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Zierhut M, Bergmann N, Hahne I, Wohlthan J, Kraft J, Braun A, Tam Ta TM, Hellmann-Regen J, Ripke S, Bajbouj M, Hahn E, Böge K. The combination of oxytocin and mindfulness-based group therapy for empathy and negative symptoms in schizophrenia spectrum disorders - A double-blinded, randomized, placebo-controlled pilot study. J Psychiatr Res 2024; 171:222-229. [PMID: 38309212 DOI: 10.1016/j.jpsychires.2024.01.014] [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: 08/13/2023] [Revised: 12/16/2023] [Accepted: 01/08/2024] [Indexed: 02/05/2024]
Abstract
Treatment options for social cognition and negative symptoms in schizophrenia spectrum disorders (SSD) remain limited. Oxytocin could be a promising augmentation approach, but the social context influences the effect in humans. This pilot study hypothesized that oxytocin in a positive social setting through mindfulness-based group therapy (MBGT) would positively affect empathy and negative symptoms as well as affect and stress in an exploratory approach in SSD. An experimental, randomized, double-blinded (participants, psychotherapists), placebo-controlled pilot study with 41 individuals with SSD was conducted at the Charité - Universitätsmedizin Berlin. Oxytocin or placebo (24 I.U.) was administered intranasally 45 min before two sessions of MBGT each. A 2 × 2 mixed model ANCOVA design was calculated to assess empathy by the Interpersonal Reactivity Index and the Multifaceted Empathy Test and negative symptoms by the Self-Evaluation of Negative Symptoms. No benefit of oxytocin compared to placebo on empathy was observed, but significant between-group differences favoring oxytocin were found regarding the negative symptoms Diminished emotional range and Avolition. Negative affect and stress were significantly reduced compared to baseline. Mindfulness increased in both groups. Results indicated protocol adherence and retention rate of 91.1%, a drop-out rate of 8.9 % and a completion of 96 % of all sessions by the participants. No severe adverse events or side effects were reported. Our findings indicate proof-of-concept and suggest a potential role of oxytocin on negative symptoms and related variables in SSD in combination with MBGT. Future research should examine the stability of these effects with larger sample sizes.
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Affiliation(s)
- Marco Zierhut
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Berlin, Germany; German Center for Mental Health (DZPG), Partner Site, Berlin, Germany.
| | - Niklas Bergmann
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany
| | - Inge Hahne
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany
| | - Josefa Wohlthan
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany
| | - Julia Kraft
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Mitte, Berlin, Germany
| | - Alice Braun
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Mitte, Berlin, Germany
| | - Thi Minh Tam Ta
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany
| | - Julian Hellmann-Regen
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany; German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
| | - Stephan Ripke
- German Center for Mental Health (DZPG), Partner Site, Berlin, Germany; Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Mitte, Berlin, Germany
| | - Malek Bajbouj
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany; German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
| | - Eric Hahn
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Berlin, Germany; German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
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Högman L, Gavalova G, Laukka P, Kristiansson M, Källman MV, Fischer H, Johansson AGM. Cognition, prior aggression, and psychopathic traits in relation to impaired multimodal emotion recognition in psychotic spectrum disorders. Front Psychiatry 2023; 14:1111896. [PMID: 37426085 PMCID: PMC10323411 DOI: 10.3389/fpsyt.2023.1111896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/03/2023] [Indexed: 07/11/2023] Open
Abstract
Background Psychopathic traits have been associated with impaired emotion recognition in criminal, clinical and community samples. A recent study however, suggested that cognitive impairment reduced the relationship between psychopathy and emotion recognition. We therefore investigated if reasoning ability and psychomotor speed were impacting emotion recognition in individuals with psychotic spectrum disorders (PSD) with and without a history of aggression, as well as in healthy individuals, more than self-rated psychopathy ratings on the Triarchic Psychopathy Measure (TriPM). Methods Eighty individuals with PSD (schizophrenia, schizoaffective disorder, delusional disorder, other psychoses, psychotic bipolar disorder) and documented history of aggression (PSD+Agg) were compared with 54 individuals with PSD without prior aggression (PSD-Agg) and with 86 healthy individuals on the Emotion Recognition Assessment in Multiple Modalities (ERAM test). Individuals were psychiatrically stable and in remission from possible substance use disorders. Scaled scores on matrix reasoning, averages of dominant hand psychomotor speed and self-rated TriPM scores were obtained. Results Associations existed between low reasoning ability, low psychomotor speed, patient status and prior aggression with total accuracy on the ERAM test. PSD groups performed worse than the healthy group. Whole group correlations between total and subscale scores of TriPM to ERAM were found, but no associations with TriPM scores within each group or in general linear models when accounting for reasoning ability, psychomotor speed, understanding of emotion words and prior aggression. Conclusion Self-rated psychopathy was not independently linked to emotion recognition in PSD groups when considering prior aggression, patient status, reasoning ability, psychomotor speed and emotion word understanding.
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Affiliation(s)
- Lennart Högman
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gabriela Gavalova
- Aleris Psychiatry, Täby Psychotic Disorders Clinic, Stockholm, Sweden
| | - Petri Laukka
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Marianne Kristiansson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm, Sweden
- Swedish National Board of Forensic Medicine, Stockholm, Sweden
| | - Malin V. Källman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm, Sweden
| | - Hakan Fischer
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Anette G. M. Johansson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm, Sweden
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Specific facial emotion recognition deficits across the course of psychosis: A comparison of individuals with low-risk, high-risk, first-episode psychosis and multi-episode schizophrenia-spectrum disorders. Psychiatry Res 2023; 320:115029. [PMID: 36586376 DOI: 10.1016/j.psychres.2022.115029] [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: 06/30/2022] [Revised: 12/17/2022] [Accepted: 12/24/2022] [Indexed: 12/26/2022]
Abstract
Our study aimed to explore the recognition of specific emotions across the course of psychosis. A visual task representing the six basic emotions was used to assess facial emotion recognition (FER) in 204 healthy controls classified into 152 low-risk (LR) and 52 high-risk for psychosis (HR), following a psychometric risk approach; and 100 patients: 44 with first-episode psychosis (FEP) and 56 with multi-episode schizophrenia-spectrum disorders (MES). First, we performed a MANCOVA to compare the four conditions. Next, we conducted a logistic regression to explore whether specific FER deficits predicted the presence of psychosis. Finally, we investigated the relationships of FER with psychosis-like experiences (PLEs) and psychotic symptoms. Global FER, anger and fear recognition were impaired in HR, FEP and MES. No differences between HR and FEP appeared. Moreover, fear and anger correctly classified 83% of individuals into LR or psychosis. FER was associated with PLEs and psychotic symptoms. Concluding, FER is early impaired in HR individuals and increases along the psychosis continuum. However, fear recognition is similarly impaired throughout the illness, suggesting a possible vulnerability marker. Furthermore, deficits in anger and fear recognition predicted the presence of psychosis. Therefore, we suggest that FER may be essential in detecting psychosis risk.
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