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Vita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, Zanca F, Giordano GM, Birkedal Glenthøj L, Nordentoft M, Galderisi S. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry 2022; 65:e58. [PMID: 36059109 PMCID: PMC9532219 DOI: 10.1192/j.eurpsy.2022.2316] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Impairment in a wide range of cognitive abilities has been consistently reported in individuals with schizophrenia. Both neurocognitive and social cognitive deficits are thought to underlie severe functional disabilities associated with schizophrenia. Despite the key role in schizophrenia outcome, cognition is still poorly assessed in both research and clinical settings. Methods In this guidance paper, we provide a systematic review of the scientific literature and elaborate several recommendations for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice. Results Expert consensus and systematic reviews provided guidance for the optimal assessment of cognitive functions in schizophrenia. Based on the reviewed evidence, we recommend a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. This European Psychiatric Association guidance recommends not only the use of observer reports but also self-reports and interview-based cognitive assessment tools. The guidance also provides a systematic review of the state of the art of assessment in the first episode of psychosis patients and in individuals at risk for psychosis. Conclusion The comprehensive review of the evidence and the recommendations might contribute to advance the field, allowing a better cognitive assessment, and avoiding overlaps with other psychopathological dimensions. The dissemination of this guidance paper may promote the development of shared guidelines concerning the assessment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to obtain recovery.
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González-Ortega I, González-Pinto A, Alberich S, Echeburúa E, Bernardo M, Cabrera B, Amoretti S, Lobo A, Arango C, Corripio I, Vieta E, de la Serna E, Rodriguez-Jimenez R, Segarra R, López-Ilundain JM, Sánchez-Torres AM, Cuesta MJ, Zorrilla I, López P, Bioque M, Mezquida G, Barcones F, De-la-Cámara C, Parellada M, Espliego A, Alonso-Solís A, Grasa EM, Varo C, Montejo L, Castro-Fornieles J, Baeza I, Dompablo M, Torio I, Zabala A, Eguiluz JI, Moreno-Izco L, Sanjuan J, Guirado R, Cáceres I, Garnier P, Contreras F, Bobes J, Al-Halabí S, Usall J, Butjosa A, Sarró S, Landin-Romero R, Ibáñez A, Selva G. Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis. Psychol Med 2020; 50:2702-2710. [PMID: 31637990 DOI: 10.1017/s0033291719002794] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. METHODS The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. RESULTS At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively). CONCLUSIONS Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
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Affiliation(s)
- I González-Ortega
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
- The National Distance Education University (UNED), Vitoria, Spain
| | - A González-Pinto
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - S Alberich
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
- The National Distance Education University (UNED), Vitoria, Spain
| | - E Echeburúa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Personality, Assessment and Psychological Treatment, University of the Basque Country, San Sebastián, Spain
| | - M Bernardo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - B Cabrera
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - S Amoretti
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Lobo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
| | - C Arango
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - I Corripio
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Vieta
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - E de la Serna
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - R Rodriguez-Jimenez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - R Segarra
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - J M López-Ilundain
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - A M Sánchez-Torres
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - M J Cuesta
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - I Zorrilla
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - P López
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - M Bioque
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - G Mezquida
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - F Barcones
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
- Department of Family Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C De-la-Cámara
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
| | - M Parellada
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - A Espliego
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - A Alonso-Solís
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E M Grasa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - C Varo
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - L Montejo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - J Castro-Fornieles
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - I Baeza
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - M Dompablo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - I Torio
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - A Zabala
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - J I Eguiluz
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - L Moreno-Izco
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - J Sanjuan
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- INCLIVA, University of Valencia, Hospital Clinico Universitario of Valencia, Spain
| | - R Guirado
- Neurobiology Unit, Department of Cell Biology, Interdisciplinary Research Structure for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, Valencia, Spain
| | - I Cáceres
- Department of Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - P Garnier
- Department of Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - F Contreras
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Bobes
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, University of Oviedo, Oviedo, Spain
| | - S Al-Halabí
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, University of Oviedo, Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain
| | - J Usall
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), Sant Boi de Llobregat, Barcelona, Spain
| | - A Butjosa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), Sant Boi de Llobregat, Barcelona, Spain
| | - S Sarró
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - R Landin-Romero
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - A Ibáñez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRyCIS), University of Alcalá, Madrid, Spain
| | - G Selva
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, INCLIVA Health Research Institute, Valencia, Spain
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Sen MS, Nehra R, Grover S. Social cognition in patients with first episode of psychosis in remission. Indian J Psychiatry 2020; 62:544-554. [PMID: 33678836 PMCID: PMC7909030 DOI: 10.4103/psychiatry.indianjpsychiatry_342_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 11/21/2022] Open
Abstract
AIM The present study aimed to compare the social cognition (SC) deficits in patients with first-episode psychosis (FEP) and healthy controls and evaluate the association of SC deficits with socio-occupational functioning, insight, quality of life, and stigma. METHODS This study included 30 patients with FEP in remission phase and 26 healthy controls matched for age, gender, education, and intelligent quotient. SC was assessed on the domains of theory of mind (ToM), social perception, and attributional bias. RESULTS Compared to healthy controls, patients with FEP had significantly higher deficits in the domains of second-order ToM (unpaired t = 4.447, P < 0.001) and Faux Pas Composite Index (unpaired t = 2.824, P = 0.007). In the correlation analysis, higher age of patients with FEP was significantly associated with more externalizing bias (Pearson's correlation coefficient = 0.38, P = 0.039) and those with lower level of education had more social cognitive deficits in the domains of Faux Pas Composite Index (Pearson's correlation coefficient = 0.43, P = 0.018), Social Perception Index (Pearson's correlation coefficient = 0.38, P = 0.04), and Nonsocial Perception Index (Pearson's correlation coefficient = 0.5, P = 0.005). Duration of untreated psychosis was associated with higher deficits in the first-order ToM (Pearson's correlation coefficient = -0.38, P = 0.04) and Externalizing Bias Index (Pearson's correlation coefficient = -0.49, P = 0.006). Longer duration of treatment was associated with higher impairment in first-order ToM index (Pearson's correlation coefficient = -0.42, P = 0.02). General psychopathology and total Positive and Negative Syndrome Scale total score correlated significantly with externalizing bias, with a higher level of psychopathology associated with more severe deficits in this domain. There was no correlation of SC with the quality of life, cognitive insight, and stigma (except for occasional correlation of stereotype endorsement and externalizing bias). CONCLUSION The present study suggests that compared to healthy controls, patients with FEP have impairment in the domains of second-order ToM and Faux Pas Composite Index. However, social cognitive deficits have only a few correlations with various psychosocial outcomes of FEP.
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Affiliation(s)
- Mahadev Singh Sen
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Giralt-López M, Miret S, Soler J, Campanera S, Parellada M, Fañanás L, Fatjó-Vilas M. The role of schizotypal traits and the OXTR gene in theory of mind in schizophrenia: A family-based study. Eur Psychiatry 2020; 63:e15. [PMID: 32093796 PMCID: PMC7315883 DOI: 10.1192/j.eurpsy.2019.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is consistent evidence that theory of mind (ToM) is impaired in schizophrenia (SZ); however, it remains unclear whether such deficits are trait- or state-dependent. We evaluated ToM in patients with schizophrenia spectrum disorders (SSDs), their healthy first-degree relatives, and controls to test its suitability as an endophenotypic marker. We also studied the modifying effect of markers of clinical and genetic liability to SZ (schizotypy and genetic variability in the oxytocin receptor gene: OXTR) on ToM in healthy individuals. METHODS The sample included 38 stable SSD patients, 80 unaffected first-degree relatives, and 81 controls. ToM was assessed using the Hinting Task (HT) and schizotypy via the Schizotypal Personality Questionnaire-Brief (SPQ-B), which generates interpersonal (SPQ-IP), cognitive-perceptual (SPQ-CP), and disorganization (SPQ-D) scores. The polymorphism rs53576 of OXTR was genotyped. RESULTS Patients presented poorer HT performance than relatives and controls (p = 0.003 and p < 0.001). High SPQ-IP and SPQ-CP scores correlated with poorer ToM performance in relatives (p = 0.010 and p = 0.030), but not in controls. OXTR was not associated with HT scores, but it showed a modifying effect within controls; high SPQ-CP was related to HT poorer performance conditional to GG genotype (p = 0.007). CONCLUSIONS ToM deficits were present in patients but not in unaffected relatives or controls. However, our data indicate the usefulness of clinical and genetic liability markers to characterize differences in ToM abilities within healthy individuals. Then, the observed link between ToM and SZ liability suggests the putative role of ToM as an endophenotypic marker. Nevertheless, new analyses in larger samples are needed.
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Affiliation(s)
- M Giralt-López
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - S Miret
- Centre de Salut Mental d'Adults de Lleida, Servei de Psiquiatria, Salut Mental i Addiccions, Hospital Universitari Santa Maria, Lleida, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - J Soler
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
| | - S Campanera
- Centre de Salut Mental d'Adults de Lleida, Servei de Psiquiatria, Salut Mental i Addiccions, Hospital Universitari Santa Maria, Lleida, Spain
| | - M Parellada
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - L Fañanás
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
| | - M Fatjó-Vilas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
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How predictive are sex and empathizing-systemizing cognitive style for entry into the academic areas of social or physical sciences? Cogn Process 2017; 19:95-106. [PMID: 29185169 DOI: 10.1007/s10339-017-0848-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 11/23/2017] [Indexed: 12/19/2022]
Abstract
Based on the Empathizing-Systemizing (E-S) theory, it was hypothesized that the underrepresentation of female students in the physical sciences and the underrepresentation of males in the social sciences relates to differences in E-S cognitive style between the sexes. This hypothesis was tested in 115 physical science students and 155 social science students from a university in the Netherlands. The students completed visuospatial tests and the systemizing quotient-revised (SQ-R) as measures for systemizing, and a Cartoon Prediction test and the empathy quotient (EQ) as measures for empathizing. Independent of sex, the physical science students scored significantly lower than social science students on EQ (with large effect size) and 'brain type' that represents the standardized difference score between EQ and SQ-R (with large effect size). Physical science students, furthermore, scored significantly higher on the Cartoon Prediction task and one of the visuospatial tasks; however, these effects were only small of size. Unlike the scores on the SQ-R and the performance tests, the 'brain type' score of the EQ and SQ-R questionnaires was a good predictor of entry into social or physical sciences. Interestingly, the typical sex differences in more empathizing and less systemizing in females compared to males were only small for EQ and 'brain type', and absent for the SQ-R and the performance tests. This study only partially confirms the E-S theory, because typical sex differences were only minor in this selective sample and only the self-report measures predicted academic area in the absence of a role for sex.
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Healey KM, Bartholomeusz CF, Penn DL. Deficits in social cognition in first episode psychosis: A review of the literature. Clin Psychol Rev 2016; 50:108-137. [PMID: 27771557 DOI: 10.1016/j.cpr.2016.10.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/23/2016] [Accepted: 10/08/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Kristin M Healey
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Cali F Bartholomeusz
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Penn
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
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Montreuil TC, Malla AK, Joober R, Bélanger C, Myhr G, Lepage M. Manualized Group Cognitive-Behavioral Therapy for Social Anxiety in At-Risk Mental State and First Episode Psychosis: A Pilot Study of Feasibility and Outcomes. Int J Group Psychother 2016; 66:225-245. [PMID: 38449179 DOI: 10.1080/00207284.2015.1106190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Social anxiety has received scant attention in studies of schizophrenia and related psychoses. However, some data suggest it may be an obstacle to vocational and functional outcome. This pilot study investigated the feasibility of a group-based cognitive behavioral therapy (CBGT) to reduce social anxiety in those at risk for developing psychosis or in the early phase. Twenty-nine patients with first-episode psychosis (FEP) or at ultra high risk for developing psychosis or often referred to as at-risk mental state (ARMS) with comorbid social anxiety attended a CBGT intervention weekly for 14 weeks in 90-minute sessions. Baseline, post-treatment, and follow-up ratings of social anxiety were measured using the Social Interaction Anxiety Scale, the Social Phobia Inventory, and the Brief Social Phobia Scale. Psychotic symptoms and general psychopathology were also measured before and after the intervention. Results suggest that the proposed CBGT is feasible and beneficial for socially anxious patients at risk, or with experience of, psychosis. Participants significantly improved on three outcome measures of social anxiety after completing this intervention (all p's < .002). Participants who completed treatment also showed a significant reduction on measures of depression and negative symptoms. Future research should examine the relative efficacy of this brief manualized CBGT intervention for the treatment of social anxiety and psychotic symptoms in a larger randomized controlled trial.
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8
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El-Missiry A, Elbatrawy A, El Missiry M, Moneim DA, Ali R, Essawy H. Comparing cognitive functions in medication adherent and non-adherent patients with schizophrenia. J Psychiatr Res 2015; 70:106-12. [PMID: 26424429 DOI: 10.1016/j.jpsychires.2015.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/19/2015] [Accepted: 09/11/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Medication non-adherence presents a considerable problem in patients with schizophrenia. Cognitive and executive functions can affect adherence. The association between medication non-adherence and cognitive impairment in schizophrenia is under investigated with limited and conflicting research data. PURPOSE OF THE STUDY To prospectively assess the rate of drug adherence among a sample of patients with schizophrenia and to compare the cognitive and executive functions between adherent and non-adherent patients. SUBJECTS AND METHODS 109 patients with schizophrenia diagnosed according to the DSM-IV classification were initially assessed by the Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale-Revised (WMS-R) and Wisconsin Card Sorting Test (WCST) and six months later by the Brief Adherence Rating Scale (BARS). RESULTS 68.8% were non-adherent to their antipsychotic medication. Adherent patients (31.2%) had significantly higher mean scores for the total, verbal and performance IQ. They had significantly higher mean scores in most of WMS subtests (orientation, information, verbal paired association, digit span, visual memory span), and higher mean scores for; total correct, conceptual level response, percentage and categories completed on the WSCT subscales (P < 0.0001). Whereas the non-adherent group had higher mean scores in; trials administered, total errors, perseverative responses, and perseverative errors (P < 0.0001). In a step regression analysis, digit span, conceptualization, total and percentage of errors were putative predictors of non-adherence. CONCLUSION Cognitive deficits, especially verbal memory and executive functions were the strongest patients' related factors associated with non adherence to medication. Psychiatrists ought to consider possible cognitive factors influencing adherence to enable offering proper interventions.
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Affiliation(s)
- Ahmed El-Missiry
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt.
| | - Amira Elbatrawy
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Marwa El Missiry
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Dalia Abdel Moneim
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Ramy Ali
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Heba Essawy
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
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Benoit A, Bodnar M, Malla AK, Joober R, Bherer L, Lepage M. Changes in memory performance over a 12-month period in relation to achieving symptomatic remission after a first-episode psychosis. Schizophr Res 2014; 153:103-8. [PMID: 24512651 DOI: 10.1016/j.schres.2014.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 11/26/2022]
Abstract
With the introduction of a clear definition of symptomatic remission from the Remission in Schizophrenia Working Group (RSWG), studies have sought to characterize cognitive functioning in remitted and non-remitted schizophrenia patients. However, most investigations of cognition and remission are cross-sectional or have studied samples of chronically ill patients. Therefore, the aim of this study was to compare cognitive performance between remitted and non-remitted first-episode psychosis (FEP) patients longitudinally. Seventy patients were categorized as remitted (n=17) or non-remitted (n=53) using the full RSWG criteria after being treated for approximately 15months, during which cognition was evaluated twice. Since our previous investigations in FEP have isolated verbal memory as a potential cognitive marker of symptomatic remission, analyses were limited to verbal, visual and working memory. We have found that non-remitted patients had a significantly worse verbal memory performance than remitted patients after 3months (F(1,68)=6.47, p=0.006) and 15months of treatment (F(1,68)=19.49, p<0.001). Visual memory was also significantly lower in non-remitted patients compared to those in remission but only at initial assessment (F(1,68)=8.21, p=0.003) while working memory performance was similar at both time points. Our findings suggest that verbal memory may be a specific and stable marker of clinical remission in FEP patients. This cognitive domain can easily be evaluated at treatment intake in the hope of identifying early on patients who are less likely to remit.
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Affiliation(s)
- Audrey Benoit
- Prevention Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montréal, Québec H4H 1R3, Canada; Université du Québec À Montréal, Psychology Department, 320 Sainte-Catherine Street East, Montréal, Québec H3C 3P8, Canada.
| | - Michael Bodnar
- Prevention Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montréal, Québec H4H 1R3, Canada; McGill University, Department of Psychology, 1205 Dr. Penfield Avenue, Montréal, Québec H3A 1B1, Canada.
| | - Ashok K Malla
- Prevention Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montréal, Québec H4H 1R3, Canada; McGill University, Department of Psychiatry, 1033 Pine Avenue West, Montréal, Québec H3A 1A1, Canada.
| | - Ridha Joober
- Prevention Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montréal, Québec H4H 1R3, Canada; McGill University, Department of Psychiatry, 1033 Pine Avenue West, Montréal, Québec H3A 1A1, Canada.
| | - Louis Bherer
- Concordia University, PERFORM Center, 7141 Sherbrooke Street West, Montréal, Québec H4B 1R6, Canada.
| | - Martin Lepage
- Prevention Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montréal, Québec H4H 1R3, Canada; Université du Québec À Montréal, Psychology Department, 320 Sainte-Catherine Street East, Montréal, Québec H3C 3P8, Canada; McGill University, Department of Psychology, 1205 Dr. Penfield Avenue, Montréal, Québec H3A 1B1, Canada; McGill University, Department of Psychiatry, 1033 Pine Avenue West, Montréal, Québec H3A 1A1, Canada.
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10
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Lepage M, Bodnar M, Bowie CR. Neurocognition: clinical and functional outcomes in schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:5-12. [PMID: 24444318 PMCID: PMC4079224 DOI: 10.1177/070674371405900103] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schizophrenia is characterized by significant heterogeneity in outcome. The last decades have witnessed a significant interest in identifying factors that can moderate or influence clinical and functional outcomes in people with schizophrenia. One factor of particular interest is neurocognition, as performance on various measures of cognitive abilities, such as memory, attention, and executive functions, have been consistently related to functional outcome and, to a lesser extent, clinical outcome. This review aims to provide an up-to-date description of recent studies examining the association between neurocognition and clinical and (or) functional outcomes. In the first section, studies examining neurocognitive performance in relation to clinical outcome are examined. When clinical outcome is defined dichotomously (for example, comparing remitted and nonremitted), verbal memory performance consistently exhibits a strong association with clinical status, with the poor outcome group showing the largest deficits. In the second section, studies exploring the relation between neurocognition and various dimensions of functional outcome are reviewed. These dimensions include independent living, social functioning, and vocational functioning, among others. Again, a strong link between neurocognitive deficits and impairments in several aspects of functioning clearly emerges from this review. Finally, several measurement issues are discussed that pertain to the need to standardize definitions of clinical and (or) functional outcomes, the importance of defining cognitive domains consistently across studies, and distinguishing between one's competence to perform tasks and what one actually does in everyday life. Addressing these measurement issues will be key to studies examining the development of effective interventions targeting neurocognitive functions and their impact on clinical and functional outcomes.
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Affiliation(s)
- Martin Lepage
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec
| | - Michael Bodnar
- Research Associate, Douglas Mental Health University Institute, Montreal, Quebec
| | - Christopher R Bowie
- Associate Professor, Department of Psychology, Queen's University, Kingston, Ontario
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11
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Korver-Nieberg N, Fett AKJ, Meijer CJ, Koeter MWJ, Shergill SS, de Haan L, Krabbendam L. Theory of mind, insecure attachment and paranoia in adolescents with early psychosis and healthy controls. Aust N Z J Psychiatry 2013; 47:737-45. [PMID: 23553238 DOI: 10.1177/0004867413484370] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Impaired Theory of Mind (ToM) is found in adults with schizophrenia and is associated with paranoid symptoms. Insecure attachment is proposed to underlie impaired ToM as well as paranoia. Insight into associations between insecure attachment and impaired ToM skills may help clinicians and patients to understand interpersonal difficulties and use this knowledge to improve recovery. This study used a visual perspective-taking task to investigate whether cognitive ToM is already impaired in adolescents with early psychosis as compared to controls. Also investigated was whether perspective-taking and paranoia are associated with insecure (adult) attachment. METHODS Thirty-two adolescent patients with early psychosis and 78 healthy controls participated in this cross-sectional study design and completed the level 1 perspective-taking task, psychopathology assessments (CAPE, PANSS), paranoid thoughts (GPTS), attachment style (PAM) and the WASI vocabulary. RESULTS Patients did not significantly differ in level-1 perspective-taking behaviour compared to healthy controls. No significant associations were found between perspective-taking, paranoia and attachment. Insecure attachment was significantly related to paranoid thoughts, after controlling for illness-related symptoms. CONCLUSION No impairment of level-1 perspective-taking was found in adolescent patients with early psychosis compared to healthy controls. Results indicate that level-1 perspective-taking is not impaired during the early stages of psychotic illness. The association between paranoia and attachment support previous findings and provide further insight into the nature of psychotic symptoms. Understanding the role of attachment in paranoia may help patients and their care workers to gain insight into the reasons for the development or persistence of symptoms. Future research should compare early psychosis samples with more chronic samples to explore whether perspective-taking deteriorates during the course of the illness.
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Affiliation(s)
- Nikie Korver-Nieberg
- AMC, Academic Psychiatric Centre, Department Early Psychosis, Amsterdam, The Netherlands.
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12
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Prevention and recovery in early psychosis (PREP(®)): building a public-academic partnership program in Massachusetts, United States. Asian J Psychiatr 2013; 6:171-7. [PMID: 23466116 DOI: 10.1016/j.ajp.2012.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 12/22/2022]
Abstract
Recently, there has been increasing emphasis on early intervention (EI) for psychotic disorders. EI programs in public mental health settings have been established in countries such as Australia, the United Kingdom, and Canada. However, there are relatively few EI programs in the United States (U.S.). Here we describe the conceptual origins and practical development of the PREP program, i.e., Prevention and Recovery in Early Psychosis, as it evolved in a public academic psychiatry setting in Boston, Massachusetts, U.S. PREP developed over a decade through a partnership between the Massachusetts Department of Mental Health and academic institutions within the Harvard Department of Psychiatry. We discuss the evolution, programmatic features, funding mechanisms, staffing, and the role of clinical training in PREP. The key principles in developing the PREP Program include the focus on early, evidence based, person-centered and phase-specific, integrated and continuous, comprehensive care. This program has served as a foundation for the emergence of related services at our institution, including a research clinic treating those at clinical high risk or within the putative "prodromal" period preceding frank psychosis. This account offers one possible blueprint for the development of EI programs despite the lack in the U.S. of a national mandate for EI or prevention-based mental health programs.
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13
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Montreuil TC, Malla AK, Joober R, Bélanger C, Lepage M. Anxiety symptoms severity and short-term clinical outcome in first-episode psychosis. Early Interv Psychiatry 2013; 7:5-11. [PMID: 23356890 DOI: 10.1111/eip.12018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 07/31/2012] [Indexed: 11/28/2022]
Abstract
AIM In psychotic disorders, a limited number of studies have documented the presence of symptoms of anxiety, especially in first-episode psychosis (FEP). There is a growing interest in better understanding how these symptoms may affect the severity of psychotic symptoms and clinical outcome. This study examined the association between symptoms of anxiety, as measured by the Hamilton Anxiety Rating Scale (HARS) and the Positive and Negative Syndrome Scale (PANSS), and short-term clinical outcome. We first examined the potential association between anxiety symptom severity among FEP patients and remission. A secondary objective explored the relation between the PANSS single item subscale 'anxiety' item and the total score value of the HARS. METHOD Data were collected on 201 FEP patients divided into remitted and unremitted groups based on clinical data at 6 months. Anxiety ratings were compared between 67 remitted and 99 unremitted patients with the HARS, and for 72 remitted and 103 unremitted patients with the (G2) PANSS. RESULTS A significant interaction Time × Group was observed on the HARS and on the PANSS G2 item. Looking at the two time points specifically, groups did not significantly differ at baseline on either the HARS or the PANSS. At 6 months, these two groups were significantly different on both anxiety rating scores - HARS [t(170) = 3.48, P = 0.001)] and PANSS G2 [t(173) = 2.51, P = 0.013)]. CONCLUSION Anxiety severity is marked in FEP, and appears to be linked to poor short-term clinical outcome. The PANSS single item (G2) seems to represent a good indicator of anxiety as it significantly correlates with a more systematic measure of anxiety, namely the HARS score. Anxiety severity appears to vary across diagnosis type.
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Affiliation(s)
- Tina C Montreuil
- Prevention and Early Intervention Program for Psychoses (PEPP - Montreal), Montreal, Canada
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14
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Bartholomeusz CF, Allott K. Neurocognitive and social cognitive approaches for improving functional outcome in early psychosis: theoretical considerations and current state of evidence. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:815315. [PMID: 22966447 PMCID: PMC3420601 DOI: 10.1155/2012/815315] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 01/25/2012] [Indexed: 01/12/2023]
Abstract
Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed.
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Affiliation(s)
- Cali F. Bartholomeusz
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, National Neuroscience Facility, The University of Melbourne, Level 2-3 Alan Gilbert Building, 161 Barry Street, Carlton South, VIC 3053, Australia
| | - Kelly Allott
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, VIC 3052, Australia
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