrenia patients during a psychotic break. Thirty-six schizophrenia inpatients and 36 healthy controls were assessed with the Irritability Questionnaire (IRQ) and two facial emotion recognition tasks, the Emotion Discrimination Test (EDT) and Emotion Identification Test (EIT). Patients were further assessed with the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II), the Positive and Negative Symptom Scale (PANSS), and the Childhood Trauma Questionnaire-28 (CTQ-28). EDT and EIT performance was significantly impaired in patients compared to healthy controls. Furthermore, patients tended to misidentify sad, surprised, or angry faces as showing fear, and this misidentification correlated with the patients' irritability. Childhood adversity increased irritability both directly and indirectly through emotion misidentification.
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Affiliation(s)
- Mustafa Melih Bilgi
- SoCAT Neuroscience Research Group, Izmir Bozyaka Research and Education Hospital, Karabaglar State Clinics, 4025 Sok., Yunus Emre Mah., Karabaglar, Izmir, Turkey.
| | - Seval Taspinar
- SoCAT Neuroscience Research Group, Siirt State Hospital, Yenimahalle Gures Cad. Siirt, Turkey.
| | - Burcu Aksoy
- SoCAT Neuroscience Research Group, Dokuz Eylul University, School of Nursing, Izmir, Turkey.
| | - Kaya Oguz
- SoCAT Neuroscience Research Group, Ege University, International Computer Institute, Information Technologies, Izmir, Turkey.
| | - Kerry Coburn
- Mercer University Department of Psychiatry and Behavioral Science, 655 First Street Macon, GA, USA.
| | - Ali Saffet Gonul
- Mercer University Department of Psychiatry and Behavioral Science, 655 First Street Macon, GA, USA; SoCAT Neuroscience Research Group, Ege School of Medicine, Department of Psychiatry, Turkey.
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15
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Walter A, Suenderhauf C, Smieskova R, Lenz C, Harrisberger F, Schmidt A, Vogel T, Lang UE, Riecher-Rössler A, Eckert A, Borgwardt S. Altered Insular Function during Aberrant Salience Processing in Relation to the Severity of Psychotic Symptoms. Front Psychiatry 2016; 7:189. [PMID: 27933003 PMCID: PMC5120113 DOI: 10.3389/fpsyt.2016.00189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
There is strong evidence for abnormal salience processing in patients with psychotic experiences. In particular, there are indications that the degree of aberrant salience processing increases with the severity of positive symptoms. The aim of the present study was to elucidate this relationship by means of brain imaging. Functional magnetic resonance imaging was acquired to assess hemodynamic responses during the Salience Attribution Test, a paradigm for reaction time that measures aberrant salience to irrelevant stimulus features. We included 42 patients who were diagnosed as having a psychotic disorder and divided them into two groups according to the severity of their positive symptoms. Whole brain analysis was performed using Statistical Parametric Mapping. We found no significant behavioral differences with respect to task performance. Patients with more positive symptoms showed increased hemodynamic responses in the left insula corresponding to aberrant salience than in patients with less positive symptoms. In addition, left insula activation correlated negatively with cumulative antipsychotic medication. Aberrant salience processing in the insula may be increased in psychosis, depending on the severity of positive symptoms. This study indicates that clinically similar psychosis manifestations share the same functional characteristics. In addition, our results suggest that antipsychotic medication can modulate insular function.
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Affiliation(s)
- Anna Walter
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Renata Smieskova
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Claudia Lenz
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - André Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Tobias Vogel
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Anne Eckert
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
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Brenner CA, Rumak SP, Burns AM. Facial emotion memory in schizophrenia: From encoding to maintenance-related EEG. Clin Neurophysiol 2016; 127:1366-1373. [DOI: 10.1016/j.clinph.2015.10.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 10/15/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022]
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