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Saperstein AM, Subhan BA, Golub JS, Medalia A. Hearing Loss in Older People With Schizophrenia: Audiologic Characteristics and Association With Psychosocial Functioning. Am J Geriatr Psychiatry 2024; 32:489-496. [PMID: 38030420 PMCID: PMC10950537 DOI: 10.1016/j.jagp.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The severity and impact of hearing deficits among adults with schizophrenia spectrum disorders may become increasingly relevant with advancing age. This study evaluated hearing ability and associated psychosocial functioning among older adults aged 50-70. DESIGN Cross-sectional analysis. SETTING Four outpatient psychiatry clinics in New York City. PARTICIPANTS Individuals aged 50-70 years with diagnoses of schizophrenia or schizoaffective disorder. MEASUREMENTS Unaided pure tone air conduction audiometry conducted using a portable audiometry system determined the pure tone average (PTA) hearing threshold across four frequencies: 500, 1k, 2k, and 4k Hz. Better ear PTA defined the hearing threshold. Audiometry data retrieved from the U.S. National Health and Nutrition Examination Survey aided interpretation of sample hearing loss rates. Standard measures evaluated psychiatric symptoms, perceived impact of hearing impairment, loneliness, and quality of life. RESULTS Among audiometry completers (N = 40), 35% (n = 14) demonstrated subclinical hearing loss (16-25 dB) and 35% (n = 14) had mild or worse hearing loss (≥26 dB). Rates were higher than expected based on age-based population data. Those who perceived hearing handicap rated it moderate (12.2%) or severe (7.3%); those who perceived tinnitus rated the impact as mild to moderate (12.2%) or catastrophic (2.4%). Neither psychiatric symptoms nor interviewer-rated quality of life was associated with hearing ability. Greater loneliness was significantly correlated with worse audiologic performance (r = 0.475, p <0.01) and greater perceived hearing handicap (r = 0.480, p <0.01). CONCLUSION Identifying the need for hearing loss treatment among aging adults with schizophrenia spectrum disorders is important given the potential implications for social functioning, cognitive, and mental health.
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Affiliation(s)
- Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry (AMS, AM), Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, New York, NY.
| | - Bibi A Subhan
- New York State Psychiatric Institute, Department of Psychiatry (BAS), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Justin S Golub
- Department of Otolaryngology-Head & Neck Surgery (JSG), Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, New York, NY
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry (AMS, AM), Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, New York, NY
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Saperstein AM, Bello I, Nossel I, Dixon LB, Medalia A. Implementation of Cognitive Health Services in Large Systems of Care: Highlights From Coordinated Specialty Care for First Episode Psychosis. Schizophr Bull 2024:sbae030. [PMID: 38517180 DOI: 10.1093/schbul/sbae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND HYPOTHESIS With increasing recognition of the importance of cognitive health for recovery in people with psychosis, questions arise as to how to implement cognitive health services in large systems of care. This paper describes the implementation of cognitive health services in OnTrackNY (OTNY), a network of clinics delivering a Coordinated Specialty Care treatment model for early psychosis, with the goal of documenting the processes, challenges, and useful adaptations. STUDY DESIGN In 2018, OTNY piloted a Cognitive Health Toolkit for implementation across 18 affiliated clinics. The toolkit intended to identify the cognitive health needs of individuals early in the course of psychosis and to integrate cognitive health into the vocabulary of wellness and recovery. Implementation involved creating mechanisms for staff training and support to, in turn, help participants improve how they use cognitive skills in daily life. STUDY RESULTS The toolkit was disseminated to all 28 OTNY programs throughout New York state by 2023. When simple assessment and decision-making tools were embedded in routine care practices, the majority of participants identified that improving memory, attention, and critical thinking skills would be helpful. Consistently, about 70% of those asked wanted to learn more about how to better their cognitive health. CONCLUSIONS Cognitive health services can be implemented in large systems of care that provide a multi-level system of implementation supports. Organizational facilitators of implementation include a training program to educate about cognitive health and the delivery of cognitive health interventions, and embedded quality assurance monitoring and improvement activities.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York-Presbyterian, New York, NY, USA
| | - Iruma Bello
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Ilana Nossel
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Lisa B Dixon
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Alice Medalia
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York-Presbyterian, New York, NY, USA
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Saperstein AM, Meyler S, Golub JS, Medalia A. Correlates of hearing loss among adults with schizophrenia. Schizophr Res 2023; 257:1-4. [PMID: 37230041 DOI: 10.1016/j.schres.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hearing loss (HL) is associated with adverse cognitive, mental, and physical health outcomes. There is evidence that across age groups HL is more prevalent in people with schizophrenia than the general population. Given that people with schizophrenia may already be vulnerable to cognitive and psychosocial disability, we sought to examine how hearing ability relates to concurrent levels of cognitive, mental and daily functioning. METHODS Community-dwelling adults with schizophrenia (N = 84) ages 22-50 completed pure tone audiometry assessments. Hearing threshold (in decibels) was defined as the lowest detectable pure tone at 1000 Hz. Pearson correlation was used to test the hypothesis that higher hearing thresholds (worse hearing) would be significantly associated with poorer performance on the Brief Assessment of Cognition in Schizophrenia (BACS). Additional analyses explored the relationships between audiometric threshold and functional capacity measured with the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and symptoms severity rated on the Positive and Negative Syndrome Scale (PANSS). RESULTS Hearing threshold was inversely and significantly correlated with the BACS composite score (r = -0.27, p = 0.017). This relationship was reduced but remained significant after controlling for age (r = -0.23, p = 0.04). Hearing threshold was not associated with VRFCAT or psychiatric symptom measures. CONCLUSIONS While schizophrenia and HL are independently associated with cognitive impairment, the magnitude of impairment in this sample was greater among those with poorer hearing. Findings warrant further mechanistic study of the relationship between hearing impairment and cognition and have implications for addressing modifiable health risk factors for higher morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States.
| | - Shanique Meyler
- The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, United States
| | - Justin S Golub
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 180 Fort Washington Avenue, New York, NY 10032, United States
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
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Dondé C, Kantrowitz JT, Medalia A, Saperstein AM, Balla A, Sehatpour P, Martinez A, O'Connell MN, Javitt DC. Early auditory processing dysfunction in schizophrenia: Mechanisms and implications. Neurosci Biobehav Rev 2023; 148:105098. [PMID: 36796472 PMCID: PMC10106448 DOI: 10.1016/j.neubiorev.2023.105098] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Schizophrenia is a major mental disorder that affects approximately 1% of the population worldwide. Cognitive deficits are a key feature of the disorder and a primary cause of long-term disability. Over the past decades, significant literature has accumulated demonstrating impairments in early auditory perceptual processes in schizophrenia. In this review, we first describe early auditory dysfunction in schizophrenia from both a behavioral and neurophysiological perspective and examine their interrelationship with both higher order cognitive constructs and social cognitive processes. Then, we provide insights into underlying pathological processes, especially in relationship to glutamatergic and N-methyl-D-aspartate receptor (NMDAR) dysfunction models. Finally, we discuss the utility of early auditory measures as both treatment targets for precision intervention and as translational biomarkers for etiological investigation. Altogether, this review points out the crucial role of early auditory deficits in the pathophysiology of schizophrenia, in addition to major implications for early intervention and auditory-targeted approaches.
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Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, F-38000 Grenoble, France; INSERM, U1216, F-38000 Grenoble, France; Psychiatry Department, CHU Grenoble Alpes, F-38000 Grenoble, France; Psychiatry Department, CH Alpes-Isère, F-38000 Saint-Egrève, France.
| | - Joshua T Kantrowitz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States; Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY 10032, United States
| | - Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY 10032, United States
| | - Andrea Balla
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States
| | - Pejman Sehatpour
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Antigona Martinez
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Monica N O'Connell
- Translational Neuroscience Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States
| | - Daniel C Javitt
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States.
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Sehatpour P, Iosifescu DV, De Baun HM, Shope C, Mayer MR, Gangwisch J, Dias E, Sobeih T, Choo TH, Wall MM, Medalia A, Saperstein AM, Kegeles LS, Girgis RR, Carlson M, Kantrowitz JT. Dose-Dependent Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia: A Double-Blind, Placebo-Controlled, Randomized, Target Engagement Clinical Trial of the NMDA Glutamate Receptor Agonist d-serine. Biol Psychiatry 2023:S0006-3223(23)00042-2. [PMID: 36958998 DOI: 10.1016/j.biopsych.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients with schizophrenia show reduced NMDA glutamate receptor-dependent auditory plasticity, which is rate limiting for auditory cognitive remediation (AudRem). We evaluate the utility of behavioral and neurophysiological pharmacodynamic target engagement biomarkers, using a d-serine+AudRem combination. METHODS Forty-five participants with schizophrenia or schizoaffective disorder were randomized to 3 once-weekly AudRem visits + double-blind d-serine (80, 100, or 120 mg/kg) or placebo in 3 dose cohorts of 12 d-serine and 3 placebo-treated participants each. In AudRem, participants indicated which paired tone was higher in pitch. The primary outcome was plasticity improvement, operationalized as change in pitch threshold between AudRem tones [(test tone Hz - reference tone Hz)/reference tone Hz] between the initial plateau pitch threshold (mean of trials 20-30 of treatment visit 1) to pitch threshold at the end of visit(s). Target engagement was assessed by electroencephalography outcomes, including mismatch negativity (pitch primary). RESULTS There was a significant overall treatment effect for plasticity improvement (p = .014). Plasticity improvement was largest within the 80 and 100 mg/kg groups (p < .001, d > 0.67), while 120 mg/kg and placebo-treated participants showed nonsignificant within-group changes. Plasticity improvement was seen after a single treatment and was sustained on subsequent treatments. Target engagement was demonstrated by significantly larger mismatch negativity (p = .049, d = 1.0) for the 100 mg/kg dose versus placebo. CONCLUSIONS Our results demonstrate sufficient proof of principle for continued development of both the d-serine+AudRem combination and our target engagement methodology. The ultimate utility is dependent on the results of an ongoing larger, longer study of the combination for clinically relevant outcomes.
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Affiliation(s)
- Pejman Sehatpour
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Nathan Kline Institute, Orangeburg, New York
| | - Dan V Iosifescu
- Nathan Kline Institute, Orangeburg, New York; Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Heloise M De Baun
- Area Psychosis, New York State Psychiatric Institute, New York, New York
| | | | - Megan R Mayer
- Area Psychosis, New York State Psychiatric Institute, New York, New York
| | - James Gangwisch
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elisa Dias
- Nathan Kline Institute, Orangeburg, New York; Psychiatry, New York University Grossman School of Medicine, New York, New York
| | | | - Tse-Hwei Choo
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melanie M Wall
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alice Medalia
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alice M Saperstein
- Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lawrence S Kegeles
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ragy R Girgis
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marlene Carlson
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joshua T Kantrowitz
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Nathan Kline Institute, Orangeburg, New York.
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Saperstein AM, Meyler S, Medalia A. Hearing Loss Among People With Schizophrenia: Implications for Clinical Practice. Psychiatr Serv 2022; 74:543-546. [PMID: 36164770 DOI: 10.1176/appi.ps.20220226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors characterized hearing loss among individuals diagnosed as having schizophrenia to inform provision of routine behavioral health services to this population. METHODS Audiometry data collected between October 2019 and December 2021 from 84 community-dwelling adults with schizophrenia and 81 age-matched participants without the condition were analyzed. Rates of hearing loss were identified within groups and across age decades (20-50 years). Hearing threshold and rates of hearing loss were compared between groups. RESULTS Participants with schizophrenia had significantly higher mean hearing thresholds (p=0.006), indicating worse hearing. This difference remained significant after controlling for age (p=0.01). A significantly larger proportion of participants with schizophrenia had mild hearing loss (24%) compared with age-matched participants (6%) (p=0.002), with higher rates of mild hearing loss observed across all ages. CONCLUSIONS Screening for and detection of hearing loss among adults with schizophrenia may be an unmet need. Hearing loss is a treatable source of cognitive and psychosocial disability, warranting scalable assessment and intervention practices.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (all authors), and New York State Psychiatric Institute, New York City (Saperstein, Medalia); Graduate Center, City University of New York, New York City (Meyler)
| | - Shanique Meyler
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (all authors), and New York State Psychiatric Institute, New York City (Saperstein, Medalia); Graduate Center, City University of New York, New York City (Meyler)
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (all authors), and New York State Psychiatric Institute, New York City (Saperstein, Medalia); Graduate Center, City University of New York, New York City (Meyler)
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Arlia C, Saperstein AM, Meyler S, Styke S, Medalia A. Disparities in technology literacy and access negatively impact cognitive remediation scalability. Schizophr Res 2022; 243:456-457. [PMID: 35501204 PMCID: PMC10685306 DOI: 10.1016/j.schres.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Christina Arlia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Shanique Meyler
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Sarah Styke
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States.
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Saperstein AM, Medalia A, Malinovsky I, Bello I, Dixon LB. Toolkit for assessing and addressing cognitive health in early psychosis: Evaluation of feasibility and utility in a coordinated specialty care setting. Early Interv Psychiatry 2021; 15:1376-1381. [PMID: 33185025 PMCID: PMC8272079 DOI: 10.1111/eip.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
AIM Methods to identify and harness individual cognitive strengths while addressing relative weaknesses have the potential to complement recovery services for first-episode psychosis but systematic implementation is needed. We developed a cognitive health toolkit, trained teams from OnTrackNY, a network of coordinated specialty care (CSC) programs and examined toolkit feasibility and clinical utility during the first year of roll-out. METHODS The toolkit includes a clinician manual, assessment and decision-making tools, and a menu of cognitive health service options. Assessment uses the WRAT5-Reading subtest and a new Self-Assessment of Cognitive Functioning which, together, determine participant- and clinician-perceived cognitive health need. Program-level data were analysed for rates of assessment, identification of cognitive health needs and cognitive health service provision. RESULTS Data from 18 OnTrackNY teams included 933 participants, including 310 new admissions. Across teams, 43.9% of newly admitted participants received a WRAT5-Reading and 41.3% received a self-assessment. Of all assessments completed in the study period, 50.7% were at or within 3-months of admission and 69.1% were within the first year of program participation. Cognitive health need was identified by self-report (57.6%) and clinician-report (69.9%) and led to provision of specific services, including psychoeducation, compensatory skills training and in some cases restorative cognitive training. CONCLUSIONS Preliminary feasibility data are encouraging but barriers to assessment need to be identified and addressed. Rates of identified cognitive health need warrant further study of the implementation process and outcomes so that cognitive health assessment and treatment practices may ultimately be disseminated to CSC programs more broadly.
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Affiliation(s)
- Alice M. Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Igor Malinovsky
- Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Iruma Bello
- Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Lisa B. Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, New York
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Medalia A, Saperstein AM, Stefancic A, Meyler S, Styke S, Qian M, Liu J, Cabassa LJ. Feasibility and acceptability of remotely accessed cognitive remediation for schizophrenia in public health settings. Psychiatry Res 2021; 301:113956. [PMID: 33962354 PMCID: PMC8206004 DOI: 10.1016/j.psychres.2021.113956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Cognitive remediation (CR) is an evidence-based therapy used to improve cognition in people with schizophrenia. However, it often requires multiple in-person clinic sessions per week, which can limit scalability. This mixed methods study considered the feasibility and acceptability of a hybrid approach, which allowed for half the sessions to be conducted remotely as homework, without the clinician present. Individuals with schizophrenia were randomized to either all in-clinic or hybrid conditions and completed questionnaires and individual interviews about their experience. CR clinicians provided feedback in complement. Because of limited access to technology, most Hybrid CR participants had to come to clinic to access computers and often sought clinician support to do their homework. Participants in the two conditions were equally satisfied per the Client Satisfaction Questionnaire, and the majority reported perceived benefit and enjoyment. Both CR participants and clinicians identified access to technology as a barrier to program feasibility, while availability of clinician support positively impacted acceptability. Suggestions to improve CR highlighted adopting a flexible approach to providing CR that accounts for participant access to technology, potential benefit from peer interaction, and need for clinician support.
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Affiliation(s)
- Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and NewYork-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States.
| | - Alice M. Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Ana Stefancic
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Shanique Meyler
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Sarah Styke
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, United States
| | - Jun Liu
- New York State Psychiatric Institute, Mental Health Data Science, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Leopoldo J. Cabassa
- Brown School of Social Work, Washington University in St. Louis, Goldfarb Hall, Room 358 Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, United States
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Saperstein AM, Choi CJ, Jahshan C, Lynch DA, Wall M, Green MF, Medalia A. Predicting response to cognitive training for schizophrenia using results from two studies with different outcomes. Schizophr Res 2021; 231:61-66. [PMID: 33770627 PMCID: PMC8222143 DOI: 10.1016/j.schres.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/24/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Collaborative data sharing between research groups provides an opportunity to explore the basis for the heterogeneity in cognitive training outcomes reported in the schizophrenia literature. The current analyses focused on the contribution of site and participant characteristics to these heterogeneous outcomes. METHODS Data from two independent studies, from New York (NY) and Los Angeles (LA), were combined to yield a sample of 132 outpatient adults with schizophrenia/schizoaffective disorder. While similar treatment doses, cognitive exercises and outcome measures were used, sites differed in use of coaching, group discussion and compensation. Between-site differences in participant demographic and baseline clinical characteristics were tested. Regression examined predictors of change in cognition (MCCB) and functional capacity (UPSA) which could explain site differences in treatment effects. RESULTS Medium to large treatment effect size differences in MCCB and UPSA favored the NY site over LA. When the studies were combined, the effect of site was significant for both outcomes with a medium effect size difference. After controlling for background characteristics, the effect of site was reduced for both outcomes, but remained significant for cognition. Improvement in UPSA was associated with better baseline MCCB (p < 0.001), lower baseline UPSA (p < 0.001) and younger age (p = 0.019). The overall model with site, baseline scores, and participant background characteristics explained about 30% to 40% of the variance in outcomes. DISCUSSION Participant and treatment characteristics are both predictive of outcomes, but treatment characteristics may be more consequential to cognitive gain, while participant characteristics may be more consequential to change in functional capacity.
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Affiliation(s)
- Alice M. Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 1051 Riverside Drive, New York, NY 10032, United States
| | - C. Jean Choi
- Mental Health Data Science, New York State Psychiatric Institute 1051 Riverside Drive, New York, NY 10032, United States
| | - Carol Jahshan
- VA Greater Los Angeles Healthcare System, Bldg 210A, 11301 Wilshire Blvd, Los Angeles, CA 90073, United States; UCLA Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States.
| | - David A. Lynch
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 1051 Riverside Drive, New York, NY 10032, United States
| | - Melanie Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 1051 Riverside Drive, New York, NY 10032, United States; Mental Health Data Science, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Michael F. Green
- VA Greater Los Angeles Healthcare System Bldg 210A, 11301 Wilshire Blvd, Los Angeles, CA 90073, United States,UCLA Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, New York, NY 10032, United States.
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11
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Saperstein AM, Medalia A, Bello I, Dixon LB. Addressing cognitive health in coordinated specialty care for early psychosis: Real-world perspectives. Early Interv Psychiatry 2021; 15:374-379. [PMID: 32307919 PMCID: PMC8237375 DOI: 10.1111/eip.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 12/14/2022]
Abstract
AIM Addressing cognitive health during the early phase of psychosis has the potential to enhance recovery outcomes, yet methods to assess and treat cognitive problems are not a systematic part of Coordinated Specialty Care (CSC) in the United States. We sought to understand how CSC providers perceive cognitive health and gauge the acceptability and appropriateness of cognitive interventions to inform the development and implementation of a cognitive health toolkit for OnTrackNY, a CSC program. METHODS Electronic surveys were sent to clinicians from 22 OnTrackNY teams. One unstructured and 10 structured questions assessed knowledge and beliefs about cognition, current cognitive health practices, the likelihood of adopting new practices, perceived facilitators, and barriers to assessing and treating cognitive health. RESULTS Fifty-three clinicians responded. Clinicians identified a range of terms associated with cognitive impairment with specific neurocognitive deficits cited most frequently. The majority perceived the evidence for cognitive impairment at the time of first episode to be moderate to strong, that specific interventions for cognition are warranted, and that there is a significant link between cognition and community functioning. While current practices vary, 88% indicated a high likelihood of integrating tools to address cognitive problems if provided. Compensatory approaches to aid cognitive functioning were viewed most favourably. CONCLUSIONS Results suggest that addressing cognitive health is acceptable and appropriate for OnTrackNY but there is a need for systematic training to integrate empirically supported interventions with existing recovery-oriented practices. Piloting a cognitive health toolkit will inform the potential uptake of assessment and treatment practices more broadly.
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Affiliation(s)
- Alice M. Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York City, New York
| | - Iruma Bello
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York City, New York
| | - Lisa B. Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York City, New York
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12
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Saperstein AM, Jones BD, Hansen MC, Medalia A. The cognitive training version of the MUSIC® model of motivation inventory: A follow-up validity study. Schizophr Res 2020; 216:516-519. [PMID: 31924371 PMCID: PMC8054066 DOI: 10.1016/j.schres.2019.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/21/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022]
Abstract
Further validation of the MUSIC® Model of Motivation Inventory (MMI) for use in Cognitive Remediation (CR) for schizophrenia is needed. The MMI was compared to the Intrinsic Motivation Inventory - Schizophrenia Research and Perceived Competency Scale following early treatment exposure in a CR clinical trial. MMI Usefulness, Success, and Interest scales were significantly correlated with corresponding comparison scales. The MMI was not correlated with pre-morbid cognitive ability. Higher expectancy for success and perceived usefulness were significantly associated with greater intensity of session attendance. Results support the convergent, divergent, and predictive validity of the MMI for CR research and clinical use.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Brett D Jones
- Virginia Tech, School of Education, 310B War Memorial Hall, Blacksburg, VA 24061, United States.
| | - Marie C Hansen
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, New York, NY 10032, United States.
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13
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Bowie CR, Bell MD, Fiszdon JM, Johannesen JK, Lindenmayer JP, McGurk SR, Medalia AA, Penadés R, Saperstein AM, Twamley EW, Ueland T, Wykes T. Cognitive remediation for schizophrenia: An expert working group white paper on core techniques. Schizophr Res 2020; 215:49-53. [PMID: 31699627 DOI: 10.1016/j.schres.2019.10.047] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Abstract
Cognitive remediation is now widely recognized as an effective treatment for cognitive deficits in schizophrenia. Its effects are meaningful, durable, and related to improvements in everyday functional outcomes. As with many therapies, the evolution of cognitive remediation has resulted in treatment programs that use a variety of specific techniques, yet share common core principles. This paper is the product of a cognitive remediation expert working group consensus meeting to identify core features of the treatment and produce recommendations for its design, conduct, reporting, and implementation. Four techniques were identified as core features of cognitive remediation: facilitation by a therapist, cognitive exercise, procedures to develop problem-solving strategies, and procedures to facilitate transfer to real world functioning. Treatment techniques within each of these core features are presented to facilitate decisions for clinical trials and implementation in clinical settings.
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Affiliation(s)
| | - Morris D Bell
- Department of Psychiatry, Yale School of Medicine, USA
| | - Joanna M Fiszdon
- Department of Psychiatry, Yale School of Medicine, USA; VA Connecticut Healthcare System, USA
| | - Jason K Johannesen
- Department of Psychiatry, Yale School of Medicine, USA; VA Connecticut Healthcare System, USA
| | - Jean-Pierre Lindenmayer
- Nathan Kline Institute for Psychiatric Research, USA; New York University School of Medicine, USA
| | | | | | - Rafael Penadés
- Hospital Clínic Barcelona, University of Barcelona, IDIBAPS-CIBERSAM, Spain
| | | | - Elizabeth W Twamley
- Department of Psychiatry, University of California, San Diego, USA; Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, USA
| | - Torill Ueland
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Norway; Department of Psychology, University of Oslo, Norway
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, UK
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14
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Medalia A, Saperstein AM, Qian M, Javitt DC. Impact of baseline early auditory processing on response to cognitive remediation for schizophrenia. Schizophr Res 2019; 208:397-405. [PMID: 30665714 PMCID: PMC6739117 DOI: 10.1016/j.schres.2019.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early auditory processing (EAP) has increasingly become a focus of efforts to identify biomarkers of treatment response in schizophrenia. EAP deficits lead to poor functional outcome via impaired cognition, and treatments that target EAP may drive downstream cognitive improvements. Assessment of baseline need provides an opportunity for cognitive remediation (CR) programs that give EAP training to personalize treatment and optimize its impact. This initial efficacy study examined the differential benefit of EAP training for those with and without baseline EAP deficits as defined by performance on the Tone Matching Test. METHODS 103 outpatient adults diagnosed with schizophrenia or schizoaffective disorder were classified as having intact (48.5%) or impaired (51.5%) EAP and randomized to a CR program with restorative exercise plans that either included EAP training (N = 49) or did not (N = 54). Cognitive and functional outcomes were measured post-treatment and 3 months later. RESULTS Only in EAP impaired participants was there a significant benefit from EAP training on verbal learning. Treatment condition did not significantly impact global cognitive or functional outcomes for either EAP group. Cognitive gains partially mediated the relationship between gains in EAP and functional capacity. CONCLUSION These findings support the importance of addressing basic auditory deficits when attempting to remediate higher order auditory impairments such as verbal learning. In addition, they highlight the need for routine assessment of EAP in cognitive remediation participants, as well as the need for more effective programs to reverse these impairments.
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Affiliation(s)
- Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY 10032, USA.
| | - Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA.
| | - Min Qian
- Columbia University Mailman School of Public Health, Department of Biostatistics, New York, NY 10032, USA.
| | - Daniel C Javitt
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA.
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15
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Medalia A, Erlich MD, Soumet-Leman C, Saperstein AM. Translating cognitive behavioral interventions from bench to bedside: The feasibility and acceptability of cognitive remediation in research as compared to clinical settings. Schizophr Res 2019; 203:49-54. [PMID: 28768601 PMCID: PMC5790637 DOI: 10.1016/j.schres.2017.07.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 12/30/2022]
Abstract
Cognitive remediation (CR) research typically addresses internal validity, and few studies consider CR in a real-world context. This study evaluated the fit between the program conditions and treatment model in research and clinical settings, with the goal of informing future research on the contextual challenges associated with the implementation of CR. Data was drawn from an initiative by New York State's Office of Mental Health (OMH), to implement CR programs for adults with Serious Mental Illness (SMI) in 16 state operated outpatient clinics. One of these clinics first became a research site for a CR randomized clinical trial, which allowed for a comparison of the feasibility and acceptability of CR in a research as compared to a clinical setting. RESULTS: The research site averaged almost triple the number of referrals as the clinical sites. Over nine months 46.51% of clinic referrals were enrolled in the CR program whereas 64.29% of research referrals were enrolled. Clinical site utilization averaged 70.53% while research site utilization averaged 90.47%. At the clinical sites, 97% of respondents reported CR was an excellent or good experience. There was high treatment fidelity for program structure and content across sites. CONCLUSIONS: This comparison of CR in clinical and research sites highlights the decrease in referrals, enrollment and utilization that occurs when a program moves from a highly controlled setting to the real world. Still, the acceptability, fill rates and utilization indicated that CR can be successfully implemented in large scale, geographically diverse, publically funded clinic settings.
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Affiliation(s)
- Alice Medalia
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States; New York State Psychiatric Institute, Division of Behavioral Health Service and Policy Research, 1051 Riverside Drive, Mailbox 100, New York, NY 10032, United States.
| | - Matthew D. Erlich
- Columbia University College of Physicians and Surgeons, Department of Psychiatry 1051 Riverside Drive, New York, NY 10032,New York State Psychiatric Institute, Division of Behavioral Health Service and Policy Research, 1051 Riverside Drive, Mailbox 100, New York, NY 10032,New York State Office of Mental Health, NYC Field Office, 330 Fifth Avenue, New York, NY 10001
| | - Charlotte Soumet-Leman
- Columbia University College of Physicians and Surgeons, Department of Psychiatry 1051 Riverside Drive, New York, NY 10032
| | - Alice M. Saperstein
- Columbia University College of Physicians and Surgeons, Department of Psychiatry 1051 Riverside Drive, New York, NY 10032,New York State Psychiatric Institute, Division of Behavioral Health Service and Policy Research, 1051 Riverside Drive, Mailbox 100, New York, NY 10032
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16
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Medalia A, Saperstein AM, Hansen MC, Lee S. Personalised treatment for cognitive dysfunction in individuals with schizophrenia spectrum disorders. Neuropsychol Rehabil 2016; 28:602-613. [PMID: 27219068 DOI: 10.1080/09602011.2016.1189341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cognitive deficits are a well-recognised issue for individuals diagnosed with schizophrenia spectrum disorders. Despite positive group findings for the use of cognitive remediation (CR) interventions, there are substantial individual differences in response to treatment. In addition, the aggregate CR literature reports low moderate effect sizes for cognitive and functional outcomes. Based on personalised medicine theory, this paper uses extant CR literature to examine the individual characteristics determined to predict treatment response. These characteristics, which fall into the broad categories of cognitive, psychological, and biological can be used as tailoring variables to personalise CR to an individual's unique profile. Personalisation through the use of these tailoring variables has the potential to improve the delivery of CR to maximise treatment outcomes.
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Affiliation(s)
- Alice Medalia
- a Department of Psychiatry , Columbia University , New York , USA
| | | | - Marie C Hansen
- a Department of Psychiatry , Columbia University , New York , USA.,b Department of Psychology , Long Island University , Brooklyn , USA
| | - Seonjoo Lee
- a Department of Psychiatry , Columbia University , New York , USA
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17
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Abstract
Motivation impairment is an often prominent component of schizophrenia symptomatology that impacts treatment engagement and reduces the functional benefit from psychosocial interventions. Intrinsic motivation in particular has been shown to be impaired in schizophrenia. Nowhere is the role of intrinsic motivation impairment more evident than in cognitive remediation for schizophrenia. This chapter describes the theoretical determinants of motivation to learn and illustrates how those determinants have been translated into therapeutic techniques that enhance intrinsic motivation in a clinical context. We review the extant research that indicates how motivation enhancing techniques yield treatment-related improvements within cognitive remediation therapy and, more broadly, in other behavioral skills-based interventions for schizophrenia.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Mailbox 104, New York, USA.
| | - Alice Medalia
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Mailbox 104, New York, USA
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19
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Abstract
BACKGROUND AND OBJECTIVES There is increasing recognition of the cognitive consequences of socioeconomic adversity during childhood, which can impair learning and negatively affect social and emotional development. However, there is a paucity of research on cognitive functioning and mental health among transition-age homeless youth. This study aimed to address this knowledge gap by examining the prevalence and functional significance of cognitive impairment and mental health disorders in a sample of 18- to 22-year-old homeless youth. METHODS Participants (N = 73) were recruited from a vocational support program at Covenant House New York, a care agency for homeless youth. Assessments included diagnostic assessment for mental health disorders and evaluation of neurocognition and vocational outcomes. RESULTS Youth demonstrated histories of academic instability, academic achievement below expectation, and high rates of untreated psychiatric disorders, the most prominent of which were anxiety, substance use, and mood disorders. Of those who had a mental health diagnosis, more than half demonstrated cognitive deficits. Performance on measures of working memory and verbal memory was <70% of that of the age-matched normative population. Cognitive impairment was associated with a significant risk for making a wage insufficient for independent living. CONCLUSIONS These data confirm the need to focus on cognitive as well as emotional and physical health in transition-age youth. Comprehensive intervention at this later developmental stage has the potential to facilitate the acquisition of skills needed for academic, vocational, and independent living success in adulthood.
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Affiliation(s)
- Alice M. Saperstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and,Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and
| | - Elizabeth J. Ronan
- Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Rachael S. Seeman
- Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Alice Medalia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and,Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
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20
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Abstract
Cognitive remediation (CR) for schizophrenia is a learning-based behavioural skills training intervention designed to enhance neuro and (or) social cognitive skills, with the ultimate goal of generalization to improve psychosocial outcomes. This review summarizes conceptual approaches to CR for schizophrenia and the evidence for efficacy in clinical research settings. Four issues are at the forefront of ongoing research: the identification of techniques that produce the largest cognitive change, delineation of techniques that enhance transfer of cognitive skills to functional skills, the identification of CR methods that can be personalized to meet the specific cognitive and functional needs of each individual, and, all the while, ensuring that when CR methods are developed in a research setting, they remain scalable for delivery in the larger clinical community. In response to these issues, 3 prominent research trends have emerged: the rise of a new generation of computerized restorative cognitive training, the integration of CR with skills training to promote generalization, and the application of techniques to enhance motivation and learning during CR. As data on the neural basis of learning in people with schizophrenia become available, new technologies that harness the ability of the brain to make sustainable, functional changes may be integrated within a therapeutic context that promotes a personalized approach to learning. The development of transportable and scalable methods of CR that maximize the ability of people with schizophrenia to improve cognition will help them achieve personal goals for recovery.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
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21
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Choi KH, Saperstein AM, Medalia A. The relationship of trait to state motivation: the role of self-competency beliefs. Schizophr Res 2012; 139:73-7. [PMID: 22627122 DOI: 10.1016/j.schres.2012.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/28/2012] [Accepted: 05/01/2012] [Indexed: 11/25/2022]
Abstract
Even when people with schizophrenia describe themselves as generally motivated and eager to engage in activities, they may not actually be motivated in the present moment. In order to better understand the relationship between trait and state motivation, we aimed to assess trait motivation and state intrinsic motivation, and investigate their relations to each other and to criterion-related variables including cognition, negative symptoms, and beliefs about one's own competency-also known as perceived competency (PC). Further, we investigated whether PC mediates the relationships between state intrinsic motivation (IM) and trait motivation dimensions. Forty individuals with schizophrenia or schizoaffective disorders were administered two self-report measures of motivation, the Motivational Trait Questionnaire (Kanfer, R., Ackerman, P., 2000. Individual differences in work motivation: further explorations of a trait framework. Appl. Psychol. 49 (3), 470-482) and the Intrinsic Motivation Inventory for Schizophrenia Research (Choi, J., Medalia, A., 2010. Intrinsic motivation and learning in a schizophrenia spectrum sample. Schizophr. Res. 118, 12-19), as well as measures of PC, cognition and symptoms. The results showed that in people with schizophrenia, trait approach motivation, but not trait avoidance motivation, is positively correlated with state intrinsic motivation and PC. There was evidence that PC partially mediates the relationship between trait approach motivation and state intrinsic motivation to do the task. These results support the role of therapies that directly address self-competency beliefs and set the groundwork for future investigations on the impact of such treatments on motivation.
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Affiliation(s)
- Kee-Hong Choi
- Columbia University College of Physicians and Surgeons, NY, United States
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22
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23
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Abstract
The deficit syndrome is thought to characterize a pathophysiologically distinct subgroup of patients with schizophrenia. Supporting this notion, prior research examining the neuropsychological correlates of the deficit syndrome has suggested the presence of a differential impairment in frontal and parietal functions. This article reports findings from 2 studies attempting to replicate and extend previous reports of a differential neuropsychological impairment in deficit schizophrenia. In the first study, we administered a comprehensive neuropsychological battery to 20 deficit and 25 nondeficit patients with schizophrenia and 25 normal healthy controls. In the second study, a meta-analysis was conducted of 13 separate studies examining the neuropsychology of the deficit syndrome. There was little evidence from either of the present studies that the deficit syndrome is associated with a selective impairment in frontal and parietal lobe functions. The first study failed to find significant differences in frontal or parietal abilities for deficit vs nondeficit patients. The meta-analytic findings revealed that deficit patients were globally more neuropsychologically impaired than nondeficit patients (effect size [ES] = 0.41). Relative to nondeficit patients, deficit patients performed poorest on tests of olfaction (ES = 1.11), social cognition (ES = 0.56), global cognition (ES = 0.52), and language (ES = 0.51). The neuropsychological impairments associated with the deficit form of schizophrenia do not follow an obvious anatomically defined pattern of impairment. The question of whether deficit patients exhibit a unique cognitive impairment profile will require a more sophisticated and rigorous examination of the neuropsychology of the deficit syndrome.
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Affiliation(s)
- Alex S. Cohen
- Department of Psychology, University of Maryland, College Park
| | | | - James M. Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, PO Box 21247, Baltimore, MD 21228
| | - Brian Kirkpatrick
- Department of Psychiatry and Health Behavior, Medical College of Georgia
| | - William T. Carpenter
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, PO Box 21247, Baltimore, MD 21228
| | - Robert W. Buchanan
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, PO Box 21247, Baltimore, MD 21228
- To whom correspondence should be addressed; e-mail:
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Schechter I, Butler PD, Jalbrzikowski M, Pasternak R, Saperstein AM, Javitt DC. A new dimension of sensory dysfunction: stereopsis deficits in schizophrenia. Biol Psychiatry 2006; 60:1282-4. [PMID: 16945346 PMCID: PMC2901805 DOI: 10.1016/j.biopsych.2006.03.064] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 03/23/2006] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Schizophrenia is a neurocognitive disorder with a wide range of cognitive and sensory impairments. Early visual processing has been shown to be especially impaired. This article investigates the integrity of binocular depth perception (stereopsis) in schizophrenia. METHODS Seventeen schizophrenia patients and 19 healthy control subjects were compared on the Graded Circles Stereo Test. Results of stereoacuity were compared between patients and control subjects using t test. RESULTS Schizophrenia patients demonstrated significantly (p = .006) reduced stereoacuity (mean = 142 arcseconds) versus control subjects (mean = 55 arcseconds). At the normative level for adults, patients performed below chance. CONCLUSIONS These findings demonstrate an impairment of binocular depth perception and further confirm deficits of early visual processing in schizophrenia. Findings are discussed in context of magnocellular/dorsal stream processing with implications for visual processing and cognitive deficits.
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Affiliation(s)
- Isaac Schechter
- Program in Cognitive Neuroscience and Schizophrenia, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York 10962, USA.
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25
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Cohen AS, Leung WW, Saperstein AM, Blanchard JJ. Neuropsychological functioning and social anhedonia: results from a community high-risk study. Schizophr Res 2006; 85:132-41. [PMID: 16730428 DOI: 10.1016/j.schres.2006.03.044] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 03/23/2006] [Accepted: 03/28/2006] [Indexed: 11/24/2022]
Abstract
Social anhedonia has shown promise as a vulnerability marker for schizophrenia-spectrum pathology. Validity data have come, in part, from findings indicating that cognitive deficits occurring in schizophrenia are also evident in individuals with elevated levels of social anhedonia. However, prior research on this topic has been limited because it has been based almost exclusively on the study of selective samples of college students. The present article reports baseline findings of neuropsychological functioning in social anhedonics and controls from a representative community sample. Data on a wide array of neuropsychological abilities from 18-19 year-old participants with (n = 85) vs. without (n = 87) elevated levels of social anhedonia were analyzed. We hypothesized that, compared to controls, social anhedonics would show impairments in memory and sustained attention. Additionally, we sought to determine if more severe cognitive impairment in anhedonics was associated with greater schizophrenia-spectrum pathology and poorer overall functioning. Compared to controls, socially anhedonic participants performed more poorly on two visual-spatial memory tasks and a test of visual-spatial construction. The groups did not statistically differ on any of the other neuropsychological measures including general cognitive ability and sustained attention. Group differences were not the result of depression, bipolar or substance abuse disorders. Neuropsychological functioning showed little relationship to current clinical symptoms and functioning. Longitudinal assessment of these participants as they move through the risk period should provide important insights into the neuropsychological correlates of the schizophrenia prodrome.
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Affiliation(s)
- Alex S Cohen
- University of Maryland, College Park, MD 20742, USA
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26
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Saperstein AM, Fuller RL, Avila MT, Adami H, McMahon RP, Thaker GK, Gold JM. Spatial working memory as a cognitive endophenotype of schizophrenia: assessing risk for pathophysiological dysfunction. Schizophr Bull 2006; 32:498-506. [PMID: 16687386 PMCID: PMC2632247 DOI: 10.1093/schbul/sbj072] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Research suggests that first-degree relatives and individuals with schizophrenia spectrum personality disorders (SSPD) may represent nonpenetrant carriers of the genetic diathesis for schizophrenia. This study examined visuospatial working memory (SWM) as a cognitive endophenotype of schizophrenia by expanding the concept of risk for pathophysiological dysfunction beyond overt psychosis. Risk was thus defined by familial status and the presence or absence of SSPD. SWM was assessed in the following groups, in order of decreasing likelihood of genetic vulnerability: 23 patients with schizophrenia, 17 SSPD relatives of patients with schizophrenia, 23 non-SSPD relatives of patients with schizophrenia, 14 SSPD community members with no family history of psychosis, and 36 non-SSPD community members. SWM performance during a computer task was quantified by A-Prime. Relative risk ratios for SWM deficits were compared among the groups. Compared with community non-SSPD volunteers, relative risk (RR) of SWM deficits was significantly elevated in patients with schizophrenia (RR = 3.76, p = .002) and SSPD family members (RR = 2.97, p = .027), but not in the family non-SSPD (RR = 1.88, p = .241) or community SSPD (RR = 1.03, p = .971) groups. The pattern of SWM performance deficits reflected the proposed model of latent genetic liability, upholding SWM as a viable cognitive endophenotype. The results underscore the importance of including both familial liability and the schizophrenia spectrum when considering risk for schizophrenia and schizophrenia-related traits. This is particularly relevant for research efforts to identify pathophysiological components of the disease.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychology, University of Maryland, College Park, 20742, USA.
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Schechter I, Butler PD, Zemon VM, Revheim N, Saperstein AM, Jalbrzikowski M, Pasternak R, Silipo G, Javitt DC. Impairments in generation of early-stage transient visual evoked potentials to magno- and parvocellular-selective stimuli in schizophrenia. Clin Neurophysiol 2005; 116:2204-15. [PMID: 16055375 PMCID: PMC2901806 DOI: 10.1016/j.clinph.2005.06.013] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 06/06/2005] [Accepted: 06/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Patients with schizophrenia demonstrate significant impairments of early visual processing, potentially implicating dysfunction of the magnocellular visual pathway. The present study evaluates transient visual evoked potential (tVEP) responses to stimuli biased toward the magnocellular (M) or parvocellular (P) systems in patients with schizophrenia vs. normal volunteers first to evaluate relative contributions of M and P systems to specific tVEP components in schizophrenia and, second, to evaluate integrity of early M and P processing in schizophrenia. METHODS Seventy-four patients with schizophrenia and schizoaffective disorder were compared with 59 control subjects using separate stimuli to assess the tVEP response to M, P and mixed M/P conditions. Stimuli were biased toward M vs. P processing by manipulation of chromatic and achromatic contrast. C1, P1, N1 and P2 components were compared between patients and controls. All subjects showed 20/32 vision or better. RESULTS Waveforms were obtained to low contrast (M), chromatic contrast (P) and high contrast (mixed M/P) stimuli in both patients and controls. C1 was present to P and mixed M/P stimuli. Patients showed a significant reduction in amplitude and an increase in latency of the C1 component. P1 was elicited primarily by M and mixed M/P stimuli, whereas N1 was elicited primarily by P and mixed M/P stimuli. Patients showed reductions in both P1 and N1 amplitudes across conditions. However, only reductions in P1 amplitude survived covariation for between group differences in visual acuity. Further, P1 amplitude reductions in the M condition correlated with a proxy measure of global outcome. CONCLUSIONS M- and P-selective stimuli elicit differential components of the tVEP. Patients with schizophrenia show significant reductions in response even to simple visual stimuli. Deficits, particularly within the M system, may correlate significantly with global outcome and level of community functioning. SIGNIFICANCE Whereas deficits in high-order cognitive processing have been extensively documented in schizophrenia, integrity of early-stage sensory processing has been studied to a lesser degree. The present findings suggest that deficits in early-stage visual processing are significantly related to overall clinical outcome in schizophrenia. Further, between-group differences in visual acuity may influence VEP results, even for subjects with 'normal' vision (20/32 or better).
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Affiliation(s)
- Isaac Schechter
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
| | - Pamela D. Butler
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
- New York University School of Medicine, New York, NY, USA
- Corresponding author. Address: Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA. Tel.: +1 845 398 6537; fax: +1 845 398 6545. E-mail address: (P.D. Butler)
| | - Vance M. Zemon
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Nadine Revheim
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
| | - Alice M. Saperstein
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
| | - Maria Jalbrzikowski
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
| | - Roey Pasternak
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
| | - Gail Silipo
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
| | - Daniel C. Javitt
- Nathan Kline Institute, Program in Cognitive Neuroscience and Schizophrenia, Orangeburg, NY, USA
- New York University School of Medicine, New York, NY, USA
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Butler PD, Zemon V, Schechter I, Saperstein AM, Hoptman MJ, Lim KO, Revheim N, Silipo G, Javitt DC. Early-stage visual processing and cortical amplification deficits in schizophrenia. Arch Gen Psychiatry 2005; 62:495-504. [PMID: 15867102 PMCID: PMC1298183 DOI: 10.1001/archpsyc.62.5.495] [Citation(s) in RCA: 271] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with schizophrenia show deficits in early-stage visual processing, potentially reflecting dysfunction of the magnocellular visual pathway. The magnocellular system operates normally in a nonlinear amplification mode mediated by glutamatergic (N-methyl-D-aspartate) receptors. Investigating magnocellular dysfunction in schizophrenia therefore permits evaluation of underlying etiologic hypotheses. OBJECTIVES To evaluate magnocellular dysfunction in schizophrenia, relative to known neurochemical and neuroanatomical substrates, and to examine relationships between electrophysiological and behavioral measures of visual pathway dysfunction and relationships with higher cognitive deficits. DESIGN, SETTING, AND PARTICIPANTS Between-group study at an inpatient state psychiatric hospital and outpatient county psychiatric facilities. Thirty-three patients met DSM-IV criteria for schizophrenia or schizoaffective disorder, and 21 nonpsychiatric volunteers of similar ages composed the control group. MAIN OUTCOME MEASURES (1) Magnocellular and parvocellular evoked potentials, analyzed using nonlinear (Michaelis-Menten) and linear contrast gain approaches; (2) behavioral contrast sensitivity measures; (3) white matter integrity; (4) visual and nonvisual neuropsychological measures, and (5) clinical symptom and community functioning measures. RESULTS Patients generated evoked potentials that were significantly reduced in response to magnocellular-biased, but not parvocellular-biased, stimuli (P = .001). Michaelis-Menten analyses demonstrated reduced contrast gain of the magnocellular system (P = .001). Patients showed decreased contrast sensitivity to magnocellular-biased stimuli (P<.001). Evoked potential deficits were significantly related to decreased white matter integrity in the optic radiations (P<.03). Evoked potential deficits predicted impaired contrast sensitivity (P = .002), which was in turn related to deficits in complex visual processing (P< or =.04). Both evoked potential (P< or =.04) and contrast sensitivity (P = .01) measures significantly predicted community functioning. CONCLUSIONS These findings confirm the existence of early-stage visual processing dysfunction in schizophrenia and provide the first evidence that such deficits are due to decreased nonlinear signal amplification, consistent with glutamatergic theories. Neuroimaging studies support the hypothesis of dysfunction within low-level visual pathways involving thalamocortical radiations. Deficits in early-stage visual processing significantly predict higher cognitive deficits.
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Affiliation(s)
- Pamela D Butler
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
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Saperstein AM, Barber RT, Vijayakumar A, Cross FA. AAAS Vietnam Resolutions. Science 1973; 180:133. [PMID: 17811640 DOI: 10.1126/science.180.4082.133-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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