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DeBats CC, Abel DB, Sullivan MM, Koesterer SC, Linton IS, Mickens JL, Russell MT, Hammer LA, Minor KS. Social Activity in Schizotypy: Measuring Frequency and Enjoyment of Social Events. Behav Sci (Basel) 2024; 14:474. [PMID: 38920806 PMCID: PMC11201023 DOI: 10.3390/bs14060474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Improving social functioning deficits-a core characteristic of schizophrenia-spectrum disorders-is often listed by patients as a key recovery goal. Evidence suggests that social deficits also extend to people with schizotypy, a group at heightened risk for psychotic and other psychopathological disorders. One challenge of social functioning research in schizotypy is understanding whether social deficits arise from receiving less pleasure from social activities or from participating less in high-pleasure activities. However, limited information exists on what constitutes highly pleasurable, common social activities. In this study, 357 college students rated the frequency and enjoyment of 38 social activities. Our aims were to categorize activities based on their frequency and enjoyment, and whether these correlated with validated social functioning and schizotypy measures. We found that social activities could be characterized based on their frequency and enjoyment and created a frequency-enjoyment matrix that could be useful for future studies. Activities were correlated with social functioning, generally reaching a small effect size level, with increasing frequency and enjoyment showing associations with greater social functioning. Further, negative and disorganized-but not positive-traits were associated with less engagement and pleasure. Although follow-up studies in community samples are needed, our findings have the potential to help researchers and clinicians better understand which activities participants are more likely to engage in and derive pleasure from. The findings may also illustrate the extent to which social deficits may be due to less engagement or less pleasure from social activities, as well as which aspects of schizophrenia-spectrum disorders are associated with these facets of social functioning.
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Affiliation(s)
- Candice C. DeBats
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Danielle B. Abel
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
- West Haven VA Medical Center, West Haven, CT 06516, USA
| | - Morgan M. Sullivan
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
- Department of Psychology, University of Indianapolis, Indianapolis, IN 46227, USA
| | - Sophia C. Koesterer
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA
| | - Imani S. Linton
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Jessica L. Mickens
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Madisen T. Russell
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Lillian A. Hammer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA;
| | - Kyle S. Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
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Muyambi K, Walsh S, Dettwiller P, Tan KL, Dennis S, Bressington D, Gray RJ, McCall A, Jones M. Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol. BMJ Open 2024; 14:e080245. [PMID: 38719282 PMCID: PMC11086511 DOI: 10.1136/bmjopen-2023-080245] [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: 09/25/2023] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Negative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive-behavioural therapy results in a modest reduction in negative symptoms. Behavioural activation may be an effective alternative treatment for negative symptoms.The study aims to examine the feasibility and acceptability of implementing a behavioural activation trial delivered in three community mental health services in South Australia to support adult consumers experiencing negative symptoms of schizophrenia. METHOD AND ANALYSIS This randomised controlled study will recruit a total of 60 consumers aged 18 years or above with mild-moderate negative symptoms of schizophrenia. The consumers will be randomly allocated to receive behavioural activation plus usual mental healthcare or usual mental healthcare alone. The intervention group will receive twelve 30 min sessions of behavioural activation, which will be delivered twice weekly over 6 weeks. In addition, we aim to recruit nine mental health workers from the three rural mental health services who will complete a 10-week online training programme in behavioural activation. Changes in negative symptoms of schizophrenia and depressive symptoms will be assessed at three time points: (a) at baseline, at 6 weeks and 3 month follow-ups. Changes in health-related quality of life (Short Form F36; secondary outcome) will be assessed at two time points: (a) at baseline and (b) immediately at postintervention after 6 weeks. At the end of the trial, interviews will be conducted with purposively selected mental health workers and consumers. Descriptive statistics and thematic analysis will be used to assess feasibility and acceptability. ETHICS AND DISSEMINATION The findings from our feasibility study will inform the design of a fully powered randomised controlled trial to test the effectiveness of behavioural activation as a treatment for negative symptoms in schizophrenia. The study protocol was approved by the Central Adelaide Local Health Network Human Research Ethics Committee. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences. TRIAL REGISTRATION NUMBER ACTRN12623000348651p.
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Affiliation(s)
- Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Pascale Dettwiller
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Kuan Liung Tan
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Shaun Dennis
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- Rural and Remote Mental Health Service, Barossa Hills Fleurieu Local Health Network, Whyalla, South Australia, Australia
| | - Daniel Bressington
- Charles Darwin University College of Nursing & Midwifery, Casuarina, Odisha, Australia
| | - Richard John Gray
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
| | - Audrey McCall
- Flinders and Upper North Local Health Network, Whyalla, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
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Schormann ALA, Pillny M, Haß K, Lincoln TM. "Goals in Focus"-a targeted CBT approach for motivational negative symptoms of psychosis: study protocol for a randomized-controlled feasibility trial. Pilot Feasibility Stud 2023; 9:72. [PMID: 37131247 PMCID: PMC10152726 DOI: 10.1186/s40814-023-01284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 03/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The reduction of goal-directed behavior is the main characteristic in motivational negative symptoms of psychosis as it accounts for the long-term decline in psychological well-being and psychosocial functioning. However, the available treatment options are largely unspecific and show only small effects on motivational negative symptoms. Interventions that directly target the relevant psychological mechanisms are likely to be more effective. For "Goals in Focus", we translated findings from basic clinical research on mechanisms underlying motivational negative symptoms into a tailored and comprehensive novel psychological outpatient treatment program. With this study, we will test the feasibility of the therapy manual and the trial procedures. We also aim to examine first estimates of the effect size that can be expected from "Goals in Focus" to inform the sample size calculation of a subsequent fully powered trial. METHODS Thirty participants diagnosed with a schizophrenia spectrum disorder and at least moderate motivational negative symptoms will be randomly assigned to either 24 sessions of "Goals in Focus" over the course of 6 months (n = 15) or to a 6-month wait-list control group (n = 15). Single-blind assessments will be conducted at baseline (t0) and 6 months after baseline completion (t1). Feasibility outcomes include patient recruitment, retention, and attendance rates. Acceptability will be rated by trial therapists and by participants at end of treatment. Primary outcome for effect size estimation is the motivational negative symptom subscale sum score of the Brief Negative Symptom Scale at t1 corrected for baseline values. Secondary outcomes include psychosocial functioning, psychological well-being, depressive symptoms, expressive negative symptoms, negative symptom factor scores, and goal pursuit in everyday life. DISCUSSION The feasibility and acceptability data will be used to improve trial procedures and the "Goals in Focus" intervention where necessary. The treatment effect on the primary outcome will provide the basis for the sample size calculation for a fully powered RCT. TRIAL REGISTRATION 1) ClinicalTrials.gov, NCT05252039 . Registered on 23 February 2022. 2) Deutsches Register Klinischer Studien, DRKS00018083 . Registered on 28 August 2019.
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Affiliation(s)
- Alisa L A Schormann
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Katharina Haß
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
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Bartolomeo LA, Raugh IM, Strauss GP. The positivity offset theory of anhedonia in schizophrenia: evidence for a deficit in daily life using digital phenotyping. Psychol Med 2023; 53:1-9. [PMID: 36722014 PMCID: PMC10600929 DOI: 10.1017/s0033291722003774] [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: 08/19/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Negative symptoms of schizophrenia have recently been proposed to result from a decoupling of (intact) hedonic experience and (diminished) approach behavior. The current study challenged this view by exploring the hypothesis that negative symptoms are driven by a specific type of emotional experience abnormality, a reduction in the positivity offset (i.e. the tendency to experience greater levels of positive relative to negative emotion in low-arousal contexts), which limits the production of approach behaviors in neutral environments. METHODS Participants included outpatients with SZ (n = 44) and healthy controls (CN: n = 48) who completed one week of active (ecological momentary assessment surveys of emotional experience and symptoms) and passive (geolocation, accelerometry) digital phenotyping. Mathematical modeling approaches from Cacioppo's Evaluative Space Model were used to quantify the positivity offset in daily life. Negative symptoms were assessed via standard clinical ratings, as well as active (EMA surveys) and passive (geolocation, accelerometry) digital phenotyping measures. RESULTS Results indicated that the positivity offset was reduced in SZ and associated with more severe anhedonia and avolition measured via clinical interviews and active and passive digital phenotyping. CONCLUSIONS These findings suggest that current conceptual models of negative symptoms, which assume hedonic normality, may need to be revised to account for reductions in the positivity offset and its connection to diminished motivated behavior. Findings identify key real-world contexts where negative symptoms could be targeted using psychosocial treatments.
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Affiliation(s)
| | - Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
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Oh J, Lee E, Cha EJ, Seo HJ, Choi KH. Community-based multi-site randomized controlled trial of behavioral activation for patients with negative symptoms of schizophrenia. Schizophr Res 2023; 252:118-126. [PMID: 36640745 DOI: 10.1016/j.schres.2022.12.051] [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: 03/18/2022] [Revised: 07/13/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Negative symptoms are closely related to the poor prognosis of schizophrenia, for which there is no effective treatment to date. Behavioral activation (BA), which is an effective treatment for depression, is a behavioral approach that targets low levels of response-contingent positive reinforcement. This study aimed to explore BA as an effective intervention for relieving the negative symptoms of schizophrenia. METHODS This was a randomized single-blind controlled trial. Eighty-four patients with schizophrenia were enrolled in community mental health settings. Excluding 14 patients who opted out of the study, 70 were randomly assigned to receive BA in addition to treatment-as-usual (BA + TAU) or treatment-as-usual (TAU) only. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS) and Brief Negative Symptom Scale (BNSS) at baseline, post-treatment, and 6-months follow-up. RESULTS Significant differences between the BA + TAU and TAU only groups were observed in the measures of negative symptoms post-treatment. The total score of CAINS was significantly decreased after BA treatment (η2 = 0.13). The tendency of the BA + TAU treatment effect was also observed for the BNSS total score and PANSS negative symptom subscale (η2 = 0.10 and η2 = 0.11, respectively). However, the difference between the two groups was not sustained at the six-month follow-up. CONCLUSIONS Our findings suggest that BA could be a promising time-limited and structured psychosocial intervention for schizophrenia-associated negative symptoms with the merit of easy dissemination. Further studies are needed to examine the factors involved in sustaining improvement.
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Affiliation(s)
- Jihye Oh
- Department of Psychiatry, Catholic University of Korea, College of Medicine, Republic of Korea
| | - Eunbyeol Lee
- Department of Psychology, Korea University, Republic of Korea
| | - Eun Ji Cha
- Department of Psychology, Korea University, Republic of Korea
| | - Ho-Jun Seo
- Department of Psychiatry, St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Republic of Korea.
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Republic of Korea.
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Brown E, Gao CX, Staveley H, Williams G, Farrelly S, Rickwood D, Telford N, Papanastasiou C, McGorry P, Thompson A. The clinical and functional outcomes of a large naturalistic cohort of young people accessing national early psychosis services. Aust N Z J Psychiatry 2022; 56:1265-1276. [PMID: 34845922 DOI: 10.1177/00048674211061285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported. METHODS We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as headspace between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time. RESULTS Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment. CONCLUSION These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.
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Affiliation(s)
- Ellie Brown
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Heather Staveley
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Georgia Williams
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Simone Farrelly
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Debra Rickwood
- Headspace National, Melbourne, VIC, Australia.,University of Canberra, Canberra, ACT, Australia
| | - Nic Telford
- Headspace National, Melbourne, VIC, Australia
| | | | - Pat McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Andrew Thompson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
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Feasibility and Benefit of Cognitive Behavioural Therapy for Psychosis via Teleconsultation in Indonesia: A Case Study of a 40-Year-Old Schizoaffective Disorder Patient. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Whilst Cognitive Behavioural Therapy for Psychosis (CBTp) has been found to reduce psychotic symptoms, most evidence supporting its implementation originates from studies in Western and high-income countries. Furthermore, questions remain regarding the efficacy of CBTp conducted via teleconsultation. Herein we report an ongoing case in Indonesia involving an individual with schizoaffective disorder, who received 60 sessions of CBTp over seven months. Sessions were delivered via a combination of voice and video calls. The patient, a 40-year-old male, was diagnosed with schizoaffective disorder at the age of 26. He exhibited symptoms of paranoid and religious delusions, hallucinations (auditory, visual, and somatic) and disorganised speech during our intake interview. Negative symptoms were not apparent. In the 14 years prior to our initial consultation, the patient was prescribed antipsychotics and demonstrated good adherence. He had no history of psychotherapy independent of our clinic. Treatment involved CBTp techniques, including psychoeducation, a symptom diary, relaxation, and behavioural experiments. Study outcome was assessed with Psychotic Symptom Rating Scales. Both hallucination and delusion subscale scores improved 53% from 53 at intake to 25 during an assessment administered 6 months later. Results from this study demonstrate that the CBTp is both feasible, and beneficial, when conducted via teleconsultation in Indonesia.
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Herniman SE, Wood SJ, Cotton SM, Allott KA, Davey C, Berk M, Phillips LJ. The specific phenotype of depression in recent onset schizophrenia spectrum disorders: A symptom profile and network comparison to recent onset major depressive disorder without psychotic features. Schizophr Res 2022; 240:52-60. [PMID: 34942537 DOI: 10.1016/j.schres.2021.11.048] [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: 10/23/2020] [Revised: 10/25/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
The specific phenotype of depression in recent-onset schizophrenia spectrum disorders (SSD) and its relation to non-psychotic depression is unknown. Symptom profile and network analysis are complementary statistical techniques that may provide important insights into the presentation and relative importance of individual symptoms that give rise to depression. The aim of the current study was to characterise the profile and network of depressive symptoms in SSD and compare it to individuals with major depressive disorder (MDD) without psychotic features. This study involved analysis of baseline data pertaining to 109 individuals with comorbid SSD and depression and 283 with MDD without psychotic features. Study cohorts were the Psychosis Recent Onset GRoningen Survey (PROGR-S) and Youth Depression Alleviation (YoDA) trials, respectively. Profile and network analyses revealed that SSD and MDD differed in the profile and relative importance of individual depressive symptoms. While reported sadness was the primary hallmark of depression in both SSD and MDD, individuals with depression in SSD were more likely to sleep more, and have lower lassitude and pessimism. While sadness had great importance in MDD and SSD, in SSD but not MDD lassitude, sleep, appetite, concentration difficulties, and inability to feel were important in the network of depressive symptoms. The specific phenotype of depression might be different in SSD compared to MDD. Symptom inequivalence or underlying functional mechanisms in SSD might result in depression in SSD that is similar to MDD with atypical features.
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Affiliation(s)
- Sarah E Herniman
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Stephen J Wood
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | - Susan M Cotton
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Kelly A Allott
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christopher Davey
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Michael Berk
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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The impact of the COVID-19 pandemic on negative symptoms in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:17-27. [PMID: 33881621 PMCID: PMC8057945 DOI: 10.1007/s00406-021-01260-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
Negative symptoms are core features of schizophrenia-spectrum disorders that are frequently observed across all phases of illness. By their nature, COVID-19 social isolation, physical distancing, and health precautions induce behavioural aspects of negative symptoms. However, it is unclear whether these prevention measures also lead to increases in experiential negative symptoms, whether such effects are equivalent across individual negative symptom domains, and if exacerbations occur equivalently across phases of illness. The current study compared negative symptom severity scores obtained during the pandemic to pre-pandemic assessments in two samples: (1) outpatients with chronic schizophrenia (SZ: n = 32) and matched healthy controls (CN: n = 31) and (2) individuals at clinical high risk for psychosis (CHR: n = 25) and matched CN (n = 30). Pre-pandemic ratings of negative symptoms were clinically elevated in SZ and CHR groups, which did not differ from each other in severity. In SZ, ratings obtained during the pandemic were significantly higher than pre-pandemic ratings for all 5 domains (alogia, blunted affect, anhedonia, avolition, and asociality) and item-level analyses indicated that exacerbations occurred on both experiential and behavioral symptoms of anhedonia, avolition, and asociality. In contrast, CHR only exhibited increases in anhedonia and avolition items during the pandemic compared to pre-ratings. Findings suggest that negative symptoms should be a critical treatment target during and after the pandemic in the schizophrenia spectrum given that they are worsening and critically related to risk for conversion, functional outcome, and recovery.
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Tikka SK, Garg S, Siddiqui MA. Prescribing Physical Activity in Mental Health: A Focused Review on the Latest Evidence, Recommendations, Challenges, and Relevance to India. Indian J Psychol Med 2021; 43:535-541. [PMID: 35210683 PMCID: PMC8826198 DOI: 10.1177/0253717620972330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sai Krishna Tikka
- Dept. of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Shobit Garg
- Dept. of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - M Aleem Siddiqui
- Dept. of Psychiatry, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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11
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Interrelationships between depressive symptoms and positive and negative symptoms of recent onset schizophrenia spectrum disorders: A network analytical approach. J Psychiatr Res 2021; 140:373-380. [PMID: 34144441 DOI: 10.1016/j.jpsychires.2021.05.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is a need to better understand the interrelationships between positive and negative symptoms of recent-onset schizophrenia spectrum disorders (SSD) and co-occurring depressive symptoms. Aims were to determine: (1) whether depressive symptoms are best conceptualised as distinct from, or intrinsic to, positive and negative symptoms; and (2) bridging symptoms. METHODS Network analysis was applied to data from 198 individuals with depressive and psychotic symptoms in SSD from the Psychosis Recent Onset GRoningen Survey (PROGR-S). Measures were: Montgomery-Åsberg Depression Rating Scale and Positive and Negative Syndrome Scale. RESULTS Positive symptoms were just as likely to be associated with depressive and negative symptoms, and had more strong associations with depressive than negative symptoms. Negative symptoms were more likely to be associated with depressive than positive symptoms, and had more strong associations with depressive than positive symptoms. Suspiciousness and stereotyped thinking bridged between positive and depressive symptoms, and apparent sadness and lassitude between negative and depressive symptoms. CONCLUSIONS Depressive symptoms might be best conceptualised as intrinsic to positive and negative symptoms pertaining to deficits in motivation and interest in the psychotic phase of SSD. Treatments targeting bridges between depressive and positive symptoms, and depressive and such negative symptoms, might prevent or improve co-occurring depressive symptoms, or vice-versa, in the psychotic phase of SSD.
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Izquierdo A, Cabello M, de la Torre-Luque A, Ayesa-Arriola R, Setien-Suero E, Mayoral-van-Son J, Vazquez-Bourgon J, Ayuso-Mateos JL, Crespo-Facorro B. A network analysis approach to functioning problems in first psychotic episodes and their relationship with duration of untreated illness: Findings from the PAFIP cohort. J Psychiatr Res 2021; 136:483-491. [PMID: 33129506 DOI: 10.1016/j.jpsychires.2020.10.019] [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: 04/22/2020] [Revised: 07/14/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The domains of functioning affected by first episode of psychosis (FEP) could be analysed as forming a network of interacting or even reinforcing elements. The reasons why longer duration of untreated psychosis (DUP) might be related to higher disability are not still clear. The aim of the present study is to evaluate how different areas of functioning are inter-related according to the length of DUP in patients with FEP, with a particular focus on studying the relative influence of each other according to lengthy delays in initial treatment. METHOD 441 participants in an epidemiological and intervention program of first episode psychosis (PAFIP) were included in our study. Functioning problems at baseline were assessed with the WHO Disability Assessment Schedule (DAS). Three networks of functioning domains have been estimated according to the length of DUP. RESULTS All the DAS items took part in the different networks. We have not found differences across the edge weights in the short, medium and long DUP groups. The domains "social withdrawal", "participation in the household activities", "general interest and information", and "low level of activity" seem to act as bridge items with other areas of functioning in people with longer DUP. CONCLUSIONS Our results could have clinical implications for patients with longer DUP, in which case, social withdrawal, household activities, level of activity and general interest in the world around them, could be high-priority target areas of treatment, since they seem to be mediating the relation between others areas of functioning.
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Affiliation(s)
- Ana Izquierdo
- Department of Psychiatry, University Hospital La Princesa. Instituto de Investigación Sanitaria Princesa, IIS Princesa, Madrid, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
| | - María Cabello
- Department of Psychiatry, University Hospital La Princesa. Instituto de Investigación Sanitaria Princesa, IIS Princesa, Madrid, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
| | - Alejandro de la Torre-Luque
- Department of Psychiatry, University Hospital La Princesa. Instituto de Investigación Sanitaria Princesa, IIS Princesa, Madrid, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
| | - Rosa Ayesa-Arriola
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Esther Setien-Suero
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Jacqueline Mayoral-van-Son
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Hospital Sierrallana, Torrelavega, Spain
| | - Javier Vazquez-Bourgon
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, University Hospital La Princesa. Instituto de Investigación Sanitaria Princesa, IIS Princesa, Madrid, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain.
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; University Hospital Virgen del Rocío, Department of Psychiatry. Instituto de Investigación Sanitaria de Sevilla, IBiS, Sevilla, Spain; University of Sevilla, Sevilla, Spain
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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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14
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Efficacy of psychological treatments for patients with schizophrenia and relevant negative symptoms: A meta-analysis. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2899. [DOI: 10.32872/cpe.v2i3.2899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background
Recent meta-analyses on the efficacy of psychological treatments for the negative symptoms of schizophrenia included mostly trials that had not specifically targeted negative symptoms. To gauge the efficacy of such treatments in the target patient population – namely people with schizophrenia who experience negative symptoms – we conducted a meta-analysis of controlled trials that had established an inclusion criterion for relevant negative symptom severity.
Method
We conducted a systematic literature search and calculated random-effects meta-analyses for controlled post-treatment effects and for pre-post changes within treatment arms. Separate analyses were conducted for different therapeutic approaches. Our primary outcome was reduction in negative symptoms; secondary outcomes were amotivation, reduced expression, and functioning.
Results
Twelve studies matched our inclusion criteria, testing Cognitive Behavioral Therapy (CBT) vs. treatment-as-usual (k = 6), Cognitive Remediation (CR) vs. treatment-as-usual (k = 2), CBT vs. CR (k = 2), and Body-oriented Psychotherapy (BPT) vs. supportive group counseling and vs. Pilates (k = 1 each). Accordingly, meta-analyses were performed for CBT vs. treatment-as-usual, CR vs. treatment-as-usual, and CBT vs. CR. CBT and CR both outperformed treatment-as-usual in reducing negative symptoms (CBT: Hedges’ g = -0.46; CR: g = -0.59). There was no difference between CBT and CR (g = 0.12). Significant pre-post changes were found for CBT, CR, and to a lesser extent for treatment-as-usual, but not for BPT.
Conclusion
Although effects for some approaches are promising, more high-quality trials testing psychological treatments for negative symptoms in their target population are needed to place treatment recommendations on a sufficiently firm foundation.
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15
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Bilderbeck AC, Raslescu A, Hernaus D, Hayen A, Umbricht D, Pemberton D, Tiller J, Søgaard B, Sambeth A, van Amelsvoort T, Reif A, Papazisis G, Pérez V, Elices M, Maurice D, Bertaina-Anglade V, Dawson GR, Pollentier S. Optimizing Behavioral Paradigms to Facilitate Development of New Treatments for Anhedonia and Reward Processing Deficits in Schizophrenia and Major Depressive Disorder: Study Protocol. Front Psychiatry 2020; 11:536112. [PMID: 33250788 PMCID: PMC7674850 DOI: 10.3389/fpsyt.2020.536112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Behavioral tasks focusing on different subdomains of reward processing may provide more objective and quantifiable measures of anhedonia and impaired motivation compared with clinical scales. Typically, single tasks are used in relatively small studies to compare cases and controls in one indication, but they are rarely included in larger multisite trials. This is due to limited systematic standardization as well as the challenges of deployment in international studies and stringent adherence to the high regulatory requirements for data integrity. The Reward Task Optimization Consortium (RTOC) was formed to facilitate operational implementation of reward processing tasks, making them suitable for use in future large-scale, international, multisite drug development studies across multiple indications. The RTOC clinical study aims to conduct initial optimization of a set of tasks in patients with major depressive disorder (MDD) or schizophrenia (SZ). Methods: We will conduct a multicenter study across four EU countries. Participants (MDD = 37, SZ = 37, with ≤80 age- and gender-matched healthy volunteers) will attend a study visit comprising screening, self-report and clinically rated assessments of anhedonia and symptom severity, and three reward processing tasks; specifically, the Grip Strength Effort task, the Doors task, and the Reinforcement Learning Working Memory task. The Grip Strength Effort and Doors tasks include simultaneous electroencephalography/event-related potential recordings. Outcomes will be compared using a two-way group design of MDD and SZ with matched controls, respectively. Further analyses will include anhedonia assessment scores as covariates. Planned analyses will assess whether our findings replicate previously published data, and multisite deployment will be evaluated through assessments of quality and conduct. A subset of participants will complete a second visit, to assess test-retest reliability of the task battery. Discussion: This study will evaluate the operational deployment of three reward processing tasks to the regulatory standards required for use in drug development trials. We will explore the potential of these tasks to differentiate patients from controls and to provide a quantitative marker of anhedonia and/or impaired motivation, establishing their usefulness as endpoints in multisite clinical trials. This study should demonstrate where multifaceted reward deficits are similar or divergent across patient populations. Registration: ClinicalTrials.gov (NCT04024371).
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Affiliation(s)
| | | | - Dennis Hernaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Anja Hayen
- P1vital Ltd, Wallingford, United Kingdom
| | | | | | - Jane Tiller
- BlackThorn Therapeutics, San Francisco, CA, United States
| | | | - Anke Sambeth
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Therese van Amelsvoort
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Victor Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Departament de Psiquitria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Matilde Elices
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Departament de Psiquitria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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16
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Reimer J, Kuhn J, Wietfeld R, Janetzky W, Leopold K. [Motivational interviewing : A possibility for doctor-patient communication in schizophrenia?]. DER NERVENARZT 2019; 90:1144-1153. [PMID: 30941459 DOI: 10.1007/s00115-019-0702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Motivational interviewing (MI) has become established nowadays as an approach for a cooperative style of conversation to promote intrinsic motivation for change by exploring and resolving ambivalences. The change of addictive behavior is no longer sought by exerting pressure or lecturing/converting attempts of convincing or persuasion but by activating existing but "buried" or newly acquired self-motivation to change. The MI is now also used to change the treatment of other health-related behavior and chronic diseases, including schizophrenic disorders. Compared to the efficacy of MI in the addiction area, the data situation in schizophrenic patients is still insufficient. According to the available studies, MI can positively influence important aspects of disease-related impairments, such as medication adherence, the frequency and severity of psychotic relapses, the duration of hospitalization, the level of function, insight into the disease and cognitive rehabilitation. The practical implementation of MI requires a good knowledge of the method as well as changes in treatment principles and work processes.
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Affiliation(s)
- Jens Reimer
- Zentrum für Psychosoziale Medizin Gesundheit Nord, 28102, Bremen, Deutschland. .,Klinikum Bremen-Ost, Züricher Str. 40, 28325, Bremen, Deutschland. .,Zentrum für Interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Universität Hamburg, Hamburg, Deutschland.
| | - Jens Kuhn
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Johanniter Krankenhaus Oberhausen, Evangelischer Klinikverbund Niederrhein gGmbH, Oberhausen, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Köln, Deutschland
| | - Rita Wietfeld
- Psychotherapie, Praxis Neurologie und Psychiatrie, Witten, Deutschland
| | | | - Karolina Leopold
- Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum am Urban, Berlin, Deutschland
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17
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Ruiz-Iriondo M, Salaberría K, Polo-López R, Iruin Á, Echeburúa E. Improving clinical symptoms, functioning, and quality of life in chronic schizophrenia with an integrated psychological therapy (IPT) plus emotional management training (EMT): A controlled clinical trial. Psychother Res 2019; 30:1026-1038. [PMID: 31651213 DOI: 10.1080/10503307.2019.1683634] [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: 10/25/2022] Open
Abstract
Objective: This paper describes the results of testing a multi-component psychological therapy that includes integrated psychological therapy (IPT), together with an adaptation of emotional management therapy (EMT), versus treatment as usual (TAU), delivered in a community mental health setting for individual with chronic schizophrenia. We investigated the effectiveness of a psychological intervention on clinical symptoms, cognitive and social functioning, as well as the feasibility of treatment and its acceptance. Method: 77 outpatients were recruited, 42 in the experimental group, who were treated with IPT + EMT, and 35 participants in control condition (TAU), both during 8 months. The subjects of both groups were assessed pre and postreatment. Results: Treatment attendance was 98% in experimental group and none of patients required hospital admission during therapy, meanwhile 11 patients from the TAU group withdrew and 3 were hospitalized during therapy. After therapy, patients in the experimental group compared to TAU, reduced clinical symptoms and improved cognitive functioning and quality of life. Conclusion: Psychological therapy seems to be a feasible intervention even in the chronic stages of the disease.
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Affiliation(s)
- Maria Ruiz-Iriondo
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
| | - Karmele Salaberría
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
| | - Rocio Polo-López
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain
| | - Álvaro Iruin
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Guipúzcoa Mental Health Network, Basque Health Service-Osakidetza, Gipuzkoa, Spain
| | - Enrique Echeburúa
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
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18
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Luther L, Fischer MW, Firmin RL, Salyers MP. Clarifying the overlap between motivation and negative symptom measures in schizophrenia research: A meta-analysis. Schizophr Res 2019; 206:27-36. [PMID: 30577993 PMCID: PMC6525651 DOI: 10.1016/j.schres.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
Motivation and negative symptom research has recently been hampered by a series of inconsistent findings, leading to calls for a greater consensus on the type of measures used across studies. To inform this issue, we conducted a meta-analysis that quantified the association between motivation measures (self-report, performance-based) and clinician-rated negative symptom measures as well as a series of moderator analyses to develop a greater understanding of the measurement factors impacting this relationship. Forty-seven eligible studies with people with schizophrenia-spectrum disorders were included. Using a random-effects meta-analytic model, a small but significant overall effect size emerged between motivation and clinician-rated negative symptoms (r = -0.18). Several significant moderators were identified, including the generation of negative symptom measures such that there was a significantly stronger relationship between motivation and second-generation (r = -0.38) than first-generation negative symptom measures (r = -0.17). Further, the type of performance-based measure used moderated the relationship, with effort discounting tasks most strongly related to negative symptoms (r = -0.44). The domain of motivation assessed (intrinsic, extrinsic, amotivation) also moderated the relationship. These findings help to identify sources of inconsistencies observed in prior studies and point to both second-generation and effort discounting tasks as the most promising types of measures, particularly for those interested in validating motivation measures or assessing the effectiveness of motivation treatments. Although additional research is needed, our results suggest that using these measures may help to reduce inconsistencies across studies and move the field forward.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA; University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, 279, Chicago, IL 60608, USA.
| | - Melanie W Fischer
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA.
| | - Ruth L Firmin
- University of California Los Angeles, Semel Institute, 760 Westwood Plaza, Los Angeles, CA 90046, USA.
| | - Michelle P Salyers
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA.
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Comparison of original and revised reinforcement sensitivity theory in clinically-stable schizophrenia and bipolar disorder patients. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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20
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Kirkpatrick B, Saoud JB, Strauss GP, Ahmed AO, Tatsumi K, Opler M, Luthringer R, Davidson M. The brief negative symptom scale (BNSS): Sensitivity to treatment effects. Schizophr Res 2018; 197:269-273. [PMID: 29275856 DOI: 10.1016/j.schres.2017.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/25/2017] [Accepted: 11/24/2017] [Indexed: 02/07/2023]
Abstract
The Brief Negative Symptom Scale (BNSS) grew out of a recommendation by the NIMH-sponsored Consensus Development Conference on Negative Symptoms that a scale based on contemporary concepts be developed. We assessed sensitivity to change of the BNSS in a trial of MIN-101, which showed efficacy for negative symptoms (PANSS pentagonal model) at daily doses of 32 and 64mg/day. Using mixed-effects model for repeated measures, we examined change in BNSS total score and in the BNSS factors of anhedonia/avolition/asociality (AAA), and expressivity (EXP). Compared to placebo, the 64mg group (N=83) showed a significant decrease in BNSS total score (effect size d [ES] 0.56, p<0.01) and both factor scores (AAA ES=0.48, EXP ES=0.46, p<0.02 for both). Patients in the trial had minimal depression and positive symptom scores; covarying for disorganization, positive symptoms, or anxiety/depression did not cause a meaningful change in the significance of the BNSS total or factor scores in this group. The 32mg group (N=78) did not differ significantly from placebo (N=83) on BNSS total score (ES=0.33, p<0.09), AAA (ES=0.25, p<0.20) or EXP (ES=0.30, p<0.12) scores. These results demonstrate the BNSS is sensitive to change.
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Affiliation(s)
| | | | | | - Anthony O Ahmed
- Department of Psychiatry, Weill Cornell School of Medicine, USA
| | | | - Mark Opler
- ProPhase LLC, New York City, New York, USA
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21
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Lum A, Skelton E, Wynne O, Bonevski B. A Systematic Review of Psychosocial Barriers and Facilitators to Smoking Cessation in People Living With Schizophrenia. Front Psychiatry 2018; 9:565. [PMID: 30459658 PMCID: PMC6232499 DOI: 10.3389/fpsyt.2018.00565] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022] Open
Abstract
Background: People living with schizophrenia are less likely to quit smoking compared with the general population and people living with other psychiatric disorders. Understanding the schizophrenia-specific psychosocial barriers and facilitators to smoking cessation is important for designing effective smoking cessation interventions. We aimed to systematically review research examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia. Methods: We followed the PRISMA statement to conduct a systematic literature review examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia. We searched EMBASE, Medline, PsycINFO, and CINAHL databases from inception to 14 June 2018 to identify relevant articles. We included peer-reviewed original research articles that examined psychosocial barriers and facilitators to smoking cessation, as well as factors associated with maintenance of smoking habits in people living with schizophrenia spectrum disorders. Qualitative, quantitative, or mixed-methods study designs were included. Three authors screened titles, abstracts, and full-texts using the eligibility criteria. We conducted a narrative synthesis of the data to account for the heterogeneity of study designs. We analyzed qualitative and quantitative studies separately. Results: We identified 685 studies from our systematic search and screened the full-text of 134 articles. The final set of 23 articles included 20 quantitative studies and 3 qualitative studies. The most commonly cited barrier to smoking cessation in people living with schizophrenia was cravings and addiction, followed by a perceived increased risk of negative affect associated with quitting smoking. People living with schizophrenia reported smoking to manage stress and to maintain social relationships. People living with schizophrenia were found to be less likely to receive cessation support from health professionals than smokers without schizophrenia. Health concerns were the most commonly mentioned facilitator to quit smoking. Conclusions: People living with schizophrenia experience a wide range of barriers to smoking cessation. The influence of these barriers on smoking cessation likelihood may be greater among people living with schizophrenia than people without psychiatric disorders. Health professionals play an important role in smoking cessation for people living with schizophrenia and should consider barriers and facilitators identified in this review to support quitting in this vulnerable population.
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Affiliation(s)
- Alistair Lum
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Eliza Skelton
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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