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Dlagnekova A, Van Staden W. Vigour as a marker of positive mental health among social media respondents. J Affect Disord 2024; 362:384-390. [PMID: 38972644 DOI: 10.1016/j.jad.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Quantitative research on vigour as a therapeutically responsive marker of positive mental health, has become possible by virtue of the validation of the Vigour Assessment Scale (VAS). Considering that its validation and therapeutic responsiveness were examined in an avolitional schizophrenia population, using the VAS outside these constraints requires that its psychometric properties be investigated in a more general non-clinical population. METHOD Social media respondents (n = 787) were recruited on social media through snowball sampling and data were obtained for statistical analyses through an online questionnaire comprising the VAS and measures of work-place vigour, active involvement in personal growth, behavioural activation, procrastination, and fatigue. RESULTS Convergent validity was confirmed in moderate to strong positive correlations between the VAS and measures approximate to vigour including physical strength (r = 0.805), cognitive liveliness (r = 0.676), planfulness (r = 0.61), and intentional behaviour (r = 0.595). Discriminant validity was evident in negative correlations with procrastination (r = -0.593) and fatigue (r = -0.786). The VAS showed good internal consistency (Cronbach α = 0.951), split-half reliability (r = 0.892), test-retest reliability (r = 0.861), and a low standard error of measurement of 3.73 within a theoretical range of 82 points. Exploratory factor analysis yielded a clear two-factor structure. LIMITATIONS Results are limited to willing participants who responded through social media. CONCLUSIONS Vigour may now be measured clinically as an indication of positive mental health and well-being. It may also be further investigated for its relations to other parameters of health, personality, and the efficacy of professional and self-enhancing interventions that aim for the cultivation of vigour.
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Affiliation(s)
- Antonia Dlagnekova
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa; Centre for Ethics and Philosophy of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Werdie Van Staden
- Centre for Ethics and Philosophy of Health Sciences, University of Pretoria, Pretoria, South Africa.
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2
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Eack SM. Defeatist beliefs about performance are important treatment targets for negative symptoms in the early course of schizophrenia. Schizophr Res 2024; 271:332-333. [PMID: 39089099 DOI: 10.1016/j.schres.2024.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 08/03/2024]
Affiliation(s)
- Shaun M Eack
- School of Social Work, University of Pittsburgh, United States of America; Department of Psychiatry, University of Pittsburgh School of Medicine, United States of America.
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3
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Filip TF, Hellemann GS, Ventura J, Subotnik KL, Green MF, Nuechterlein KH, McCleery A. Defeatist performance beliefs in individuals with recent-onset schizophrenia: Relationships with cognition and negative symptoms. Schizophr Res 2024; 270:212-219. [PMID: 38924939 PMCID: PMC11323074 DOI: 10.1016/j.schres.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/01/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The cognitive model of negative symptoms of schizophrenia suggests that defeatist performance beliefs (DPB), or overgeneralized negative beliefs about one's performance, are an intermediary variable along the pathway from impaired neurocognitive performance to negative symptoms and functioning in daily life. Although reliable associations between these variables have been established in chronic schizophrenia, less is known about the nature of these relationships in recent-onset schizophrenia (ROSz). This current study tested the associations between DPB and variables in the cognitive model (neurocognitive performance, negative symptoms, functioning) as well as mediation by DPB of the association between neurocognitive performance and negative symptoms in ROSz. METHODS A total of 52 participants (32 adults with ROSz and 20 non-psychiatric healthy comparators; HC) completed in-lab measures of neurocognitive performance, self-reported defeatist performance beliefs, and clinician administered measures of negative symptoms and functional outcome. Bivariate relationships among these variables were tested with Pearson correlations. Bootstrapped regression analyses were conducted to test the strength of the indirect effect of neurocognitive performance on negative symptoms through DPB. RESULTS Defeatist performance beliefs were significantly elevated in ROSz, and were associated with neurocognitive performance, negative symptoms, and functional outcome as predicted by the cognitive model. There was a significant indirect effect of neurocognition on experiential negative symptoms through DPB, indicating DPB are a partial mediator of the relationship between neurocognitive performance and negative symptoms. CONCLUSION These findings are consistent with the cognitive model of negative symptoms and extend previous findings in both ROSz and established schizophrenia. Specifically, these data demonstrate that DPB are elevated among ROSz and the associations with neurocognition and clinical outcomes (e.g., negative symptoms and functioning) are of similar magnitude to those reported in chronic schizophrenia. DPB may therefore be a viable treatment target in the early course of illness.
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Affiliation(s)
- Tess F Filip
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, United States of America
| | - Gerhard S Hellemann
- Department of Public Health, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Amanda McCleery
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, United States of America; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States of America.
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4
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Luther L, Raugh IM, Grant PM, Beck AT, Strauss GP. The Role of Defeatist Performance Beliefs in State Fluctuations of Negative Symptoms in Schizophrenia Measured in Daily Life via Ecological Momentary Assessment. Schizophr Bull 2024:sbae128. [PMID: 39066666 DOI: 10.1093/schbul/sbae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND HYPOTHESIS The Cognitive Model of Negative Symptoms is a prominent model that posits that defeatist performance beliefs (DPB) are a key psychological mechanism underlying negative symptoms in those with schizophrenia (SZ). However, the ecological validity of the model has not been established, and temporally specific evaluations of the model's hypotheses have not been conducted. This study tested the model's key hypotheses in real-world environments using ecological momentary assessment (EMA). STUDY DESIGN Fifty-two outpatients with SZ and 55 healthy controls (CN) completed 6 days of EMA. Multilevel models examined concurrent and time-lagged associations between DPB and negative symptoms in daily life. STUDY RESULTS SZ displayed greater DPB in daily life than CN. Furthermore, greater DPB were associated with greater concurrently assessed negative symptoms (anhedonia, avolition, and asociality) in daily life. Time-lagged analyses indicated that in both groups, greater DPB at time t led to elevations in negative symptoms (anhedonia, avolition, or asociality) at t + 1 above and beyond the effects of negative symptoms at time t. CONCLUSIONS Results support the ecological validity of the Cognitive Model of Negative Symptoms and identify a temporally specific association between DPB and subsequent negative symptoms that is consistent with the model's hypotheses and a putative mechanistic pathway in Cognitive Behavioral Therapy for negative symptoms. Findings suggest that DPB are a psychological factor contributing to negative symptoms in real-world environments. Implications for measuring DPB in daily life and providing just-in-time mobile health-based interventions to target this mechanism are discussed.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
| | - Paul M Grant
- Center for Recovery-Oriented Cognitive Therapy, Beck Institute, Philadelphia, PA
| | - Aaron T Beck
- Center for Recovery-Oriented Cognitive Therapy, Beck Institute, Philadelphia, PA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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5
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Faerman A, Nabasny A, Wright B, Juengst SB. Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion. J Head Trauma Rehabil 2024; 39:E105-E112. [PMID: 38709831 DOI: 10.1097/htr.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI). DESIGN Secondary analysis of a concussion cohort study. PARTICIPANTS One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center. MAIN MEASURES Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks. RESULTS Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (β = .362, P < .001), anxiety (β = .332, P < .001), and impulsivity (β = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (β = .493, P < .001), fatigue (β = .449, P < .001), self-reported executive dysfunction (β = .376, P < .001), and overall burden from concussive symptoms (β = .477, P < .001). CONCLUSIONS Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.
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Affiliation(s)
- Afik Faerman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California (Dr Faerman); Departments of Applied Clinical Research (Mr Nabasny and Dr Wright) and Physical Medicine and Rehabilitation (Drs Wright and Juengst), University of Texas Southwestern Medical Center, Dallas; Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas (Dr Juengst)
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6
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Bismark AW, Mikhael T, Mitchell K, Holden J, Granholm E. Pupillary responses as a biomarker of cognitive effort and the impact of task difficulty on reward processing in schizophrenia. Schizophr Res 2024; 267:216-222. [PMID: 38569395 DOI: 10.1016/j.schres.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
Negative symptoms of schizophrenia robustly predict functional outcomes but remain relatively resistant to available treatments. Better measures of negative symptoms, especially motivational deficits, are needed to better understand these symptoms and improve treatment development. Recent research shows promise in linking behavioral effort tasks to motivational negative symptoms, reward processing deficits, and defeatist attitudes, but few studies account for individual or group (patient v. control) differences in cognitive ability to perform the tasks. Individuals with poorer abilities might be less motivated to perform tasks because they find them more difficult to perform. This study used a personalized digit span task to control task difficulty while measuring task effort via pupillary responses (greater dilation indicates greater cognitive effort) at varying monetary rewards ($1 & $2). Participants with schizophrenia (N = 34) and healthy controls (N = 41) performed a digit span task with personalized max span lengths and easy (max- 2 digits) and overload (max+ 2 digits) conditions. Consistent with many studies, pupillary responses (cognitive effort) increased with greater difficulty until exceeding capacity. A similar pattern of reward responsivity was seen in both groups, such that greater reward increased dilation (effort) comparably for both groups when difficulty was within capacity. Neither patients nor controls exerted increased effort for greater reward when difficulty exceeded capacity. In patients, positive relationships were found between pupil dilation and defeatist performance beliefs if task difficulty was within capacity; a relationship that reversed if the task was too difficult. The findings demonstrate the importance of accounting for cognitive capacity and task difficulty when evaluating motivation and reward sensitivity and illustrate the utility of pupillary responses as an objective measure of effort in schizophrenia.
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Affiliation(s)
- Andrew W Bismark
- Department of Psychiatry, University of California, San Diego, USA; VA San Diego Healthcare System, USA
| | - Tanya Mikhael
- VA San Diego Healthcare System, USA; Central Texas Veterans Healthcare System, USA
| | - Kyle Mitchell
- Department of Psychiatry, University of California, San Diego, USA; Johns Hopkins University School of Nursing, USA
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, USA; VA San Diego Healthcare System, USA.
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7
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Gawęda Ł, Kowalski J, Aleksandrowicz A, Bagrowska P, Dąbkowska M, Pionke-Ubych R. A systematic review of performance-based assessment studies on cognitive biases in schizophrenia spectrum psychoses and clinical high-risk states: A summary of 40 years of research. Clin Psychol Rev 2024; 108:102391. [PMID: 38301343 DOI: 10.1016/j.cpr.2024.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
Cognitive models of psychosis have stimulated empirical studies on cognitive biases involved in schizophrenia spectrum psychoses and their symptoms. This systematic review aimed to summarize the studies on the role of cognitive biases as assessed in different performance-based tasks in schizophrenia spectrum psychoses and clinical high-risk states. We focused on five cognitive biases linked to psychosis, i.e., aberrant salience, attentional biases, source monitoring biases, jumping to conclusions, and bias against disconfirmatory evidence. We identified N = 324 studies published in N = 308 articles fulfilling inclusion criteria. Most studies have been cross-sectional and confirmed that the schizophrenia spectrum psychoses are related to exaggerated cognitive biases compared to healthy controls. On the contrary, less evidence suggests a higher tendency for cognitive biases in the UHR sample. The only exceptions were source monitoring and jumping to conclusions, which were confirmed to be exaggerated in both clinical groups. Hallucinations and delusions were the most frequent symptoms studied in the context of cognitive biases. Based on the findings, we presented a hypothetical model on the role of interactions between cognitive biases or additive effects of biases in shaping the risk of psychosis. Future research is warranted for further development of cognitive models for psychosis.
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Affiliation(s)
- Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
| | - Joachim Kowalski
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Adrianna Aleksandrowicz
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Paulina Bagrowska
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Małgorzata Dąbkowska
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Renata Pionke-Ubych
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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8
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Raugh IM, Strauss GP. Trait Mindfulness in Psychotic Disorders: Dimensions Predicting Symptoms, Cognition, and Functional Outcome. Behav Ther 2024; 55:55-67. [PMID: 38216237 PMCID: PMC10787159 DOI: 10.1016/j.beth.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Mindfulness-based treatments are efficacious for psychotic disorders (PD). However, which components of mindfulness (i.e., attentive monitoring and nonjudgmental acceptance) are most relevant treatment targets is unclear. Further, there is a dearth of literature examining clinical correlates of mindfulness in people with PD. The present study aimed to examine group differences and clinical correlates of mindfulness in people with PD. We hypothesized that PD would report lower monitoring and acceptance than CN and that mindfulness components would be associated with symptoms including dysfunctional beliefs, alexithymia, neurocognitive ability, positive symptoms, and mood symptoms. Groups included individuals with PD (n = 54) and nonpsychiatric controls (n = 55). Participants completed self-report measures of mindfulness and related constructs and clinical interviews of symptoms. Results of ANOVA models indicated that global mindfulness was lower in PD relative to CN, with greatest differences evident for acceptance in the affective psychosis group. Regression models found that greater monitoring was associated with improved neurocognitive performance, while acceptance was associated with lower defeatist beliefs, alexithymia, and depression/anxiety symptoms. Results highlight the importance of targeting acceptance in the psychosocial treatment of PDs, especially for those with mood symptoms.
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9
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D'Anna G, Zarbo C, Cardamone G, Zamparini M, Calza S, Rota M, Correll CU, Rocchetti M, Starace F, de Girolamo G. Interplay between negative symptoms, time spent doing nothing, and negative emotions in patients with schizophrenia spectrum disorders: results from a 37-site study. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:63. [PMID: 37735175 PMCID: PMC10514038 DOI: 10.1038/s41537-023-00372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/26/2023] [Indexed: 09/23/2023]
Abstract
This study evaluated the relationship between negative symptoms, daily time use (productive/non-productive activities, PA/NPA), and negative emotions in schizophrenia-spectrum disorders (SSDs): 618 individuals with SSDs (311 residential care patients [RCPs], 307 outpatients) were surveyed about socio-demographic, clinical (BPRS, BNSS) and daily time use (paper-and-pencil Time Use Survey completed twice/week) characteristics. Among them 57 RCPs and 46 outpatients, matched to 112 healthy controls, also underwent ecological monitoring of emotions (8 times/day for a week) through Experience Sampling Method (ESM). RCPs spent significantly less time in PA than outpatients. Patients with more negative symptomatology spent more time in NPA and less in PA compared to patients with milder symptoms. Higher time spent in NPA was associated with negative emotions (p < 0.001 during workdays) even when correcting for BNSS total and antipsychotic polypharmacy (p = 0.002 for workdays, p = 0.006 for Sundays). Future studies are needed to explore in more detail the relationship between negative emotions, negative symptoms, time use, and functioning in individuals with SSDs, providing opportunities for more informed and personalised clinical treatment planning and research into interactions between different motivational, saliency and behavioural aspects in individuals with SSDs.
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Grants
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
- RF-2018-12365514 Ministero della Salute (Ministry of Health, Italy)
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Affiliation(s)
- Giulio D'Anna
- Department of Mental Health, AUSL Toscana Centro, Prato, Italy
| | - Cristina Zarbo
- Department of Psychology, University of Milano Bicocca, Milan, Italy
| | | | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
| | - Matteo Rota
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Pathological Addiction, AUSL di Modena, Modena, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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10
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Abstract
BACKGROUND AND HYPOTHESIS Social motivation, defined as the fundamental human desire to seek out, engage in, and maintain interpersonal bonds, has become a growing area of research in schizophrenia. The major focus has been on understanding the impact of social reward-related processes. An obvious but rarely acknowledged fact is that social interactions, much like other goal-directed acts, require the exertion of effort. In this Review Article, we argue that social motivation in schizophrenia can be conceptualized through the lens of an established framework: effort-based decision-making (EBDM). STUDY DESIGN We conducted a literature review on social reward processing in schizophrenia, then extended these findings by applying concepts and insights from the literature on EBDM to the study of social motivation. STUDY RESULTS Within the EBDM framework, decisions about whether or not to pursue social interactions are bound by cost/benefit calculations. That is, people do not pursue social behaviors when the estimated "cost" of the required effort outweighs the anticipated "benefit" or reward. We propose that people with schizophrenia are less likely to engage in social interaction compared with healthy samples because they: (1) underestimate the benefits of relationships (based on expectations of reward/punishment), (2) overestimate the effort costs associated with social interaction, and/or (3) fail to integrate cost-benefit information in an optimal manner. CONCLUSIONS EBDM is an especially promising framework of social motivation that goes beyond the current focus on social reward processing to include a focus on effort.
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Affiliation(s)
- Lauren T Catalano
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Michael F Green
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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11
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Ehret BC, Titone MK, Carey CJ, Martinez A, Chalker SA, Granholm EL, Depp CA. Are all reasons for living made equally? Reasons for living and dysfunctional attitudes in psychotic disorders and bipolar I. Psychol Psychother 2023; 96:748-761. [PMID: 37039342 DOI: 10.1111/papt.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Persons with schizophrenia, schizoaffective, or bipolar I disorder are more likely to die by suicide compared to the general population. Dysfunctional attitudes have been shown to be significant predictors of cognitive vulnerability to depression, hopelessness, and poor problem-solving skills, which predict suicidal ideation. Dysfunctional attitudes are common in persons with schizophrenia spectrum disorders (SSDs) and bipolar I. The Reasons for Living Inventory (RFLI) examines distinct reasons for not dying by suicide. This study's objectives were to examine the relationship between the RFLI subscales and dysfunctional attitudes among persons with SSDs and bipolar I. We hypothesized significant positive correlations between two RFLI subscales (Fear of Suicide and Fear of Social Disapproval) and total score on the Dysfunctional Attitude Scale (DAS). We did not expect significant correlations between other subscales. DESIGN AND METHODS This correlational, cross-sectional study examined baseline scores on the RFLI and dysfunctional attitudes (DAS) among N = 102 outpatients with SSDs or bipolar I. RESULTS Significant positive correlations were observed between RFLI subscales Fear of Suicide and Fear of Social Disapproval and DAS total scores. No other significant relationships were observed. CONCLUSIONS Certain reasons for living (i.e. fear of suicide and social disapproval) may be associated with dysfunctional attitudes among persons with SSDs or bipolar I. These, in turn, may place these individuals at a greater risk for suicide by increasing their cognitive vulnerability. These findings may inform clinical treatment targets for persons with SSDs and bipolar I.
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Affiliation(s)
- Blaire C Ehret
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Madison K Titone
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin J Carey
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Alexandra Martinez
- Graduate School of Education and Psychology, Pepperdine University, Malibu, California, USA
| | - Samantha A Chalker
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Eric L Granholm
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin A Depp
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
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12
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Randhawa A, Kühn S, Schöttle D, Moritz S, Gallinat J, Ascone L. The effects of assessing character strengths vs. psychopathology on mood, hope, perceived stigma and cognitive performance in individuals with psychosis. PLoS One 2023; 18:e0289872. [PMID: 37561694 PMCID: PMC10414607 DOI: 10.1371/journal.pone.0289872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES The main objective of the present study was to investigate whether assessments of psychopathology vs. character strengths were associated with systematic differences concerning transient psychological states (i.e., cognitive performance, state mood, optimism, therapy motivation, perceived stigma) in individuals with psychotic disorders. An additional goal was to evaluate the acceptance and appraisal of a subsequent online character-strength intervention, consisting of top-two strengths feedback, and to explore associations between character strengths and psychotic symptoms. The study thus aimed to contribute to the discussion on the extension of current treatment approaches for schizophrenia through positive psychological interventions. METHODS The study was implemented online applying a randomized within-subject cross-over design in N = 39 patients with self-reported psychosis. After a baseline assessment, briefly capturing psychological states (including cognition: TMT A/B, positive and negative affect, motivation for change/ therapy, optimism, and self-stigma) participants were randomly assigned to a first questionnaire block, which addressed either individual character strengths (VIA-IS) or psychopathology (CAPE & BSI). This was followed by a second, brief assessment of transient psychological states, whereafter the second questionnaire block was conducted, this time with the respective opposite (strengths or psychopathology) assessment. A final psychological states assessment was conducted. Afterwards, participants received feedback on their top-two strengths and a brief psycho-education, followed by a qualitative assessment. RESULTS Contrary to expectations, there were no differences between the psychological states after the pathology vs. character strengths assessment blocks. Character strengths mainly correlated negatively with negative symptoms, with medium to large effect sizes. Participants were generally satisfied with the intervention and rated a focus on personal strengths in psychotherapy as highly important. CONCLUSION Our main hypothesis stating that the assessment of character strengths (vs. psychopathology) is associated with differences in subsequent psychological states could not be confirmed. Qualitative findings indicate that the emphasis on individual character strengths interventions is well accepted and viewed as important. The associations of character strengths with negative symptoms are important from the background of the cognitive model or defeatist beliefs (e.g., amotivation due to perceiving the self as 'incapable'), which could be addressed in experimental or intervention studies targeting character strengths.
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Affiliation(s)
- Aman Randhawa
- Universitätsklinikum Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Simone Kühn
- Universitätsklinikum Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
- Lise-Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Daniel Schöttle
- Universitätsklinikum Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Steffen Moritz
- Universitätsklinikum Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Jürgen Gallinat
- Universitätsklinikum Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Leonie Ascone
- Universitätsklinikum Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
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Gussmann E, Lucae S, Falkai P, Padberg F, Egli S, Kopf-Beck J. Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach. Front Psychiatry 2023; 14:1160075. [PMID: 37324820 PMCID: PMC10267344 DOI: 10.3389/fpsyt.2023.1160075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023] Open
Abstract
Background Treatment guidelines for psychosis recommend offering psychotherapy already in the acute illness phase. However, there is a lack of available interventions adapted to the specific needs and key change mechanisms of inpatients experiencing severe symptoms and crisis. In this article we outline the scientific development process of a needs-oriented and mechanism-based group intervention for acute psychiatric inpatients with psychosis (MEBASp). Methods To guide our intervention design, we used Intervention Mapping (IM), a six-step framework for developing evidence-based health interventions that consisted of an extensive literature review, an in-depth problem definition and needs analysis, the modeling of change mechanisms and outcomes and the production of an intervention prototype. Results Our low-threshold modularized group intervention consists of nine stand-alone sessions (two per week) within three modules and targets different aspects of metacognitive and social change mechanisms. Module I and II aim to reduce acute symptoms by fostering cognitive insight, Module III focuses on reducing distress via cognitive defusion. Therapy contents are adapted from existing metacognitive treatments such as the Metacognitive Training and presented in a destigmatizing, simply understandable and experience-oriented way. Conclusion MEBASp is currently evaluated in a single-arm feasibility trial. Using a systematic and rigorous development methodology and providing a detailed description of the development steps demonstrated to be invaluable in improving the intervention's scientific foundation, validity, and replicability for similar research.
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Affiliation(s)
- Eva Gussmann
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Peter Falkai
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychology, LMU Munich, Munich, Germany
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14
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Chen G, Chen J, Tian H, Lin C, Zhu J, Ping J, Chen L, Zhuo C, Jiang D. Validity and reliability of a Chinese version of the self-evaluation of negative symptoms. Brain Behav 2023; 13:e2924. [PMID: 36908244 PMCID: PMC10097046 DOI: 10.1002/brb3.2924] [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: 11/15/2022] [Revised: 01/19/2023] [Accepted: 02/04/2023] [Indexed: 03/14/2023] Open
Abstract
The negative symptoms of schizophrenia can be present at any clinical stage, but evaluating the negative symptoms always remains challenging. To screen the negative symptoms effectively, self-evaluation should be introduced. To date, professional psychiatrists used almost all of the scales available to screen the negative symptoms but could not obtain an accurate outcome. At the same time, an advanced self-assessment scale is needed to accompany the patients' self-feeling-based treatment strategies to understand their feelings about their symptoms. Hence, Chinese self-evaluation of negative symptoms (SNS) should be introduced in China. This study aims to examine the validity and reliability of the Chinese version of SNS. Two hundred patients with schizophrenia were included in this study and were evaluated entirely with the self-assessed negative symptoms by the Chinese version. The correlation analysis was performed between SNS and the Scale for Assessment of Negative Symptoms (SANS) to assess the criterion validity of SNS for screening negative symptoms. Exploratory factor analysis was used to determine the constructive validity of the SNS. Two senior professional psychiatrists were involved in this assessment based on their clinical experience and capability to define the severity of the negative symptoms. Receiver operating characteristic curve (ROC) analysis was performed to assess the cutoff point of SNS. Cronbach's alpha coefficient and intraclass correlation (ICC) coefficient were used to determine the reliability of SNS. We have the following findings: The Chinese version of SNS demonstrated a significant correlation with the SANS (r = .774, p < .05). Exploratory factor analysis demonstrated that the factor loading varies from .442 to .788. ROC analysis demonstrated that at SNS ≥ 8, the patients demonstrated a mild severity of negative symptoms, and at SNS ≥ 15, the patients demonstrated a severe severity of negative symptoms. Subsequently, 9 < SNS < 14 was defined as a moderate severity of negative symptoms. The Cronbach's alpha and ICC coefficients of the Chinese version SNS were .877 and .774, respectively. Our results showed that the acceptable validity and reliability of the Chinese version of SNS confirmed that SNS is an ideal tool for self-assessment of the negative symptoms in patients with schizophrenia.
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Affiliation(s)
- Guangdong Chen
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Jiayue Chen
- Department of PsychiatryTianjin Medical University Affiliated of Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin Fourth Center HospitalTianjinChina
| | - Hongjun Tian
- Department of PsychiatryTianjin Medical University Affiliated of Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin Fourth Center HospitalTianjinChina
| | - Chongguang Lin
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Jingjing Zhu
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Jing Ping
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Langlang Chen
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Chuanjun Zhuo
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
- Department of PsychiatryTianjin Medical University Affiliated of Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin Fourth Center HospitalTianjinChina
- Department of Psychiatry, Tianjin Anding HospitalTianjin Mental Health Center of Tianjin Medical UniversityTianjinChina
| | - Deguo Jiang
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
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Monsonet M, Amedy A, Kwapil TR, Barrantes-Vidal N. A psychosocial pathway to paranoia: The interplay between social connectedness and self-esteem. Schizophr Res 2023; 254:199-207. [PMID: 36931182 DOI: 10.1016/j.schres.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 01/11/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
The quantity and quality of social contacts have been related to self-esteem, and both social relationships and self-esteem have been implicated in the pathways to paranoia. However, how social relationships interplay with self-esteem to trigger paranoia is not well understood. This study aims to investigate whether different measures of social connectedness (social support, loneliness, and desired friendship), as well as the frequency of social contact, impact paranoia and other positive and negative psychotic-like experiences (PLE) through the indirect effect of self-esteem. Data from a sample of 169 nonclinically ascertained participants oversampled for schizotypy scores were analyzed using two different approaches: retrospective trait-like and ecological momentary measures of social connectedness. Results showed that self-esteem mediates the pathways from poor social support and social longing, but not from loneliness, to paranoia and other cognitive PLE. In contrast, pathways from social connectedness to perceptual PLE and negative PLE were not mediated by self-esteem. Results were consistent across trait-like and momentary measures. Finally, self-esteem was not implicated in the pathways from the frequency of social contact and paranoia or other forms of PLE. These results provide a comprehensive picture of how social connectedness drives specific symptoms of psychosis through self-esteem. Findings underscore the need to explore separately the quality and quantity of social relationships and suggest that the subjective experience of meaningful social bonds is key social determinants of mental health. Therefore, addressing inadequacies of social connectedness could substantially improve symptomatic and functional outcomes of psychosis.
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Affiliation(s)
- Manel Monsonet
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Amad Amedy
- Department of Psychology, Vanderbilt University, United States of America
| | - Thomas R Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER de Salud Mental, Instituto de Salud Carlos III, Spain.
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16
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Huang LY, Jackson BS, Rodrigue AL, Tamminga CA, Gershon ES, Pearlson GD, Keshavan MS, Keedy SS, Hill SK, Sweeney JA, Clementz BA, McDowell JE. Antisaccade error rates and gap effects in psychosis syndromes from bipolar-schizophrenia network for intermediate phenotypes 2 (B-SNIP2). Psychol Med 2022; 52:2692-2701. [PMID: 33622437 DOI: 10.1017/s003329172000478x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Antisaccade tasks can be used to index cognitive control processes, e.g. attention, behavioral inhibition, working memory, and goal maintenance in people with brain disorders. Though diagnoses of schizophrenia (SZ), schizoaffective (SAD), and bipolar I with psychosis (BDP) are typically considered to be distinct entities, previous work shows patterns of cognitive deficits differing in degree, rather than in kind, across these syndromes. METHODS Large samples of individuals with psychotic disorders were recruited through the Bipolar-Schizophrenia Network on Intermediate Phenotypes 2 (B-SNIP2) study. Anti- and pro-saccade task performances were evaluated in 189 people with SZ, 185 people with SAD, 96 people with BDP, and 279 healthy comparison participants. Logistic functions were fitted to each group's antisaccade speed-performance tradeoff patterns. RESULTS Psychosis groups had higher antisaccade error rates than the healthy group, with SZ and SAD participants committing 2 times as many errors, and BDP participants committing 1.5 times as many errors. Latencies on correctly performed antisaccade trials in SZ and SAD were longer than in healthy participants, although error trial latencies were preserved. Parameters of speed-performance tradeoff functions indicated that compared to the healthy group, SZ and SAD groups had optimal performance characterized by more errors, as well as less benefit from prolonged response latencies. Prosaccade metrics did not differ between groups. CONCLUSIONS With basic prosaccade mechanisms intact, the higher speed-performance tradeoff cost for antisaccade performance in psychosis cases indicates a deficit that is specific to the higher-order cognitive aspects of saccade generation.
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Affiliation(s)
- Ling-Yu Huang
- Departments of Psychology & Neuroscience, University of Georgia, Athens, GA, USA
| | - Brooke S Jackson
- Departments of Psychology & Neuroscience, University of Georgia, Athens, GA, USA
| | - Amanda L Rodrigue
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | | | | | - Sarah S Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - S Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Brett A Clementz
- Departments of Psychology & Neuroscience, University of Georgia, Athens, GA, USA
| | - Jennifer E McDowell
- Departments of Psychology & Neuroscience, University of Georgia, Athens, GA, USA
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17
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Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis. SCHIZOPHRENIA 2022; 8:74. [PMID: 36114173 PMCID: PMC9481626 DOI: 10.1038/s41537-022-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.
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18
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McLeod HJ. Splitting Things Apart to Put Them Back Together Again: A Targeted Review and Analysis of Psychological Therapy RCTs Addressing Recovery From Negative Symptoms. Front Psychiatry 2022; 13:826692. [PMID: 35633793 PMCID: PMC9133443 DOI: 10.3389/fpsyt.2022.826692] [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: 12/01/2021] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
Negative symptoms have attracted growing attention as a psychological treatment target and the past 10 years has seen an expansion of mechanistic studies and clinical trials aimed at improving treatment options for this frequently neglected sub-group of people diagnosed with schizophrenia. The recent publication of several randomized controlled trials of psychological treatments that pre-specified negative symptoms as a primary outcome warrants a carefully targeted review and analysis, not least because these treatments have generally returned disappointing therapeutic benefits. This mini-review dissects these trials and offers an account of why we continue to have significant gaps in our understanding of how to support recovery in people troubled by persistent negative symptoms. Possible explanations for mixed trial results include a failure to separate the negative symptom phenotype into the clinically relevant sub-types that will respond to mechanistically targeted treatments. For example, the distinction between experiential and expressive deficits as separate components of the wider negative symptom construct points to potentially different treatment needs and techniques. The 10 negative symptom-focused RCTs chosen for analysis in this mini-review present over 16 different categories of treatment techniques spanning a range of cognitive, emotional, behavioral, interpersonal, and metacognitive domains of functioning. The argument is made that treatment development will advance more rapidly with the use of more precisely targeted psychological treatments that match interventions to a focused range of negative symptom maintenance processes.
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Affiliation(s)
- Hamish J. McLeod
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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19
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Riehle M, Pillny M, Lincoln TM. Expanding the positivity offset theory of anhedonia to the psychosis continuum. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:47. [PMID: 35853895 PMCID: PMC9261090 DOI: 10.1038/s41537-022-00251-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
People with schizophrenia and negative symptoms show diminished net positive emotion in low-arousing contexts (diminished positivity offset) and co-activate positive and negative emotion more frequently (increased ambivalence). Here, we investigated whether diminished positivity offset and increased ambivalence covary with negative symptoms along the continuum of psychotic symptoms. We conducted an online-study in an ad-hoc community sample (N = 261). Participants self-reported on psychotic symptoms (negative symptoms, depression, positive symptoms, anhedonia) and rated positivity, negativity, and arousal elicited by pleasant, unpleasant, and neutral stimuli. The data were analyzed with multilevel linear models. Increasing levels of all assessed symptom areas showed significant associations with diminished positivity offset. Increased ambivalence was related only to positive symptoms. Our results show that the diminished positivity offset is associated with psychotic symptoms in a community sample, including, but not limited to, negative symptoms. Ecological validity and symptom specificity require further investigation.
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Affiliation(s)
- Marcel Riehle
- Clinical Psychology and Psychotherapy, Institute for Psychology, Universität Hamburg, Hamburg, Germany.
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute for Psychology, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute for Psychology, Universität Hamburg, Hamburg, Germany
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20
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Abram SV, Weittenhiller LP, Bertrand CE, McQuaid JR, Mathalon DH, Ford JM, Fryer SL. Psychological Dimensions Relevant to Motivation and Pleasure in Schizophrenia. Front Behav Neurosci 2022; 16:827260. [PMID: 35401135 PMCID: PMC8985863 DOI: 10.3389/fnbeh.2022.827260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Motivation and pleasure deficits are common in schizophrenia, strongly linked with poorer functioning, and may reflect underlying alterations in brain functions governing reward processing and goal pursuit. While there is extensive research examining cognitive and reward mechanisms related to these deficits in schizophrenia, less attention has been paid to psychological characteristics that contribute to resilience against, or risk for, motivation and pleasure impairment. For example, psychological tendencies involving positive future expectancies (e.g., optimism) and effective affect management (e.g., reappraisal, mindfulness) are associated with aspects of reward anticipation and evaluation that optimally guide goal-directed behavior. Conversely, maladaptive thinking patterns (e.g., defeatist performance beliefs, asocial beliefs) and tendencies that amplify negative cognitions (e.g., rumination), may divert cognitive resources away from goal pursuit or reduce willingness to exert effort. Additionally, aspects of sociality, including the propensity to experience social connection as positive reinforcement may be particularly relevant for pursuing social goals. In the current review, we discuss the roles of several psychological characteristics with respect to motivation and pleasure in schizophrenia. We argue that individual variation in these psychological dimensions is relevant to the study of motivation and reward processing in schizophrenia, including interactions between these psychological dimensions and more well-characterized cognitive and reward processing contributors to motivation. We close by emphasizing the value of considering a broad set of modulating factors when studying motivation and pleasure functions in schizophrenia.
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Affiliation(s)
- Samantha V Abram
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren P Weittenhiller
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Claire E Bertrand
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
| | - John R McQuaid
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel H Mathalon
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Judith M Ford
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Susanna L Fryer
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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21
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Bosqui T, Shannon C, Anderson R, Turkington A, Barrett S, McCaul R, Cooper S, O'Donnell D, Rushe T, Mulholland C. Neighbourhood effects on psychotic and depressive symptoms in the context of religious sectarianism in Northern Ireland: A data linkage study. Int J Soc Psychiatry 2022; 68:264-272. [PMID: 33349094 DOI: 10.1177/0020764020982642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The incidence of psychotic disorders is higher in ethnic minorities groups. The 'ethnic density effect', in which living in a neighbourhood with a low own-group proportion increases the risk of psychosis, is one explanatory factor. The density effect in the ethno-religious and sectarian context of Northern Ireland has been found to be reversed, particularly for Catholics, in which there is harmful effect of high own-group density areas. This is partly explained by high urbanicity, deprivation and unemployment, but is otherwise not well understood. AIMS This study aimed to examine the density effect at the level of symptomology (positive and negative psychosis symptoms and depressive symptoms) in a representative sample of people with a first episode of psychosis in Northern Ireland. METHOD Data linkage methodology was used drawing on data from the Northern Ireland First Episode Psychosis Study (NIFEPS) and the 2001 Census of Northern Ireland. RESULTS In total, 223 people between the ages of 18 to 64 were included in the study. A significant density effect was found for Catholics for total psychosis scores, but not for positive, negative and depressive symptoms, nor for general psychopathology, after adjusting for individual and area characteristics. The model accounted for just over 12% of the variance. No effect was found for Protestants. CONCLUSION The findings suggest that the density effect for Catholics is unrelated to the core features of psychosis (hallucinations, delusions and anhedonia) but rather to broader cognitive and emotional disturbances and area deprivation. Explanations of exposure to social adversity and inequality are proposed, with implications for public mental health and social policy.
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Affiliation(s)
- Tania Bosqui
- Department of Psychology, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Stephen Cooper
- Department of Psychiatry, Queen's University Belfast, Belfast, UK
| | - Donna O'Donnell
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Teresa Rushe
- School of Psychology, Queen's University Belfast, Belfast, UK
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Morillo-Kraus E, Fonseca-Pedrero E, Senín-Calderón C, Rodríguez-Testal JF. Perception of belonging and social anticipatory pleasure: Mediating variables of negative symptoms in the general population. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Porter L, Jones C, Fox A. Reliability of the Calgary depression scale for schizophrenia: A meta-analysis. Schizophr Res 2022; 240:32-45. [PMID: 34920367 DOI: 10.1016/j.schres.2021.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND A challenge for clinicians working with individuals diagnosed with schizophrenia is distinguishing depressive symptoms from negative symptoms of schizophrenia. The Calgary Depression Scale for Schizophrenia (CDSS) was developed for this purpose. No review has previously explored its reliability across multiple studies using advanced statistical means. OBJECTIVES This meta-analysis aimed to quantify the CDSS' internal consistency, inter-rater reliability (IRR) and test-retest reliability. METHOD A systematic literature search was conducted to find articles reporting on the CDSS' reliability. Articles were screened against the inclusion and exclusion criteria, with data extracted from 40 studies. Overall meta-analytic effects were calculated, and for internal consistency and IRR coefficients subsequent analyses explored between-study variation. The small test-retest reliability dataset limited analysis. FINDINGS The internal consistency meta-analytic effect was 0.83 (95% CI:0.82-0.84). Higgins I2 indicated an acceptable level of variation between studies' alpha estimates. This suggests all items in the CDSS are measuring the same construct (i.e. symptoms of depression). The IRR meta-analytic effect was 0.88 (95% CI:0.86-0.91), with Higgins I2 indicating high levels of heterogeneity. This was not deemed problematic variance as it is within levels expected for psychometric measures and, therefore, considered acceptable for this literature. This reflects high level of agreement between different raters when using the CDSS on the same client. CONCLUSIONS This review suggests the CDSS has good internal consistency and excellent IRR. Further research will help understand its test-retest reliability.
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Affiliation(s)
- Laura Porter
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland.
| | - Christopher Jones
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Fox
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland
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Jaya ES, Pillny M, Lincoln TM, Riehle M. Does social defeat cause negative symptoms? A prospective study in a multi-national community sample. Compr Psychiatry 2022; 113:152289. [PMID: 34942483 DOI: 10.1016/j.comppsych.2021.152289] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022] Open
Abstract
Psychological models of the consequences of ostracism (i.e. being socially excluded and ignored) and negative symptoms in schizophrenia suggest that repeatedly experiencing ostracism can lead to elevated levels of amotivation, anhedonia, and asociality (i.e. negative symptoms). We tested this assumption in a prospective study, following up a large multi-national community sample from Germany, Indonesia, and the United States (N = 962) every four months over one year. At each of the four assessment points (T0 - T3), participants rated their recent ostracism experiences and negative symptoms. Using cross-lagged panel analyses we found a) that negative symptoms and experiences of ostracism were significantly associated in each of the four assessment points, b) that ostracism predicted negative symptoms over time (T2 to T3), and c) that negative symptoms increased ostracism (T0 to T1). The results are in line with the social defeat model of negative symptoms and suggest a bi-directional longitudinal relationship between ostracism and negative symptoms. Moving forward, it will therefore be important to gain an understanding of potential moderators involved in the mechanism.
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Affiliation(s)
- Edo S Jaya
- Faculty of Psychology, Universitas Indonesia, Depok, Indonesia; Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany.
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Marcel Riehle
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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25
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Formulating psychosis: a thematic analysis of CBTp trainees’ experiences. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Abstract
The NICE guidance states that cognitive behavioural therapy (CBT) should now be offered to everyone with psychosis in the UK. This has rightly resulted in an increased demand for adherent therapy from qualified clinicians. Individualised formulation is a key component of CBT for psychosis, yet many trainees struggle to make sense of and apply the theoretical models on which these are based. This study explored trainee and recently qualified therapists’ experience of formulating CBT for psychosis, to help us understand how best to guide training and clinical practice. We ran focus groups with trainees who were completing, or had recently completed, postgraduate training in CBT for psychosis. We then analysed verbatim transcripts of the semi-structured interviews. and completed a thematic analysis of the data using inductive open coding. Three over-arching themes were generated: (1) purpose of formulation, (2) formulation in practice, and (3) (reflection on) learning to formulate. Training programmes and clinical supervisors should focus on fostering trainees’ and newly qualified therapists’ ability to develop simple, targeted formulations. These will draw on maintenance and developmental models of psychosis, depending on the person’s needs and goals. Opportunities for procedural learning are likely to improve skilful formulation, and use as the basis for therapeutic change.
Key learning aims
(1)
CBT for psychosis is best guided by individualised formulation.
(2)
The range and complexity of current theoretical models is challenging.
(3)
A qualitative analysis of trainee and recently qualified therapists’ experiences highlights means of facilitating understanding and application of these models.
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26
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Zhou J, Li J, Zhao Q, Ou P, Zhao W. Working memory deficits in children with schizophrenia and its mechanism, susceptibility genes, and improvement: A literature review. Front Psychiatry 2022; 13:899344. [PMID: 35990059 PMCID: PMC9389215 DOI: 10.3389/fpsyt.2022.899344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
The negative influence on the cognitive ability of schizophrenia is one of the issues widely discussed in recent years. Working memory deficits are thought to be a core cognitive symptom of schizophrenia and lead to poorer social functions and worse academic performance. Previous studies have confirmed that working memory deficits tend to appear in the prodromal phase of schizophrenia. Therefore, considering that children with schizophrenia have better brain plasticity, it is critical to explore the development of their working memory. Although the research in this field developed gradually in recent years, few researchers have summarized these findings. The current study aims to review the recent studies from both behavior and neuroimaging aspects to summarize the working memory deficits of children with schizophrenia and to discuss the pathogenic factors such as genetic susceptibility. In addition, this study put forward some practicable interventions to improve cognitive symptoms of schizophrenia from psychological and neural perspectives.
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Affiliation(s)
- Jintao Zhou
- School of Psychology, Nanjing Normal University, Nanjing, China.,Department of Psychology, Fudan University, Shanghai, China
| | - Jingfangzhou Li
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Qi Zhao
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, Macao SAR, China
| | - Peixin Ou
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, Macao SAR, China
| | - Wan Zhao
- School of Psychology, Nanjing Normal University, Nanjing, China
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27
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Renz KE, Pillny M, Lincoln TM. Increasing motivation in effort-based decision-making tasks: effects of salience and reward expectancy manipulations. Cogn Neuropsychiatry 2022; 27:20-34. [PMID: 34812121 DOI: 10.1080/13546805.2021.2007068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A significant proportion of patients with affective and psychotic disorders show a marked reduction in goal-directed behaviour, which is also reflected in the behavioural outcomes of effort-based decision-making paradigms. The factors underlying this reduction are not yet fully understood. Reward salience and reward expectancy have been discussed as factors that potentially influence approach behaviour. The aim of this study was thus to test their effects on behaviour in an effort-based decision-making paradigm. METHODS In two studies with community samples we applied a modified version of the Balloon Task. In study 1, we manipulated reward salience in a within-subject design (N = 32) by highlighting the monetary rewards. In study 2, we manipulated reward expectancy in a between-subject design (N = 72) by adding five practice trials with either positive or negative feedback prior to the task. RESULTS The salience of rewards manipulation significantly increased effort expenditure and the allocation of effort to the level of rewards whereas the reward expectancy manipulation did not. CONCLUSIONS The finding that increasing the salience of rewards increases motivated behaviour in an effort-based decision-making paradigm offers promising possibilities for intervention in disorders characterised by motivational deficits, such asaffective and psychotic disorders.
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Affiliation(s)
- Katharina E Renz
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
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28
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Swanson L, Schwannauer M, Bird T, Eliasson E, Millar A, Moritz S, Griffiths H. Metacognitive Training Modified for Negative Symptoms (MCT-N): A Feasibility study. Clin Psychol Psychother 2021; 29:1068-1079. [PMID: 34792834 DOI: 10.1002/cpp.2692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although patients often prioritise the treatment of negative symptoms, few psychological interventions targeting negative symptoms exist. This study attempts to fill this gap by piloting a modified Metacognitive training programme, specifically targeted at negative symptoms (MCT-N), with a group of patients with prominent negative symptoms. METHOD We adopted a mixed methods case series design, providing detailed quantitative data on changes over time, to focus on potential mechanisms underlying the intervention, in combination with qualitative interviews. RESULTS The intervention showed good feasibility as demonstrated by the attendance rate, the positive feedback from participants and the multidisciplinary team, and the improvements on negative symptoms observed following the intervention. Multilevel modelling showed that depression, internalised stigma, and reflective functioning explained the variance in negative symptoms. DISCUSSION The pilot study indicated that the intervention has high feasibility and that improvements in negative symptoms can be partially explained by improvements on depression, stigma, and reflective functioning.
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Affiliation(s)
- Linda Swanson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh.,NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh.,Region Sörmland, Sweden, Centre for Clinical Research Sörmland, Eskilstuna
| | - Matthias Schwannauer
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Tim Bird
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Emma Eliasson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Audrey Millar
- NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Germany, Department of Psychiatry and Psychotherapy, Hamburg
| | - Helen Griffiths
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
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29
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Dlagnekova A, van Staden W, Masenge A. Validity and reliability of the Vigour Assessment Scale in avolitional schizophrenia outpatients. Schizophr Res 2021; 235:36-43. [PMID: 34304145 DOI: 10.1016/j.schres.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 02/22/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
A few items of existing schizophrenia scales measure avolition, but no research has been reported on vigour in schizophrenia, including whether avolition would be more or less the inverse of vigour. Such research requires a valid and reliable measure of vigour. In the absence of this, this study developed and examined the validity and the reliability of the Vigour Assessment Scale (VAS) among 242 avolitional schizophrenia outpatients in relation to measures of workplace vigour, behavioral inhibition and activation, procrastination, fatigue, anxiety, depressive features, and active involvement in personal growth. Convergent validity was found in moderate to strong correlations (r = 0.5 to 0.714) between the VAS and measures approximate to vigour. Discriminant validity was found in lower and/or inverse correlations with depression (r = -0.423), anxiety (r = -0.279), behaviour inhibition (r = -0.045), procrastination (r = -0.656), and fatigue (r = -0.684). Internal consistency was good with Cronbach's alpha coefficients above 0.8, and strong correlations for split-half (r = 0.71) and test-retest (r = 0.77) reliability. The standard error of measurement was seven on a scale of 145 points. An exploratory factor analysis yielded a 27-item version with a six-factor structure accounting for 61.9% of the cumulative variance. These results suggest that the VAS is a valid and reliable instrument in avolitional schizophrenia outpatients, suitable for use in further research on vigour and when vigour is pursued therapeutically or in efficacy studies. Subject to further validation, the VAS may be used in other clinical populations (e.g., in depression) and healthy populations where vigour may be pursued as a desirable attribute.
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Affiliation(s)
| | - Werdie van Staden
- Department of Psychiatry, University of Pretoria, South Africa; Centre for Ethics and Philosophy of Health Sciences, University of Pretoria, South Africa.
| | - Andries Masenge
- Department of Statistics, University of Pretoria, South Africa
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30
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Clay KB, Raugh IM, Bartolomeo LA, Strauss GP. Defeatist performance beliefs in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Early Interv Psychiatry 2021; 15:865-873. [PMID: 32743974 DOI: 10.1111/eip.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high-risk (CHR) for psychosis. METHODS Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition. RESULTS Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's < .01). In SZ, higher DPBs were associated with greater negative symptoms (r's = .31-.37, p's < .01), poorer social functioning and impaired social cognition (r = -.40, P < .001). In CHR, greater DPBs were associated with poorer social functioning (r = -.52, P < .05) and impairments in the neurocognitive domains of reasoning (r = -.48, P < .05) and processing speed (r = -.41, P < .05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples. CONCLUSIONS Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness.
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Affiliation(s)
- Kendall B Clay
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Lisa A Bartolomeo
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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31
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Cowan HR, Mittal VA, McAdams DP. Narrative identity in the psychosis spectrum: A systematic review and developmental model. Clin Psychol Rev 2021; 88:102067. [PMID: 34274799 DOI: 10.1016/j.cpr.2021.102067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 01/19/2023]
Abstract
Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity-the study of internalized, evolving life stories-provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.
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Affiliation(s)
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical and Social Sciences, Institute for Policy Research, Northwestern University, United States
| | - Dan P McAdams
- Psychology, School of Education and Social Policy, Northwestern University, United States
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32
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Möller TJ, Georgie YK, Schillaci G, Voss M, Hafner VV, Kaltwasser L. Computational models of the "active self" and its disturbances in schizophrenia. Conscious Cogn 2021; 93:103155. [PMID: 34130210 DOI: 10.1016/j.concog.2021.103155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
Abstract
The notion that self-disorders are at the root of the emergence of schizophrenia rather than a symptom of the disease, is getting more traction in the cognitive sciences. This is in line with philosophical approaches that consider an enactive self, constituted through action and interaction with the environment. We thereby analyze different definitions of the self and evaluate various computational theories lending to these ideas. Bayesian and predictive processing are promising approaches for computational modeling of the "active self". We evaluate their implementation and challenges in computational psychiatry and cognitive developmental robotics. We describe how and why embodied robotic systems provide a valuable tool in psychiatry to assess, validate, and simulate mechanisms of self-disorders. Specifically, mechanisms involving sensorimotor learning, prediction, and self-other distinction, can be assessed with artificial agents. This link can provide essential insights to the formation of the self and new avenues in the treatment of psychiatric disorders.
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Affiliation(s)
- Tim Julian Möller
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
| | - Yasmin Kim Georgie
- Department of Computer Science, Humboldt-Universität zu Berlin, Germany.
| | - Guido Schillaci
- The BioRobotics Institute and Dept. of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Martin Voss
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine and St. Hedwig Hospital, Berlin, Germany.
| | | | - Laura Kaltwasser
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
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33
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Luo H, Zhao Y, Fan F, Fan H, Wang Y, Qu W, Wang Z, Tan Y, Zhang X, Tan S. A bottom-up model of functional outcome in schizophrenia. Sci Rep 2021; 11:7577. [PMID: 33828168 PMCID: PMC8027854 DOI: 10.1038/s41598-021-87172-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/10/2021] [Indexed: 02/01/2023] Open
Abstract
Schizophrenia results in poor functional outcomes owing to numerous factors. This study provides the first test of a bottom-up causal model of functional outcome in schizophrenia, using neurocognition, vocal emotional cognition, alexithymia, and negative symptoms as predictors of functional outcome. We investigated a cross-sectional sample of 135 individuals with schizophrenia and 78 controls. Using a series of structural equation modelling analyses, a single pathway was generated among scores from the MATRICS Consensus Cognitive Battery (MCCB), vocal emotion recognition test, Toronto Alexithymia Scale (TAS), Brief Negative Symptom Scale, and the Personal and Social Performance Scale. The scores for each dimension of the MCCB in the schizophrenia group were significantly lower than that in the control group. The recognition accuracy for different emotions (anger, disgust, fear, sadness, surprise, and satire, but not calm was significantly lower in the schizophrenia group than in the control group. Moreover, the scores on the three dimensions of TAS were significantly higher in the schizophrenia group than in the control group. On path analysis modelling, the proposed bottom-up causal model showed a strong fit with the data and formed a single pathway, from neurocognition to vocal emotional cognition, to alexithymia, to negative symptoms, and to poor functional outcomes. The study results strongly support the proposed bottom-up causal model of functional outcome in schizophrenia. The model could be used to better understand the causal factors related to the functional outcome, as well as for the development of intervention strategies to improve functional outcomes in schizophrenia.
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Affiliation(s)
- Hongge Luo
- grid.440734.00000 0001 0707 0296School of Public Health, North China University of Science and Technology, Tangshan, China ,grid.440734.00000 0001 0707 0296College of Psychology, North China University of Science and Technology, Tangshan, China
| | - Yanli Zhao
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Fengmei Fan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Hongzhen Fan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yunhui Wang
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Wei Qu
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yunlong Tan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Xiujun Zhang
- grid.440734.00000 0001 0707 0296School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Shuping Tan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
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34
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Ordóñez-Camblor N, Paino M, Fonseca-Pedrero E, Pizarro-Ruiz JP. Mediation of the stigma in the influence of negative symptomatology over recovery in psychosis. Int J Clin Health Psychol 2021; 21:100220. [PMID: 33552164 PMCID: PMC7856466 DOI: 10.1016/j.ijchp.2021.100220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background/Objective: The interest in recovery processes in psychotic disorders has boosted the necessity of knowledge about the factors that could influence in such recovery. Negative symptomatology and the stigma have been negatively linked to the recovery process in psychosis. The aim of this investigation is to improve the understanding of how the recovery process is affected by negative symptomatology based on the analysis of the mediating effects of the internalized stigma. Method: The sample was composed of 114 people that had experienced, at some point in their life, at least one clinically relevant psychotic episode. CAPE-42, STORI and ISMI were used for the evaluation. The macro PROCESS for SPSS was used. The indirect effect was calculated using 10.000 samples of bootstrap for the bootstrap confidence intervals (IC) corrected for bias. Results: The results show that the influence of negative symptomatology predicts the stigmatization of the person regarding his disorder. This predicts a negative influence in the recovery process of the psychosis. Conclusions: These results back the importance of adding the reduction of the stigma as a specific strategy to improve the recovery process in psychotic disorders.
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Affiliation(s)
- Nuria Ordóñez-Camblor
- Departament of Health Sciences, Faculty of Health Sciences, University of Burgos, Spain
| | - Mercedes Paino
- Departament of Psychology, Faculty of Psychology, University of Oviedo, Spain
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35
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Motivation in schizophrenia: preliminary findings of a theory-driven approach using time-series network analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-020-01321-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Mahmood Z, Van Patten R, Keller AV, Lykins HC, Perivoliotis D, Granholm E, Twamley EW. Reducing negative symptoms in schizophrenia: Feasibility and acceptability of a combined cognitive-behavioral social skills training and compensatory cognitive training intervention. Psychiatry Res 2021; 295:113620. [PMID: 33290939 PMCID: PMC7779756 DOI: 10.1016/j.psychres.2020.113620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/28/2020] [Indexed: 12/25/2022]
Abstract
The current study examined the feasibility and acceptability of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared with Goal-Focused Supportive Contact (SC) in a pilot randomized controlled trial for people with schizophrenia with high negative symptom severity. The sample included 55 participants from five community settings; masters-level study clinicians delivered interventions on-site. Participants completed assessments of cognitive, functional, and psychiatric symptoms at baseline, mid-treatment, post-treatment (12.5 weeks), and 6-month follow-up. Enrollment goals were not initially met, necessitating the addition of a fifth site; however, all groups and assessments were completed on-site. Study procedures were acceptable, as evidenced by 100% enrollment and completion of baseline assessments following informed consent; however, over 1/3rd of participants dropped out. No modifications were necessary to the intervention procedures and CBSST-CCT fidelity ratings were acceptable. The intervention was deemed acceptable among participants who attended ≥1 session, as evidenced by similar attendance rates in CBSST-CCT compared to SC. Among CBSST-CCT participants, lower positive symptoms were significantly associated with better attendance. Overall, we found mixed evidence for the feasibility and acceptability of the CBSST-CCT protocol in people with schizophrenia with high negative symptoms. Challenges are highlighted and recommendations for future investigations are provided.
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Affiliation(s)
- Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA.
| | - Ryan Van Patten
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA.
| | - Amber V Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA.
| | - Hannah C Lykins
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA.
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA; Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116B), San Diego, CA 92161, USA.
| | - Eric Granholm
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA; Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116B), San Diego, CA 92161, USA.
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92120, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603), La Jolla, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161, USA.
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37
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Ebrahimi A, Poursharifi H, Dolatshahi B, Rezaee O, Hassanabadi HR, Naeem F. The Cognitive Model of Negative Symptoms in Schizophrenia: A Hierarchical Component Model With PLS-SEM. Front Psychiatry 2021; 12:707291. [PMID: 34366940 PMCID: PMC8339582 DOI: 10.3389/fpsyt.2021.707291] [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: 05/09/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
The cognitive model of negative symptoms suggests that some dysfunctional beliefs mediate the relationship between neurocognitive deficits and negative symptoms and disability. This study tested the hypothesis that dysfunctional performance beliefs mediate neurocognitive deficits, negative symptoms, and disability. We used a hierarchal component model with 85 men patients diagnosed with chronic schizophrenia. Results showed a moderate to strong correlation between dysfunctional performance beliefs, neurocognitive deficits, negative symptoms, and disability. These results support the Hierarchal component model (HCM) of the cognitive model of negative symptoms. Our results indicated that the disability in schizophrenia is mediated through dysfunctional performance beliefs, neurocognitive deficits, and negative symptoms pathway. Further, dysfunctional performance beliefs have a crucial role in this pathway. Therefore, targeting this vicious cycle of dysfunctional beliefs can improve disability in patients with schizophrenia.
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Affiliation(s)
- Ali Ebrahimi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Poursharifi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Omid Rezaee
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Hassanabadi
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
| | - Farooq Naeem
- Department of Psychiatry, University of Toronto & Centre for Addiction and Mental Health, Toronto, ON, Canada
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Thakkar KN, Ghermezi L, Silverstein SM, Slate R, Yao B, Achtyes ED, Brascamp JW. Stronger tilt aftereffects in persons with schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 130:186-197. [PMID: 33301337 DOI: 10.1037/abn0000653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Individuals with schizophrenia may fail to appropriately use temporal context and apply past environmental regularities to the interpretation of incoming sensory information. Here we use the visual system as a test bed for investigating how prior experience shapes perception in individuals with schizophrenia. Specifically, we use visual aftereffects, illusory percepts resulting from prior exposure to visual input, to measure the influence of prior events on current processing. At a neural level, visual aftereffects arise due to attenuation in the responses of neurons that code the features of the prior stimulus (neuronal adaptation) and subsequent disinhibition of neurons signaling activity at the opposite end of the feature dimension. In the current study, we measured tilt aftereffects and negative afterimages, 2 types of aftereffects that reflect, respectively, adaptation of cortical orientation-coding neurons and adaptation of subcortical and retinal luminance-coding cells in persons with schizophrenia (PSZ; n = 36) and demographically matched healthy controls (HC; n = 22). We observed stronger tilt aftereffects in PSZ compared to HC, but no difference in negative afterimages. Stronger tilt aftereffects were related to more severe negative symptoms. These data suggest oversensitivity to recent regularities, in the form of stronger visual adaptation, at cortical, but not subcortical, levels in schizophrenia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Granholm E, Holden J, Dwyer K, Mikhael T, Link P, Depp C. Mobile-Assisted Cognitive Behavioral Therapy for Negative Symptoms: Open Single-Arm Trial With Schizophrenia Patients. JMIR Ment Health 2020; 7:e24406. [PMID: 33258792 PMCID: PMC7738249 DOI: 10.2196/24406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Negative symptoms are an important unmet treatment need for schizophrenia. This study is a preliminary, open, single-arm trial of a novel hybrid intervention called mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn). OBJECTIVE The primary aim was to test whether mCBTn was feasible and could reduce severity of the target mechanism, defeatist performance attitudes, which are associated with experiential negative symptoms and poor functioning in schizophrenia. METHODS Participants with schizophrenia or schizoaffective disorder (N=31) who met prospective criteria for persistent negative symptoms were enrolled. The blended intervention combines weekly in-person group therapy with a smartphone app called CBT2go. The app extended therapy group skills, including recovery goal setting, thought challenging, scheduling of pleasurable activities and social interactions, and pleasure-savoring interventions to modify defeatist attitudes and improve experiential negative symptoms. RESULTS Retention was excellent (87% at 18 weeks), and severity of defeatist attitudes and experiential negative symptoms declined significantly in the mCBTn intervention with large effect sizes. CONCLUSIONS The findings suggest that mCBTn is a feasible and potentially effective treatment for experiential negative symptoms, if confirmed in a larger randomized controlled trial. The findings also provide support for the defeatist attitude model of experiential negative symptoms and suggest that blended technology-supported interventions such as mCBTn can strengthen and shorten intensive psychosocial interventions for schizophrenia. TRIAL REGISTRATION ClinicalTrials.gov NCT03179696; https://clinicaltrials.gov/ct2/show/NCT03179696.
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Affiliation(s)
- Eric Granholm
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Kristen Dwyer
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Tanya Mikhael
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Peter Link
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Colin Depp
- VA San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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Raffard S, Capdevielle D, Attal J, Novara C, Bortolon C. Apathy in Obsessive-Compulsive Disorder and Its Psychological Correlates: Comparison With Individuals With Schizophrenia. J Neuropsychiatry Clin Neurosci 2020; 32:168-174. [PMID: 31266408 DOI: 10.1176/appi.neuropsych.19010018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Apathy, defined as reduced goal-directed behavior, is a frequent symptom in mental and neurological disorders but has been poorly studied in individuals with obsessive-compulsive disorder (OCD). The primary aim of this study was to examine levels of apathy between individuals with OCD, healthy control subjects, and individuals with schizophrenia, a mental disorder with high levels of apathy. The second aim was to assess whether the psychological factors that have been previously shown as underlying apathy in other mental disorders were associated with apathy in patients with OCD. METHODS This exploratory study included 25 individuals with OCD, 24 individuals with schizophrenia, and 24 healthy control subjects. Apathy was assessed using the Lille Apathy Rating Scale. Measures of depression, sensibility to punishment and reward, defeatist performance beliefs, and cognitive functioning were also assessed. RESULTS Individuals diagnosed with OCD and schizophrenia scored significantly higher than healthy control subjects on the apathy total score. Levels of apathy among OCD patients were mainly associated with depression but also dysexecutive functioning and defeatist beliefs. CONCLUSIONS These findings suggest that motivational deficits could play a central role in disability caused by OCD. Similar to other mental disorders, various psychological factors, including depression, defeatist beliefs, and dysexecutive functioning, are involved in apathetic manifestations. However, the fact that depression is the variable most associated with apathy indicates that apathetic symptoms in patients with OCD must be considered mainly as secondary rather than primary symptoms.
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Affiliation(s)
- Stéphane Raffard
- Université Paul Valéry Montpellier, Montpellier, France (Raffard); Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France (Raffard, Capdevielle, Attal, Novara); Groupe Ramsay Générale de Santé, Clinique RECH, Montpellier, France (Novara); Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Grenoble, France (Bortolon)
| | - Delphine Capdevielle
- Université Paul Valéry Montpellier, Montpellier, France (Raffard); Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France (Raffard, Capdevielle, Attal, Novara); Groupe Ramsay Générale de Santé, Clinique RECH, Montpellier, France (Novara); Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Grenoble, France (Bortolon)
| | - Jérôme Attal
- Université Paul Valéry Montpellier, Montpellier, France (Raffard); Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France (Raffard, Capdevielle, Attal, Novara); Groupe Ramsay Générale de Santé, Clinique RECH, Montpellier, France (Novara); Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Grenoble, France (Bortolon)
| | - Caroline Novara
- Université Paul Valéry Montpellier, Montpellier, France (Raffard); Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France (Raffard, Capdevielle, Attal, Novara); Groupe Ramsay Générale de Santé, Clinique RECH, Montpellier, France (Novara); Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Grenoble, France (Bortolon)
| | - Catherine Bortolon
- Université Paul Valéry Montpellier, Montpellier, France (Raffard); Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France (Raffard, Capdevielle, Attal, Novara); Groupe Ramsay Générale de Santé, Clinique RECH, Montpellier, France (Novara); Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Grenoble, France (Bortolon)
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Ngô TL, Chaloult L, Fortier P, Monday J, Jomphe J, Turcotte J, Bouthillier D, Bérubé F. La thérapie cognitivo-comportementale dans les cliniques spécialisées du Pavillon Albert-Prévost dans les 50 dernières années : innovations et évolution. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1073524ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le Pavillon Albert-Prévost (PAP) a joué un rôle de premier plan dans le développement d’une psychiatrie moderne. Cette institution de soins et d’enseignement en santé mentale a été profondément marquée par la pensée freudienne et a longtemps été considérée comme un lieu phare de l’enseignement de la psychanalyse en milieu hospitalier au Québec. Mais le PAP a aussi su intégrer au fil des ans d’autres approches thérapeutiques, basées sur les données probantes. Si l’arrivée de cliniciens novateurs dans les années 1980, a permis la sensibilisation du milieu à d’autres approches thérapeutiques, la transformation du dispositif de soins en cliniques spécialisées, en 1994, marque un point décisif dans le développement de la thérapie cognitivo-comportementale, mais surtout dans son intégration dans le traitement quotidien de patients souffrant de problématiques diverses et dans son enseignement à des générations de cliniciens.
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Affiliation(s)
- Thanh-Lan Ngô
- M.D., M. Sc. FRCPC, psychiatre, CIUSSS du Nord-de-l’Île-de-Montréal – Professeur agrégé de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Louis Chaloult
- M.D., FRCPC, psychiatre, ex-professeur adjoint de clinique au Département de psychiatrie de l’Université de Montréal
| | - Pierre Fortier
- MA., ergothérapeute, psychologue, psychothérapeute – Professeur adjoint de clinique, École de réadaptation, Université de Montréal - Chargé de cours, Département de psychologie, UQAM
| | - Jacques Monday
- M.D., FRCPC, psychiatre, ex-professeur titulaire au Département de psychiatrie de l’Université de Montréal
| | - Julie Jomphe
- MD, FRCPC, psychiatre, CISSS Lanaudière – Chargée d’enseignement de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Julie Turcotte
- M.D., M. Sc. FRCPC, psychiatre, CIUSSS du Nord-de-l’Île-de-Montréal – Professeur adjoint de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Donald Bouthillier
- Ph. D., psychologue – Chargé de cours, Département de psychologie, Université de Montréal
| | - France Bérubé
- B. Sc., ergothérapeute, Clinique des maladies affectives et Clinique Cartierville, CIUSSS du Nord-de-l’Île-de-Montréal
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Metacognition Is Uniquely Related to Concurrent and Prospective Assessments of Negative Symptoms Independent of Verbal Memory in Serious Mental Illness. J Nerv Ment Dis 2020; 208:837-842. [PMID: 32740145 DOI: 10.1097/nmd.0000000000001219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The inability to synthesize information into experience of self and others could be one significant cause of negative symptoms. To explore this possibility, we examined the relationships between baseline metacognition and concurrent and prospective negative symptoms controlling for verbal memory. The participants were 62 adults diagnosed with serious mental illness enrolled in outpatient treatment. Metacognition was measured with the Metacognitive Assessment Scale-Abbreviated, symptoms were assessed using the Brief Psychiatric Rating Scale, and verbal memory was assessed using the California Verbal Learning Test. Significant correlations were found, indicating that poorer overall metacognition was associated with greater levels of negative symptoms assessed concurrently (r = 0.39) and 1 month later (r = 0.36). A significant relationship persisted after controlling for verbal memory and education. These findings support the idea that metacognitive deficits are related to negative symptoms and point to the potential of metacognitive interventions to positively influence negative symptoms.
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Does Self-Efficacy Predict Functioning in Older Adults with Schizophrenia? A Cross-Sectional and Longitudinal Mediation Analysis. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McGovern JE, Reddy LF, Reavis EA, Green MF. Pupillary change on a cognitive effort task in schizophrenia: Associations with cognition and motivation. Int J Psychophysiol 2020; 155:1-7. [DOI: 10.1016/j.ijpsycho.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
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Décombe A, Brunel L, Capdevielle D, Raffard S. Too much or too little? Exploring effort perception in schizophrenia within the framework of motivational intensity theory. Cogn Neuropsychiatry 2020; 25:312-327. [PMID: 32727294 DOI: 10.1080/13546805.2020.1798220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: To explain motivational difficulties in schizophrenia (SZ), attention has focused on the reward system and effort-based decision-making deficits. However, according to motivational intensity theory (MIT), effort is not directly determined by reward but by task difficulty. Moreover, no studies have examined the effort perception in the SZ. Therefore, this cross-sectional study compared effort perception in SZ group with healthy controls. Method: Task difficulty was manipulated by increasing the distance covered (from 8 to 48 metres). Walking speed, perceptions of difficulty and effort were assessed for all difficulty levels. Clinical and bodyweight variables were recorded. Results: As postulated by MIT, perceived effort and difficulty increased with task difficulty in both groups. Perceived effort and difficulty were higher in the SZ group. Perceptions of effort were positively correlated with BMI in SZ, but not with clinical variables. Importantly, although SZ patients perceived the task as more effortful, walking speed was similar between groups. Conclusions: Taken together, these results suggested that individuals with SZ perceived more strongly the effort and the difficulty of the task but could mobilise more effort to complete it. This observation may explain in part the decrease in engaging in physical demanding activities in daily life in SZ.
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Affiliation(s)
- Amandine Décombe
- Department of Psychology, Epsylon, Paul Valery University of Montpellier, Montpellier, France.,University Department of Psychiatry Adult, Hôpital la Colombière, University Hospital of Montpellier, Montpellier, France
| | - Lionel Brunel
- Department of Psychology, Epsylon, Paul Valery University of Montpellier, Montpellier, France
| | - Delphine Capdevielle
- University Department of Psychiatry Adult, Hôpital la Colombière, University Hospital of Montpellier, Montpellier, France.,Inserm, Unit 1061, Neuropsychiatry, Epidemiology and Clinical Research, University of Montpellier, Montpellier, France
| | - Stéphane Raffard
- Department of Psychology, Epsylon, Paul Valery University of Montpellier, Montpellier, France.,University Department of Psychiatry Adult, Hôpital la Colombière, University Hospital of Montpellier, Montpellier, France
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Cowan HR, Mittal VA, Allen DN, Gold JM, Strauss GP. Heterogeneity of emotional experience in schizophrenia: Trait affect profiles predict clinical presentation and functional outcome. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:760-767. [PMID: 32584084 DOI: 10.1037/abn0000554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The current study examined whether subgroups of individuals with schizophrenia could be identified based on their profiles of trait positive and negative emotional experience, and whether those subgroups differed in their symptom presentation and functional outcome. Participants included 192 outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ) and 149 demographically matched healthy controls who completed the trait version of the Positive and Negative Affect Scale, as well as symptom and functional outcome assessments. Cluster analysis determined whether patients could be separated into meaningful subgroups based on their trait emotional experience profiles, and discriminant function analysis determined whether these groups were valid and adequately separated. Forty-two percent of the patients fell into an affectively normal cluster, whereas 28% and 30% fell into low positive affect (PA) and high negative affect (NA) clusters, respectively. These subgroups differed significantly on positive symptoms, negative symptoms, Diagnostic and Statistical Manual of Mental Disorders diagnoses, and functional outcomes. Trait emotional experience is heterogeneous in outpatients with psychotic disorders, and meaningful subgroups of patients with different profiles of PA and NA can be identified. These subgroups show meaningful differences in clinical presentation, which may necessitate different treatment approaches. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Thonon B, Levaux MN, Della Libera C, Larøi F. Switch, a new intervention that targets motivational negative symptoms in people with schizophrenia: An uncontrolled pilot study. J Clin Psychol 2020; 76:1797-1806. [PMID: 32453892 DOI: 10.1002/jclp.22963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE People diagnosed with schizophrenia experience difficulties in their daily life, which is best explained by motivational negative symptoms. This study explores the feasibility, acceptability, and efficacy of Switch, a new multifactorial intervention that targets motivational deficits. METHOD Eight participants with schizophrenia or schizoaffective disorder followed around 30 individual sessions of Switch over 12 months. Participants and their informants were interviewed at baseline (T0), at 6 months (T1), at the end of the intervention (T2), and at 6 months follow-up (T3). RESULTS T0-T1 paired sample t tests showed large improvements on motivational deficits, general negative symptoms, and apathy and functional outcomes (both as rated by informants). At T2 and T3, moderate to large improvements were maintained. Switch was well accepted by participants. CONCLUSIONS This preliminary investigation provides evidence that Switch may be a feasible, acceptable, and effective intervention specifically designed to target motivational deficits and improve daily functioning.
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Affiliation(s)
- Bénédicte Thonon
- Psychology and Neuroscience of Cognition Research Unit, Université de Liège, Liège, Belgium
| | | | - Clara Della Libera
- Psychology and Neuroscience of Cognition Research Unit, Université de Liège, Liège, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit, Université de Liège, Liège, Belgium.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT-Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
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Abstract
BACKGROUND Patients in every stage of the psychosis continuum can present with negative symptoms. While no treatment is currently available to address these symptoms, a more refined characterization of their course over the lifetime could help in elaborating interventions. Previous reports have separately investigated the prevalence of negative symptoms within each stage of the psychosis continuum. Our aim in this review is to compare those prevalences across stages, thereby disclosing the course of negative symptoms. METHODS We searched several databases for studies reporting prevalences of negative symptoms in each one of our predetermined stages of the psychosis continuum: clinical or ultra-high risk (UHR), first-episode of psychosis (FEP), and younger and older patients who have experienced multiple episodes of psychosis (MEP). We combined results using the definitions of negative symptoms detailed in the Brief Negative Symptom Scale, a recently developed tool. For each negative symptom, we averaged and weighted by the combined sample size the prevalences of each negative symptom at each stage. RESULTS We selected 47 studies totaling 1872 UHR, 2947 FEP, 5039 younger MEP, and 669 older MEP patients. For each negative symptom, the prevalences showed a comparable course. Each negative symptom decreased from the UHR to FEP stages and then increased from the FEP to MEP stages. CONCLUSIONS Certain psychological, environmental, and treatment-related factors may influence the cumulative impact of negative symptoms, presenting the possibility for early intervention to improve the long-term course.
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Liemburg EJ, Enriquez-Geppert S, Wardenaar KJ, Bruggeman R, Aleman A. Expressive deficits and amotivation as mediators of the associations between cognitive problems and functional outcomes: Results from two independent cohorts. Schizophr Res 2020; 218:283-291. [PMID: 31948899 DOI: 10.1016/j.schres.2019.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
Many individuals with severe mental disorders have difficulties in vocational and social functioning, which are regarded the most important outcomes, together with clinical symptoms. To understand the underlying mechanisms, research is increasingly focused on factors influencing functional outcomes. One established association has been shown between cognition and community functioning with negative symptoms as a possible mediator. Although it has been shown that negative symptoms consist of two subdomains, thus far negative symptoms have been assessed as one unitary construct. This study considers for the first time subdomains of negative symptoms as putative mediators (expressive deficits, amotivation) of the association between cognition (neuro- and social cognition) and functional outcome (living situation, occupation, social functioning). We expected that specific subdomains of negative symptoms (e.g. amotivation) would mediate the effect of cognition on specific functional outcomes (e.g. social functioning) independently from illness duration. To assess this, we included two independent cohorts, consisting of participants with different illness duration. These two independent cohorts consisted of patients with a recent-onset psychotic disorder: PROGR-S (first time treated; N = 1129) and GROUP (illness duration preferably <5 years; N = 1200). Using linear regression, mediation analyses were performed with two cognition domains (neurocognition and social cognition) as predictors, negative symptoms (Expressive deficits and Amotivation as indexed with items from the Positive and Negative Syndrome Scale) as mediators and three measures of functional outcomes (living situation, occupation and social functioning) as outcome measures. The analyses were repeated with the same outcome measures three years later. Three main results were obtained. I) Both in the cross-sectional and longitudinal analyses, the associations of neurocognition (both cohorts) and social cognition (GROUP) with social functioning were mediated by amotivation. II) The association between cognition and living situation was mediated by Expressive deficits in one cohort (GROUP) but not in the cohort assessing first-episode psychosis (PROGR-S). III) The association between cognition and occupation was mediated by Amotivation in PROGR-S and by Expressive deficits in GROUP. CONCLUSION: The current results show a less robust mediating role for specific negative symptom domains regarding the associations of cognition with occupation and living situation that may depend on the duration of psychotic illness. However, Amotivation, mediates the association between cognition and social functioning, which holds true for patients experiencing a first-onset and patients with a longer illness duration alike. The results may have implications for the development of therapeutic approaches focusing on amotivation to improve social functioning. GENERAL SCIENTIFIC SUMMARY: This study stresses the importance of distinguishing subdomains of negative symptoms, cognition and functioning. Our results show that specific negative symptom dimensions mediate the effects of cognition on specific functional outcomes.
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Affiliation(s)
- Edith J Liemburg
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Postbox 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research center, CC72, Postbox 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, CC80, Postbox 30.001, 9700 RB Groningen, the Netherlands.
| | - Stefanie Enriquez-Geppert
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Postbox 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, Department of Psychology, Grote Kruisstraat 2/1, 9712 TS, the Netherlands.
| | - Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, Rob Giel Research center, CC72, Postbox 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, CC80, Postbox 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, CC72, Postbox 30.001, 9700 RB, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, the Netherlands.
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, Rob Giel Research center, CC72, Postbox 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, Department of Psychology, Grote Kruisstraat 2/1, 9712 TS, the Netherlands.
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Postbox 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, Department of Psychology, Grote Kruisstraat 2/1, 9712 TS, the Netherlands.
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García-Mieres H, Villaplana A, López-Carrilero R, Grasa E, Barajas A, Pousa E, Feixas G, Ochoa S. The Role of Personal Identity on Positive and Negative Symptoms in Psychosis: A Study Using the Repertory Grid Technique. Schizophr Bull 2020; 46:572-580. [PMID: 32275754 PMCID: PMC7147580 DOI: 10.1093/schbul/sbz082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND People with psychosis experience disruptions in personal identity that affect positive and negative symptoms, but the complexity of these phenomena needs to be addressed in an in-depth manner. Using the Personal Construct Theory, we examined whether distinct dimensions of personal identity, as measured with the Repertory Grid Technique along with other cognitive factors, might influence psychotic symptomatology. METHOD Eighty-five outpatients with schizophrenia-spectrum disorders completed a repertory grid, an observed-rated interview of psychotic symptoms, and measures of cognitive insight, depressive symptoms, neurocognition, and theory of mind. RESULTS Structural equation models revealed that interpersonal dichotomous thinking directly affected positive symptoms. Self-discrepancies influenced positive symptoms by mediation of depressive symptoms. Interpersonal cognitive differentiation and interpersonal cognitive richness mediated the impact of self-reflectivity and neurocognitive deficits in negative symptomatology. CONCLUSIONS This study is the first of its kind to examine the structure of personal identity in relation to positive and negative symptoms of psychosis. Results suggest interventions targeted to improving interpersonal dichotomous thinking, self-discrepancies, interpersonal cognitive differentiation, and interpersonal cognitive richness may be useful in improving psychotic symptoms.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain,Parc Sanitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain,To whom correspondence should be addressed; Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebrón, 171, 08035, Barcelona, Spain; tel: +34-93-3125123, fax: +34-93-556-96-74, ,
| | - Anna Villaplana
- Parc Sanitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain
| | - Eva Grasa
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain,Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
| | - Ana Barajas
- Centro de Higiene Mental Les Corts, Barcelona, Spain
| | - Esther Pousa
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain,Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain,Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
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