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Hernandez R, Schneider S, Pinkham AE, Depp CA, Ackerman R, Pyatak EA, Badal VD, Moore RC, Harvey PD, Funsch K, Stone AA. Comparisons of Self-Report With Objective Measurements Suggest Faster Responding but Little Change in Response Quality Over Time in Ecological Momentary Assessment Studies. Assessment 2024:10731911241245793. [PMID: 38634454 DOI: 10.1177/10731911241245793] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Response times (RTs) to ecological momentary assessment (EMA) items often decrease after repeated EMA administration, but whether this is accompanied by lower response quality requires investigation. We examined the relationship between EMA item RTs and EMA response quality. In one data set, declining response quality was operationalized as decreasing correspondence over time between subjective and objective measures of blood glucose taken at the same time. In a second EMA study data set, declining response quality was operationalized as decreasing correspondence between subjective ratings of memory test performance and objective memory test scores. We assumed that measurement error in the objective measures did not increase across time, meaning that decreasing correspondence across days within a person could be attributed to lower response quality. RTs to EMA items decreased across study days, while no decrements in the mean response quality were observed. Decreasing EMA item RTs across study days did not appear problematic overall.
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Affiliation(s)
| | | | | | - Colin A Depp
- University of California San Diego, USA
- Veterans Affairs San Diego Healthcare System, CA, USA
| | | | | | | | | | - Philip D Harvey
- University of Miami, FL, USA
- Bruce W. Carter Veterans Affairs Medical Center, Miami, FL, USA
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Gorora ME, Dalkner N, Moore RC, Depp CA, Badal VD, Ackerman RA, Pinkham AE, Harvey PD. A meta-cognitive Wisconsin Card Sorting Test in people with schizophrenia and bipolar disorder: Self-assessment of sorting performance. Psychiatry Res 2024; 334:115831. [PMID: 38428288 PMCID: PMC10947823 DOI: 10.1016/j.psychres.2024.115831] [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: 09/22/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
People with serious mental illness have challenged self-awareness, including momentary monitoring of performance. A core feature of this challenge is in the domain of using external information to guide behavior, an ability that is measured very well by certain problem-solving tasks such as the Wisconsin Card Sorting Test (WCST) . We used a modified WCST to examine correct sorts and accuracy decisions regarding the correctness of sort. Participants with schizophrenia (n = 99) or bipolar disorder (n = 76) sorted 64 cards and then made judgments regarding correctness of each sort prior to feedback. Time series analyses examined the course of correct sorts and correct accuracy decisions by examining the momentary correlation and lagged correlation on the next sort. People with schizophrenia had fewer correct sorts, fewer categories, and fewer correct accuracy decisions (all p<.001). Positive response biases were seen in both groups. After an incorrect sort or accuracy decision, the groups were equally likely to be incorrect on the next sort or accuracy decision. Following correct accuracy decisions, participants with bipolar disorder were significantly (p=.003) more likely to produce a correct sort or accuracy decision. These data are consistent with previous studies implicating failures to consider external feedback for decision making. Interventions aimed at increasing consideration of external information during decision making have been developed and interventions targeting use of feedback during cognitive test performance are in development.
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Affiliation(s)
- Mary E Gorora
- University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, United States
| | - Nina Dalkner
- University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, United States; Medical University Graz, Austria
| | | | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA, United States; San Diego VA Medical Center La Jolla, CA, United States
| | - Varsha D Badal
- UCSD Health Sciences Center, La Jolla, CA, United States
| | | | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX, United States
| | - Philip D Harvey
- University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, United States; Bruce W. Carter VA Medical Center, Miami, FL, United States.
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Lieberman A, Parrish EM, Depp CA, Harvey PD, Pinkham AE, Joiner TE. Demoralization in Schizophrenia: A Pathway to Suicidal Ideation? Arch Suicide Res 2024; 28:554-568. [PMID: 37013824 DOI: 10.1080/13811118.2023.2195454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Individuals with schizophrenia are at increased risk for suicide, and the Demoralization Hypothesis states that non-delusional awareness of one's social, cognitive, or occupational deterioration elicits depression and hopelessness. Both depression and hopelessness are established risk factors for suicide and are features of schizophrenia. The present study investigated whether insight into one's schizophrenia yields suicidal ideation, specifically by way of thwarted belongingness and perceived burdensomeness, which are constructs related to demoralization and measured by the Interpersonal Needs Questionnaire (INQ). METHODS Three separate models explored the mediating role of INQ scores on suicidal ideation in 99 participants with schizophrenia. With suicidal ideation entered as the dependent variable and INQ scores entered as the mediator, the first model included insight as the independent variable, the second included cognitive functioning, and the third included cognitive deterioration post-illness-onset. RESULTS Consistent with our hypothesis, INQ scores related to suicidal ideation (B = .03, SE = .01, p < .001). However, neither insight, cognitive functioning, nor cognitive deterioration predicted INQ scores or suicidal ideation. Additionally, INQ scores did not mediate relationships with suicidal, ideation. CONCLUSION Although INQ scores led to increased suicidal ideation, neither insight into illness, current cognitive functioning, nor shift in functioning led to increased INQ scores. Implications are discussed, and future directions are proposed.
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Dowell-Esquivel C, Czaja SJ, Kallestrup P, Depp CA, Saber JN, Harvey PD. Computerized Cognitive and Skills Training in Older People With Mild Cognitive Impairment: Using Ecological Momentary Assessment to Index Treatment-Related Changes in Real-World Performance of Technology-Dependent Functional Tasks. Am J Geriatr Psychiatry 2024; 32:446-459. [PMID: 37953132 PMCID: PMC10950539 DOI: 10.1016/j.jagp.2023.10.014] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Cognitive and functional skills training improves skills and cognitive test performance, but the true test of efficacy is real-world transfer. We trained participants with mild cognitive impairment (MCI) or normal cognition (NC) for up to 12 weeks on six technology-related skills using remote computerized functional skills assessment and training (FUNSAT) software. Using ecological momentary assessment (EMA), we measured real-world performance of the technology-related skills over 6 months and related EMA-identified changes in performance to training gains. DESIGN Randomized clinical trial with post-training follow-up. SETTING A total of 14 Community centers in New York City and Miami. PARTICIPANTS Older adults with normal cognition (n = 72) or well-defined MCI (n = 92), ranging in age from 60 to 90, primarily female, and racially and ethnically diverse. INTERVENTION Computerized cognitive and skills training. MEASUREMENTS EMA surveys measuring trained and untrained functional skills 3 or more days per week for 6 months and training gains from baseline to end of training. RESULTS Training gains in completion times across all 6 tasks were significant (p <0.001) for both samples, with effect sizes more than 1.0 SD for all tasks. EMA surveys detected increases in performance for both trained (p <0.03) and untrained (p <0.001) technology-related skills for both samples. Training gains in completion times predicted increases in performance of both trained and untrained technology-related skills (all p <0.001). CONCLUSIONS Computerized training produces increases in real-world performance of important technology-related skills. These gains continued after the end of training, with greater gains in MCI participants.
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Affiliation(s)
| | - Sara J Czaja
- Weil Cornell School of Medicine (SJC), New York, NY; i-Function, Inc. (SJC, PK, PDH) Miami, FL
| | | | | | | | - Philip D Harvey
- University of Miami Miller School of Medicine (CDE, PDH), Miami, FL; i-Function, Inc. (SJC, PK, PDH) Miami, FL.
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Parrish EM, Pinkham A, Moore RC, Harvey PD, Granholm E, Roesch S, Joiner T, Depp CA. An ecological momentary cognitive assessment study of over-attribution of threat and suicide risk factors in people with serious mental illness. Schizophr Res 2024; 266:136-144. [PMID: 38401412 DOI: 10.1016/j.schres.2024.02.028] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/19/2023] [Accepted: 02/17/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION People with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder) are at increased risk of suicidal ideation (SI). Over-attribution of social threat, or attributing threatening emotions to neutral faces, may contribute to social isolation through increased social avoidance and decreased social approach motivation. These factors are related to suicide, as well as perceived burdensomeness (PB) and thwarted belongingness (TB). This study examined how over-attribution of threat relates to PB, TB, and social motivations. METHOD N = 273 participants with SMI were assessed for current SI and behavior, and were stratified into SI (N = 130) vs. non-SI (N = 143) groups. Participants completed smartphone surveys (via ecological momentary assessments [EMA]) 3×/day for 10 days. They also completed the Mobile Ecological Test of Emotion Recognition (METER) 1×/day. Linear mixed models and multi-level mediation tested the relationships between over-attribution of threat, METER performance, PB/TB, and social motivations. RESULTS Participants with and without SI did not significantly differ in over-attribution of threat or METER performance. In separate models, there was a relationship of over-attribution of threat with increased PB (B = 1.00, SE = 0.21, t = 4.72, p < .001), reduced social approach motivation (B = -0.74, SE = 0.22, t = -3.33, p < .001), and increased social avoidance (B = 0.90, SE = 0.24, t = 3.70, p < .001), all significant when adjusting for facial affect recognition ability. A model examining social motivations as a mediator between over-attribution of threat and PB/TB was not significant. CONCLUSION These results suggest that over-attribution of threat relates to interpersonal constructs related to SI irrespective of facial affect abilities. This study may inform understanding of social cognitive processes related to suicide in SMI.
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Affiliation(s)
- Emma M Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Amy Pinkham
- The University of Texas at Dallas, Dallas, TX, USA
| | - Raeanne C Moore
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL, USA
| | - Eric Granholm
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Scott Roesch
- San Diego State University Department of Psychology, San Diego, CA, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Colin A Depp
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Patapoff MA, Jester DJ, Daly RE, Mausbach BT, Depp CA, Glorioso DK. Remotely-administered resilience and self-compassion intervention targeting loneliness and stress in older adults: a single-case experimental design. Aging Ment Health 2024; 28:369-376. [PMID: 37814972 PMCID: PMC10842569 DOI: 10.1080/13607863.2023.2262411] [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: 06/15/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Loneliness and chronic stress are prevalent issues for older adults that have been linked to adverse health outcomes. We conducted a remote resilience and self-compassion intervention targeting loneliness and chronic stress. METHODS This study utilized a multiple-phase-change single-case experimental design with three consecutive 6-week phases: control, intervention, follow-up. Assessments and biomarker collection (blood pressure, inflammation, sleep actigraphy) were conducted at each phase. Participants completed a 6-week remotely-administered resilience and self-compassion intervention using techniques from cognitive behavioral therapy and resilience training. Repeated measures ANOVAs were conducted over the 12-week period from control (week 0) to intervention completion (week 12) and over the 18-week period from control (week 0) to follow-up (week 18) in supplemental analyses. RESULTS Participants reported a reduction in stress (p < 0.001; ηp2 = 0.15), depression (p = 0.02; ηp2 = 0.08), and loneliness (p = 0.003; ηp2 = 0.18), and an increase in self-compassion (p = 0.01; ηp2 = 0.13) from control to intervention completion (weeks 0-12). Post-hoc tests revealed that stress reduced significantly during the intervention phase (weeks 6-12) and loneliness reduced significantly during the control phase (weeks 0-6). Some improvements in blood pressure, inflammation, and sleep quality were noted in a subsample of participants. CONCLUSION Findings indicate that our remote resilience and self-compassion intervention for older adults targeting loneliness and chronic stress was efficacious.
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Affiliation(s)
- Molly A Patapoff
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Dylan J Jester
- Women's Operational Military Exposure Network (WOMEN), VA Palo Alto Health Care System
| | - Rebecca E Daly
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brent T Mausbach
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Colin A Depp
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Danielle K Glorioso
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Parrish EM, Chalker S, Cano M, Harvey PD, Taylor CT, Pinkham A, Moore RC, Ackerman RA, Depp CA. Ecological Momentary Assessment of Social Approach and Avoidance Motivations in Serious Mental Illness: Connections to Suicidal Ideation and Symptoms. Arch Suicide Res 2024; 28:123-140. [PMID: 36377277 PMCID: PMC10183051 DOI: 10.1080/13811118.2022.2137445] [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] [Indexed: 11/17/2022]
Abstract
AIM People with serious mental illness (SMI) are at an increased risk for suicide. Social approach and avoidance motivations are linked to social functioning, and social isolation is a risk factor for suicide. This study uses ecological momentary assessment (EMA) to understand social approach and avoidance motivations in relation to symptoms and suicidal ideation (SI). METHODS Participants (N = 128) diagnosed with schizophrenia, schizoaffective disorder, or a mood disorder with psychotic features completed assessments of SI and symptoms at baseline. They completed EMA surveys 3×/day for 10 days. EMA surveys included questions about approach and avoidance motivations and psychotic symptoms. Participants were split into four groups based on the median scores of approach and avoidance. RESULTS Participants with SI at baseline had higher mean social avoidance motivation, t(126) = 2.84, p = .003, and lower mean social approach motivation, t(126) = -2.44, p = .008, than participants without baseline SI. Greater baseline positive symptoms were related to greater mean avoidance, r = .231, p = .009, but not approach motivation. The low approach/high avoidance group had significantly higher current SI than those with high approach/low avoidance (p < .001). Overall, the low approach/high avoidance group reported more EMA-measured voices than the low approach/low avoidance group (p < .001) and the high approach/low avoidance group (p < .001). Similarly, the low approach/high avoidance group reported more EMA-measured suspiciousness than the low approach/low avoidance (p < .001) and the high approach/low avoidance groups (p < .001). CONCLUSION The results of this study point to the role of social approach and avoidance motivations in relation to SI and psychotic symptoms. Clinically, exposure therapies and cognitive behavioral therapies may help to address these social approach and avoidance processes linked to SI.
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Affiliation(s)
- Emma M. Parrish
- San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Samantha Chalker
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Mayra Cano
- University of California San Diego Department of Psychiatry, San Diego, California
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL
| | - Charles T. Taylor
- University of California San Diego Department of Psychiatry, San Diego, California
| | - Amy Pinkham
- The University of Texas at Dallas, Richardson, TX
| | - Raeanne C. Moore
- University of California San Diego Department of Psychiatry, San Diego, California
| | | | - Colin A. Depp
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
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Parrish EM, Steenkamp L, Chalker SA, Moore RC, Pinkham A, Depp CA. Systematic Review of the Link Between Social Cognition and Suicidal Ideation and Behavior in People With Serious Mental Illness. Schizophr Bull Open 2024; 5:sgae007. [PMID: 38617732 PMCID: PMC11014866 DOI: 10.1093/schizbullopen/sgae007] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background and Hypothesis People with serious mental illness (SMI; psychotic and affective disorders with psychosis) are at an increased risk of suicide, yet there is limited research on the correlates of suicide in SMI. Social cognitive impairments are common among people with SMI and several studies have examined social cognition and suicidal ideation (SI) and behavior. This systematic review aims to evaluate the links between various domains of social cognition, SI, and suicidal behavior in SMI. Study Design Electronic databases (PubMed and PsycInfo) were searched through June 2023. Records obtained through this search (N = 618) were screened by 2 independent reviewers according to inclusion criteria. Relevant data were extracted, and study quality was assessed. Study Results Studies (N = 16) from 12 independent samples were included in the systematic review (N = 2631, sample sizes ranged from N = 20 to N = 593). Assessments of social cognition and SI and behavior varied widely between studies. Broadly, effects were mixed. Better emotion recognition of negative affect was linked to SI and a history of suicide attempts, though there is little consistent evidence for the relationship of emotion recognition and SI or behavior. On the other hand, better theory of mind ability was linked to SI and a history of suicide attempts. Furthermore, negative attributional bias was linked to current SI, but not a history of SI or attempt. Conclusions This review suggests mixed associations between social cognition, SI, and behavior in SMI. Future research should evaluate additional mediators and moderators of social cognition and suicide, employing prospective designs.
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Affiliation(s)
- Emma M Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lisa Steenkamp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Samantha A Chalker
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amy Pinkham
- Department of Psychology, The University of Texas at Dallas, Dallas, TX, USA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Harvey PD, Strassnig A, Strassnig M, Heaton A, Kuehn K, Torre P, Sundermann EE, Pinkham A, Depp CA, Black G, Wharton W, Waldrop D, Anderson AM, Moore RC. Mild Cognitive Impairment, But Not HIV Status, is Related to Reduced Awareness of Level of Cognitive Performance Among Older Adults. Am J Geriatr Psychiatry 2023; 31:1117-1128. [PMID: 37544836 PMCID: PMC10732243 DOI: 10.1016/j.jagp.2023.07.009] [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: 05/23/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Self-assessment of cognitive abilities can be an important predictor of clinical outcomes. This study examined impairments in self-assessments of cognitive performance, assessed with traditional neuropsychological assessments and novel virtual reality tests among older persons with and without human immunodeficiency virus (HIV) and mild cognitive impairment (MCI). METHODS One hundred twenty-two participants (82 persons with HIV; 79 MCI+) completed a traditional neuropsychological battery, DETECT virtual reality cognitive battery, and self-reported their general cognitive complaints, depressive symptoms, and perceptions of DETECT performance. Relationships between DETECT performance and self-assessments of performance were examined as were the correlations between general cognitive complaints and performance. These relations were evaluated across HIV and MCI status, considering the associations of depressive symptoms, performance, and self-assessment. RESULTS We found no effect of HIV status on objective performance or self-assessment of DETECT performance. However, MCI+ participants performed worse on DETECT and traditional cognitive tests, while also showing a directional bias towards overestimation of their performance. MCI- participants showed a bias toward underestimation. Cognitive complaints were reduced compared to objective performance in MCI+ participants. Correlations between self-reported depressive symptoms and cognitive performance or self-assessment of performance were nonsignificant. CONCLUSIONS MCI+ participants underperformed on neuropsychological testing, while overestimating performance. Interestingly, MCI- participants underestimated performance to approximately the same extent as MCI+ participants overestimated. Practical implications include providing support for persons with MCI regarding awareness of limitations and consideration that self-assessments of cognitive performance may be overestimated. Similarly, supporting older persons without MCI to realistically appraise their abilities may have clinical importance.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences (PDH, MS), Miller School of Medicine, University of Miami, Miami, FL; Research Service (PDH), Miami VA Healthcare System, Miami, FL
| | | | - Martin Strassnig
- Department of Psychiatry and Behavioral Sciences (PDH, MS), Miller School of Medicine, University of Miami, Miami, FL
| | - Anne Heaton
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA
| | - Kevin Kuehn
- Department of Medicine (KK), University of California San Diego, San Diego, CA
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences (PT), San Diego State University, San Diego, CA
| | - Erin E Sundermann
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA
| | - Amy Pinkham
- School of Behavioral and Brain Sciences (AP), The University of Texas at Dallas, Richardson, TX
| | - Colin A Depp
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA; VA San Diego Healthcare System (CAD), San Diego, CA
| | | | | | | | | | - Raeanne C Moore
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA.
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Parrish EM, Quynh A, Scott V, Chalker SA, Chang C, Kamarsu S, Twamley EW, Depp CA. Suicide Safety Plan Self-knowledge in Serious Mental Illness: Psychiatric Symptom Correlates and Effects of Brief Intervention. Community Ment Health J 2023; 59:1639-1646. [PMID: 37340170 DOI: 10.1007/s10597-023-01155-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
Psychiatric symptoms experienced by people with serious mental illness (SMI; schizophrenia, bipolar and other psychotic disorders) may impact suicide safety planning. This study examined safety plan self-knowledge, or an individual's own knowledge and awareness of their safety plan, in a sample of people with SMI. Participants (N = 53) with SMI at elevated risk of suicide completed a 4-session intervention that included safety plans, with one intervention group that included mobile augmentation. Self-knowledge was assessed from previous safety plans at 4-, 12- and 24-weeks. Fewer warning signs generated was correlated with greater psychiatric symptoms (r = - .306, p = .026) and suicidal ideation (r = - .298, p = .030). Fewer coping strategies generated was correlated with greater suicidal ideation (r = .- 323, p = .018). Preliminarily, there was greater self-knowledge of warning signs over time among participants in the mobile intervention. These preliminary findings highlight the relationship of safety plan self-knowledge to symptoms and suggest that mobile augmentation of safety planning may be beneficial. Trial Registration: NCT03198364.
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Affiliation(s)
- Emma M Parrish
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Avery Quynh
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Vanessa Scott
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Samantha A Chalker
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Cindy Chang
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Snigdha Kamarsu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Dalkner N, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Immediate post performance judgements about cognitive performance in schizophrenia and bipolar disorder: associations with test performance and subjective overall judgments regarding abilities. Cogn Neuropsychiatry 2023; 28:450-466. [PMID: 37942934 PMCID: PMC10841634 DOI: 10.1080/13546805.2023.2276972] [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: 06/02/2022] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The study explored associations between the accuracy of post assessment judgements of cognitive performance with global self-assessments of psychosocial functioning compared to evaluations generated by observers in schizophrenia and bipolar disorder. METHODS An abbreviated cognitive assessment based on the MATRICS Consensus Cognitive Battery was administered to 122 individuals with schizophrenia and 113 with bipolar disorder. They provided self-estimates of their performance after each subtest. In addition, self-reports on cognition, social cognition, and everyday functioning were collected and compared to observer ratings. RESULTS Both groups overestimated their cognitive function, but in bipolar disorder, there was 30% shared variance between task performance and self-rated task performance (vs. 5% in schizophrenia). Significant correlations were found between self-reported everyday outcomes and both actual and self-assessed performance. In schizophrenia, immediate judgements were only related to self-rated functioning, not to observer rated functioning. In bipolar disorder, impairments in self-assessment of performance correlated with observer ratings of cognitive ability, which was not observed in schizophrenia. CONCLUSIONS While both groups showed correlations between cognitive performance and introspective accuracy, individuals with bipolar disorder showed higher accuracy in assessing their cognitive performance and other outcomes. Notably, impairments in introspective accuracy were associated with observer-rated functioning exclusively in bipolar disorder.
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Affiliation(s)
- Nina Dalkner
- Medical University Graz, Austria
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Colin A. Depp
- UCSD Health Sciences Center, La Jolla, CA
- San Diego VA Medical Center La Jolla, CA
| | | | - Amy E. Pinkham
- University of Texas at Dallas, Richardson, TX
- University of Texas Southwestern Medical Center, Dallas TX
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, FL
- Bruce W. Carter VA Medical Center, Miami, FL
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12
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Parrish EM, Harvey PD, Ackerman RA, Moore RC, Depp CA, Gagnier M, Pinkham AE. The Tripartite Model of Depression in Schizophrenia and Bipolar Disorder: A Secondary Analysis. J Nerv Ment Dis 2023; 211:841-847. [PMID: 37734155 PMCID: PMC10615707 DOI: 10.1097/nmd.0000000000001714] [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] [Indexed: 09/23/2023]
Abstract
ABSTRACT Models of affect, like the tripartite model, suggest that positive affect (PA) and negative affect (NA) are independent between subjects and negatively correlated within. Correlations may differ in bipolar disorder (BD) and schizophrenia. Using ecological momentary assessment (EMA) and clinical ratings, this secondary analysis evaluated the tripartite model by examining PA and NA. Two hundred eighty-one participants with BD or a psychotic disorder completed 30 days of EMA of PA and NA, and clinical raters assessed depression. PA and NA were more related between subjects and less related within subjects among participants with schizophrenia. In BD, lower momentary PA was positively associated with clinical ratings of depression, although greater momentary NA was not significantly associated with clinical ratings. In schizophrenia, the inverse was found. These results suggest that the tripartite model was not confirmed in people with schizophrenia or BD. However, PA and NA manifested associations in BD that were more congruent with population studies than in schizophrenia. These findings may have implications for clinical interventions targeting depression, PA, and NA in these populations.
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Affiliation(s)
- Emma M. Parrish
- San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL
| | | | - Raeanne C. Moore
- University of California San Diego Department of Psychiatry, San Diego, California
| | - Colin A. Depp
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Marc Gagnier
- University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL
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13
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Ehret BC, Titone MK, Carey CJ, Martinez A, Chalker SA, Granholm EL, Depp CA. Are all reasons for living made equally? Reasons for living and dysfunctional attitudes in psychotic disorders and bipolar I. Psychol Psychother 2023; 96:748-761. [PMID: 37039342 DOI: 10.1111/papt.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Persons with schizophrenia, schizoaffective, or bipolar I disorder are more likely to die by suicide compared to the general population. Dysfunctional attitudes have been shown to be significant predictors of cognitive vulnerability to depression, hopelessness, and poor problem-solving skills, which predict suicidal ideation. Dysfunctional attitudes are common in persons with schizophrenia spectrum disorders (SSDs) and bipolar I. The Reasons for Living Inventory (RFLI) examines distinct reasons for not dying by suicide. This study's objectives were to examine the relationship between the RFLI subscales and dysfunctional attitudes among persons with SSDs and bipolar I. We hypothesized significant positive correlations between two RFLI subscales (Fear of Suicide and Fear of Social Disapproval) and total score on the Dysfunctional Attitude Scale (DAS). We did not expect significant correlations between other subscales. DESIGN AND METHODS This correlational, cross-sectional study examined baseline scores on the RFLI and dysfunctional attitudes (DAS) among N = 102 outpatients with SSDs or bipolar I. RESULTS Significant positive correlations were observed between RFLI subscales Fear of Suicide and Fear of Social Disapproval and DAS total scores. No other significant relationships were observed. CONCLUSIONS Certain reasons for living (i.e. fear of suicide and social disapproval) may be associated with dysfunctional attitudes among persons with SSDs or bipolar I. These, in turn, may place these individuals at a greater risk for suicide by increasing their cognitive vulnerability. These findings may inform clinical treatment targets for persons with SSDs and bipolar I.
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Affiliation(s)
- Blaire C Ehret
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Madison K Titone
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin J Carey
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Alexandra Martinez
- Graduate School of Education and Psychology, Pepperdine University, Malibu, California, USA
| | - Samantha A Chalker
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Eric L Granholm
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin A Depp
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
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14
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Sokol LL, Troost JP, Bega D, Paulsen JS, Kluger BM, Applebaum AJ, Frank S, Nance MA, Anderson KE, Perlmutter JS, Depp CA, Grafman J, Cella D, Carlozzi NE. Death Anxiety in Huntington Disease: Longitudinal Heath-Related Quality-of-Life Outcomes. J Palliat Med 2023; 26:907-914. [PMID: 36607769 PMCID: PMC10316526 DOI: 10.1089/jpm.2022.0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Objective: Death anxiety, represented by the HDQLIFE™ Concern with Death and Dying (CwDD) patient-reported outcome (PRO) questionnaire, captures a person's worry about the death and dying process. Previous work suggests that death anxiety remains an unremitting burden throughout all stages of Huntington disease (HD). Although palliative interventions have lessened death anxiety among people with advanced cancer, none has yet to undergo testing in the HD population. An account of how death anxiety is associated with longitudinal changes to aspects of health-related quality of life (HRQoL) would help optimize neuropalliative interventions for people with HD. Methods: HDQLIFE collected PROs concerning physical, mental, social, and cognitive HRQoL domains and clinician-rated assessments from people with HD at baseline and 12 and 24 months. Linear mixed-effects models were created to determine how baseline death anxiety was associated with follow-up changes in HRQoL PROs after controlling for baseline death anxiety and other disease and sociodemographic covariates. Results: Higher baseline HDQLIFE CwDD is associated with 12- and 24-month declines in HDQLIFE Speech Difficulties, neurology quality of life (NeuroQoL) Depression, Suicidality, HDQLIFE Meaning and Purpose, and NeuroQoL Positive Affect and Well-being. Interpretation: Death anxiety may be a risk factor for worsening mental health and speech difficulty. A further prospective study is required to evaluate whether interventions on death anxiety or mental health generally can reduce declines in HRQoL for people with HD over time.
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Affiliation(s)
- Leonard L. Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane S. Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Benzi M. Kluger
- Department of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samuel Frank
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Karen E. Anderson
- Department of Psychiatry, Georgetown University, Washington, DC, USA
| | - Joel S. Perlmutter
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think + Speak Lab, Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - David Cella
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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15
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Badal VD, Depp CA, Harvey PD, Ackerman RA, Moore RC, Pinkham AE. Confidence, accuracy judgments and feedback in schizophrenia and bipolar disorder: a time series network analysis. Psychol Med 2023; 53:4200-4209. [PMID: 35478065 DOI: 10.1017/s0033291722000939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Inaccurate self-assessment of performance is common among people with serious mental illness, and it is associated with poor functional outcomes independent from ability. However, the temporal interdependencies between judgments of performance, confidence in accuracy, and feedback about performance are not well understood. METHODS We evaluated two tasks: the Wisconsin Card Sorting Test (WCST) and the Penn Emotion recognition task (ER40). These tasks were modified to include item-by-item confidence and accuracy judgments, along with feedback on accuracy. We evaluated these tasks as time series and applied network modeling to understand the temporal relationships between momentary confidence, accuracy judgments, and feedback. The sample constituted participants with schizophrenia (SZ; N = 144), bipolar disorder (BD; N = 140), and healthy controls (HC; N = 39). RESULTS Network models for both WCST and ER40 revealed denser and lagged connections between confidence and accuracy judgments in SZ and, to a lesser extent in BD, that were not evidenced in HC. However, associations between feedback regarding accuracy with subsequent accuracy judgments and confidence were weaker in SZ and BD. In each of these comparisons, the BD group was intermediate between HC and SZ. In analyses of the WCST, wherein incorporating feedback is crucial for success, higher confidence predicted worse subsequent performance in SZ but not in HC or BD. CONCLUSIONS While network models are exploratory, the results suggest some potential mechanisms by which challenges in self-assessment may impede performance, perhaps through hyperfocus on self-generated judgments at the expense of incorporation of feedback.
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Affiliation(s)
- Varsha D Badal
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California, USA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, La Jolla, California, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Miami VA Healthcare System, Miami, FL, USA
| | - Robert A Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, La Jolla, California, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
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16
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Chang CJ, Fischer IC, Depp CA, Norman SB, Livingston NA, Pietrzak RH. A disproportionate burden: Prevalence of trauma and mental health difficulties among sexual minority versus heterosexual U.S. military veterans. J Psychiatr Res 2023; 161:477-482. [PMID: 37086703 DOI: 10.1016/j.jpsychires.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/23/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/24/2023]
Abstract
This study examined sociodemographic, military, and trauma characteristics, and mental health concerns that differ by sexual orientation in a nationally representative sample of U.S. military veterans. Data were analyzed from 4069 veterans who participated in the National Health and Resilience Veterans Study (NHRVS). Compared with veterans who self-reported as heterosexual (n = 3,491, 94.7%), sexual minority veterans (n = 161, 5.3%) were more likely to be younger, women, Hispanic, unmarried/partnered, have lower household income, and to have enlisted in the military, and served for 4-9 years (relative to 3 or less or 10 or more). After adjusting for demographic variables, sexual minority veterans remained more likely to report childhood sexual abuse (odds ratio [OR] = 2.82), military sexual trauma (OR = 2.29), adverse childhood experiences (Cohen's d = 0.11), current and lifetime drug use disorder (ORs = 3.66 and 2.41, respectively), current alcohol use disorder (OR = 1.62), current and lifetime posttraumatic stress disorder (PTSD; ORs = 2.03 and 1.55, respectively), non-suicidal self-injury (NSSI; OR = 3.19), and future suicide intent (OR = 2.65). Among sexual minority veterans, more years of military service was associated with greater odds of lifetime PTSD, and lower annual household income with greater odds of lifetime drug use disorder and NSSI. Consistent with research in non-veterans, results suggest that sexual minority veterans experience greater trauma and mental health burden relative to their heterosexual peers. They further underscore the importance of interventions that prevent and mitigate adverse mental health outcomes in this population.
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Affiliation(s)
- Cindy J Chang
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Ian C Fischer
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA
| | - Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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17
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Chang CJ, Dorrell KD, Feinstein BA, Depp CA, Ehret BC, Selby EA. Testing the interpersonal theory of suicide in a sample of sexual minority young adults: Attention to within-group differences. Suicide Life Threat Behav 2023. [PMID: 36897041 DOI: 10.1111/sltb.12952] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION This study investigated demographic differences in interpersonal theory of suicide factors and their associations with suicide attempts among sexual minority young adults. METHODS 784 sexual minority young adults ages 18-29 (42.7% cisgender men, 42.2% cisgender women, 15.1% transgender/gender diverse; 62.2% non-Hispanic White; 50.5% gay/lesbian, 49.5% bisexual+) completed an online survey assessing lifetime suicide attempts and interpersonal theory of suicide factors. RESULTS Demographic differences included (1) greater perceived burdensomeness among transgender/gender diverse participants compared to other gender groups; (2) greater acquired capability for suicide and suicide attempts among cisgender men compared to cisgender women; (3) greater acquired capability for suicide among bisexual+ compared to gay/lesbian participants; and (4) a lower number of suicide attempts among Asian/Asian American sexual minority participants compared to most other sexual minority participants. All interpersonal theory of suicide factors were significantly associated with a higher number of suicide attempts, though only perceived burdensomeness and acquired capability for suicide remained significant when examining all three simultaneously. No two- or three-way interactions between interpersonal theory of suicide factors were significant. CONCLUSION The interpersonal theory of suicide may be useful for understanding suicide attempts in this population, with perceived burdensomeness and acquired capability being particularly relevant to consider.
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Affiliation(s)
- Cindy J Chang
- U.S. Department of Veterans Affairs, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Kate D Dorrell
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Colin A Depp
- U.S. Department of Veterans Affairs, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Blaire C Ehret
- U.S. Department of Veterans Affairs, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Edward A Selby
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, USA
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18
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Parrish EM, Harvey PD, Ackerman RA, Pinkham AE, Depp CA, Holden J, Granholm E. Time-course and convergence of positive and negative moods in participants with schizophrenia: An ecological momentary assessment study. J Psychiatr Res 2023; 159:76-81. [PMID: 36689853 DOI: 10.1016/j.jpsychires.2023.01.026] [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: 05/27/2022] [Revised: 10/11/2022] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Many people with schizophrenia report low levels of negative affect (NA), which may reflect biases in emotion processing. In the general population there is an inverse correlation between positive affect (PA) and NA. It is possible that this relationship is different among people with schizophrenia. This study aims to understand the relationship between PA and NA among people with schizophrenia, and explore PA and NA variability in relationship to social context. METHOD 105 participants with schizophrenia answered ecological momentary assessment (EMA) surveys seven times/day for seven days. They reported their experiences of mood states on a scale of one to seven: happiness, sadness, relaxation, and anxiety, as well as their social context (alone vs. with someone). Mood variability was calculated using the mean square of successive difference, and multilevel modeling was used to understand the time-course of reported moods within- and between-person. RESULTS 45% of surveys reported the absence of NA, though there was an inverse within-subjects correlation between PA and NA. Between-subjects, there was a large inverse correlation between PA and NA. Greater mood variability was associated with a greater number of social interactions. DISCUSSION The results of this study point to both the role of social context in mood variability, and momentary trends in mood experiences, with some individuals reporting no NA, some indicating both PA and NA, and some indicating a more normative affect pattern. Later research should address the possible impact of emotion perception bias and social interactions on moods states in schizophrenia.
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Affiliation(s)
- Emma M Parrish
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Research Service Miami VA Medical Center, Miami, FL, USA
| | | | | | - Colin A Depp
- University of California San Diego Department of Psychiatry, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jason Holden
- University of California San Diego Department of Psychiatry, San Diego, CA, USA
| | - Eric Granholm
- University of California San Diego Department of Psychiatry, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Abstract
OBJECTIVE Safety planning is a suicide prevention intervention that relies partly on an individual's social relationships as distractions during or help in a suicidal crisis. The primary objectives of this study were to estimate rates of missingness on social aspects of safety plans to determine whether rates differ by demographic characteristics and diagnoses and to examine whether missing social contacts on safety plans may affect clinical outcomes. METHODS Data were drawn from the U.S. Department of Veterans Affairs San Diego Healthcare System's electronic medical record (N=1,602 individuals) from 2018 to 2021. Safety plans were coded according to the absence of listed distraction or help contacts, and clinical records of suicide attempts, suicide deaths, and use of crisis services were recorded for 1 year after completion of the safety plan. RESULTS In total, 30% of plans lacked a contact for distraction or help. Male veterans were less likely to have a distraction contact listed, and veterans identifying as Hispanic or Latino were more likely to have a help contact listed. The lack of a help contact (odds ratio [OR]=2.11) and having neither distraction nor help contacts (OR=2.45) were associated with a markedly higher risk for next-year suicide attempt or death. The lack of a help contact was associated with increased odds of a next-year psychiatric inpatient hospitalization (OR=1.90) and an emergency department visit (OR=1.88). CONCLUSIONS A lack of social contacts on safety plans may be a potential indicator for increased suicide risk among veterans.
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Affiliation(s)
- Samantha A Chalker
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Emma M Parrish
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Camila S Martinez Ceren
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Marianne Goodman
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Neal Doran
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
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Depp CA, Parrish EM, Chalker SA, Ehret BC, Kamarsu S, Perivoliotis D, Granholm E. Pilot feasibility trial of a brief mobile-augmented suicide prevention intervention for serious mental illness. Psychiatr Rehabil J 2023; 46:74-82. [PMID: 36809018 DOI: 10.1037/prj0000547] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 02/23/2023]
Abstract
OBJECTIVE People with serious mental illnesses (SMIs) are at high risk for suicidal ideation and behavior, and yet few suicide prevention interventions have been customized for this group. We describe the outcomes of a pilot trial of Mobile SafeTy And Recovery Therapy (mSTART), a four-session suicide-focused cognitive behavioral intervention for SMI, designed for the transition from acute to outpatient care and augmented with ecological momentary intervention to reinforce intervention content. METHODS The primary objective of this pilot trial was to evaluate the feasibility, acceptability, and preliminary effectiveness of START. Seventy-eight people with SMI and elevated suicidal ideation were randomized to either: (a) mSTART or (b) START alone (i.e., without mobile augmentation). Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of mobile intervention), and 24 weeks. The primary outcome of the study was change in suicidal ideation severity. Secondary outcomes included psychiatric symptoms, coping self-efficacy, and hopelessness. RESULTS A total of 27% of randomized persons were lost to follow-up after baseline, and engagement with mobile augmentation was variable. There was clinically significant improvement (d = 0.86) in suicidal ideation severity scores sustained over 24 weeks, with similar effects seen for secondary outcomes. Preliminary comparison indicated a medium effect size (d = 0.48) advantage at 24 weeks of mobile augmentation in suicidal ideation severity scores. Treatment credibility and satisfaction scores were high. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE START, regardless of mobile augmentation, was associated with sustained improvement in suicidal ideation severity and secondary outcomes in people with SMI at-risk for suicide in this pilot trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, Stein Institute for Research on Aging, University of California San Diego
| | | | - Samantha A Chalker
- Department of Psychiatry, Stein Institute for Research on Aging, University of California San Diego
| | - Blaire C Ehret
- Department of Psychiatry, Stein Institute for Research on Aging, University of California San Diego
| | - Snigdha Kamarsu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Dimitri Perivoliotis
- Department of Psychiatry, Stein Institute for Research on Aging, University of California San Diego
| | - Eric Granholm
- Department of Psychiatry, Stein Institute for Research on Aging, University of California San Diego
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Steenkamp LR, Parrish EM, Chalker SA, Badal VD, Pinkham AE, Harvey PD, Depp CA. Childhood trauma and real-world social experiences in psychosis. Schizophr Res 2023; 252:279-286. [PMID: 36701936 DOI: 10.1016/j.schres.2022.12.039] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Childhood trauma is associated with a variety of negative outcomes in psychosis, but it is unclear clear if childhood trauma affects day-to-day social experiences. We aimed to examine the association between childhood trauma and functional and structural characteristics of real-world social relationships in psychosis. METHODS Participants with psychotic disorders or affective disorders with psychosis completed ecological momentary assessments (EMAs) over ten days (N = 209). Childhood trauma was assessed retrospectively using the Childhood Trauma Questionnaire. Associations between childhood trauma and EMA-assessed social behavior and perceptions were examined using linear mixed models. Analyses were adjusted for sociodemographic characteristics and psychotic and depressive symptom severity. RESULTS Higher levels of childhood trauma were associated with more perceived threat (B = -0.19, 95 % CI [-0.33, -0.04]) and negative self-perception (B = -0.18, 95 % CI [-0.34, -0.01]) during recent social interactions, as well as reduced social motivation (B = -0.29, 95 % CI [-0.47, -0.10]), higher desire for social avoidance (B = 0.34, 95 % CI [0.14, 0.55]), and lower sense of belongingness (B = -0.24, 95 % CI [-0.42, -0.06]). These negative social perceptions were mainly linked with emotional abuse and emotional neglect. In addition, paranoia was more strongly associated with negative social perceptions in individuals with high versus low levels of trauma. Childhood trauma was not associated with frequency (i.e., time spent alone) or type of social interactions. CONCLUSION Childhood trauma - particularly emotional abuse and neglect - is associated with negative social perceptions but not frequency of real-world social interactions. Our findings suggest that childhood trauma may affect day-to-day social experiences beyond its association with psychosis.
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Affiliation(s)
- Lisa R Steenkamp
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Emma M Parrish
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Samantha A Chalker
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States; Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Varsha D Badal
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States; Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, United States
| | - Amy E Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, United States; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States; Veterans Affairs San Diego Healthcare System, San Diego, CA, United States; Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, United States.
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22
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Dalkner N, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Negative mood states as a correlate of cognitive performance and self-assessment of cognitive performance in bipolar disorder versus schizophrenia. Schizophr Res 2023; 252:1-9. [PMID: 36608492 PMCID: PMC9974828 DOI: 10.1016/j.schres.2022.12.034] [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: 05/12/2022] [Revised: 08/15/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Mood states have been reported to manifest a cross-sectional correlation with self-assessment accuracy across functional domains and psychiatric conditions. Ecological momentary assessment (EMA) provides a strategy to examine the momentary course and correlates of mood states. This study tested the association of moods assessed longitudinally with accuracy of immediate self-assessments of cognitive test performance in participants with schizophrenia and bipolar disorder. METHODS 240 well-diagnosed participants with schizophrenia and bipolar disorder completed a subset of tests from the MATRICS Consensus Cognitive Battery and an immediate self-assessment of cognitive performance. Differences between actual and self-reported performance were used to index the accuracy of self-assessment. Daily smartphone EMA, 3× per day for 30 days, sampled participants´ momentary moods (sad, happy, relaxed, anxious), aggregated into positive affect and negative affect (NA). RESULTS Bipolar participants had better cognitive performance, but both samples had equivalent mis-estimation. Repeated-measures analyses found that NA did not manifest significant variability over time either between or within participants in the two diagnostic groups. Within-group analyses found that higher average NA was associated with greater mis-estimation and poorer cognitive performance in participants with bipolar disorder, but not in those with schizophrenia. CONCLUSION Negative moods had a significant association with impairments in self-assessment of cognitive performance in participants with bipolar disorder. Our study did not confirm previous cross-sectional findings of more accurate self-assessment associated with greater NA in schizophrenia. These findings suggest that cross-sectional assessments, particularly self-reports, may lead to different results than aggregated data from longitudinal evaluations.
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Affiliation(s)
- Nina Dalkner
- Medical University Graz, Austria; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA, USA; San Diego VA Medical Center La Jolla, CA, USA
| | | | | | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA; Bruce W. Carter VA Medical Center, Miami, FL, USA.
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23
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Badal VD, Depp CA, Pinkham AE, Harvey PD. Dynamics of task-based confidence in schizophrenia using seasonal decomposition approach. Schizophr Res Cogn 2023; 32:100278. [PMID: 36718249 PMCID: PMC9883296 DOI: 10.1016/j.scog.2023.100278] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
Objective Introspective Accuracy (IA) is a metacognitive construct that refers to alignment of self-generated accuracy judgments, confidence, and objective information regarding performance. IA not only refers to accuracy and confidence during tasks, but also predicts functional outcomes. The consistency and magnitude of IA deficits suggest a sustained disconnect between self-assessments and actual performance. The cognitive origins of IA are unclear and are not simply due to poor performance. We tried to capture task and diagnosis-related differences through examining confidence as a timeseries. Method This relatively large sample (N = 171; Bipolar = 71, Schizophrenia = 100) study used item by item confidence judgments for tasks including the Wisconsin Card Sorting Task (WCST) and the Emotion Recognition task (ER-40). Using a seasonal decomposition approach and AutoRegressive, Integrative and Moving Averages (ARIMA) time-series analyses we tested for the presence of randomness and perseveration. Results For the WCST, comparisons across participants with schizophrenia and bipolar disorder found similar trends and residuals, thus excluding perseverative or random responding. However, seasonal components were weaker in participants with schizophrenia, reflecting a reduced impact of feedback on confidence. In contrast, for the ER40, which does not require identification of a sustained construct, seasonal, trend, and residual analyses were highly comparable. Conclusion Seasonal analysis revealed that confidence judgments in participants with schizophrenia on tasks requiring responses to feedback reflected diminished incorporation of external information, not random or preservative responding. These analyses highlight how time series analyses can specify potential faulty processes for future intervention.
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Affiliation(s)
- Varsha D. Badal
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA,VA San Diego Healthcare System, La Jolla, CA, USA,Corresponding author at: Stein Institute for Research on Aging, Department of Psychiatry (0664), University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0664, USA.
| | - Amy E. Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA,Research Service, Miami VA Healthcare System, USA
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24
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Hoffman SN, Depp CA, Taylor CT. Examining affective reactivity as a link between suicidality and social disconnection. J Psychiatr Res 2023; 157:271-275. [PMID: 36527740 PMCID: PMC10846674 DOI: 10.1016/j.jpsychires.2022.12.008] [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: 07/13/2022] [Revised: 11/10/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
The link between suicidality and social disconnection is well-established. We explored possible mechanisms that may account for this link using a positive and negative valence systems framework in a clinical sample with and without suicidality (i.e., suicidal ideation and/or behaviors in the past month). Participants (N = 228) interacted with a trained confederate during a controlled conversation task designed to generate social affiliation. Participant-rated positive affect (PA) and negative affect (NA) were collected during the task (baseline, anticipation, post). Participant-rated desire for future interaction was collected after the task. We tested if (1) groups with (n = 82) and without (n = 146) suicidality differed in affect during the task and (2) whether affect accounted for the link between suicidality and desire for future interaction. Results revealed that groups differed in PA, but not NA, throughout the task. Participants with suicidality reported no significant changes in PA over the task (ps > .05); and, experienced less PA at post-task compared to those without (p = .003, d = 0.38) whereas participants without suicidality reported increased PA at post-task compared to baseline and anticipation of the task, ps < .001. Mediation analysis suggested blunted post-task PA accounted for the relationship between suicidality and less desire for future interaction, 95%CI [-2.59,-0.51]. Diminished PA reactivity during social affiliation opportunities may help explain the link between suicidality and social disconnection. Preliminary findings highlight PA as a potential mechanistic target for improving social connection for individuals at risk for suicide, though prospective and experimental research is needed.
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Affiliation(s)
- Samantha N Hoffman
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
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25
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Jeste DV, Glorioso DK, Depp CA, Lee EE, Daly RE, Jester DJ, Palmer BW, Mausbach BT. Remotely Administered Resilience- and Wisdom-Focused Intervention to Reduce Perceived Stress and Loneliness: Pilot Controlled Clinical Trial in Older Adults. Am J Geriatr Psychiatry 2023; 31:58-64. [PMID: 35965169 PMCID: PMC9847241 DOI: 10.1016/j.jagp.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/19/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Older adults are vulnerable to perceived stress and loneliness, exacerbated by the COVID-19 pandemic. We previously reported inverse relationships between loneliness/perceived stress and wisdom/resilience. There are few evidence-based tele-health interventions for older adults. We tested a new remotely-administered manualized resilience- and wisdom-focused behavioral intervention to reduce perceived stress and loneliness in older adults. METHODS This pilot controlled clinical trial used a multiple-phase-change single-case experimental design, with three successive 6-week phases: control, intervention, and follow-up periods. The intervention included six once-a-week one-hour sessions. Participants were 20 adults >65 years, without dementia. RESULTS All 20 participants completed every session. The study indicated feasibility and acceptability of the intervention. While the sample was too small for demonstrating efficacy, there was a reduction (small-to-medium effect size) in perceived stress and loneliness, and increase in resilience, happiness, and components of wisdom and positive perceptions of aging. CONCLUSION These preliminary data support feasibility, acceptability, and possible efficacy of a remotely-administered resilience- and wisdom-focused intervention in older adults to reduce stress and loneliness.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Danielle K Glorioso
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Colin A Depp
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Ellen E Lee
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Rebecca E Daly
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Dylan J Jester
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Barton W Palmer
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Brent T Mausbach
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA.
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26
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Horan WP, Depp CA, Hurst S, Linthicum J, Vargas G, Klein H, Keefe RSE, Harvey PD. Qualitative Analysis of the Content Validity of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) in Schizophrenia: A Multi-Stakeholder Perspective. Schizophr Bull Open 2023; 4:sgad012. [PMID: 38026054 PMCID: PMC10664622 DOI: 10.1093/schizbullopen/sgad012] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The US Food and Drug Agency (FDA) requires clinical trials targeting cognitive impairment associated with schizophrenia (CIAS) to demonstrate the functional relevance of cognitive improvements by employing a functional co-primary measure. Although quantitative evidence supports the suitability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for this purpose, FDA guidelines for qualification of clinical outcome assessments require evidence of content validity, defined as qualitative evidence that key stakeholders view the measure as relevant and important. To collect this important qualitative data, semi-structured interviews were conducted with outpatients with schizophrenia (n = 24), caregivers (n = 12), and professional peer support specialists (n = 12) to elicit their views about the definition and importance of functional independence, the importance of the functional domains assessed by the VRFCAT (meal planning, using transportation, handling money, shopping), and the relevance of the VRFCAT tasks to these domains. Qualitative thematic analyses revealed consistent themes across groups in defining functional independence, including performing instrumental self-care, financial, and social tasks; making decisions autonomously; and not depending on others to carry out daily activities. There were, however, notable differences in their views regarding the importance of and barriers to functional independence. All groups viewed the VRFCAT as assessing skill domains that are central to independent functioning and, with some minor differences, the VRFCAT tasks were viewed as relevant and meaningful examples of the domains. These qualitative results provide converging evidence that key stakeholders view the VRFCAT as a content-valid measure.
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Affiliation(s)
- William P Horan
- WCG Clinical Endpoint Solutions, Cary, NC
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Colin A Depp
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, CA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, CA
| | | | - Gabriela Vargas
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Research Service Bruce W. Carter VA Medical Center, Miami, FL
| | - Hans Klein
- WCG Clinical Endpoint Solutions, Cary, NC
| | | | - Philip D Harvey
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Research Service Bruce W. Carter VA Medical Center, Miami, FL
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27
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Chalker SA, Martinez Ceren CS, Ehret BC, Depp CA. Suicide-Focused Group Therapy. Crisis 2022; 44:485-496. [PMID: 36537106 DOI: 10.1027/0227-5910/a000892] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background: Although there are several studies focusing on group models for therapy specific to suicidal thoughts and behaviors, scoping reviews providing an overview of these studies' findings are limited. Aims: The aim of this paper was to conduct a scoping review of group therapies that explicitly target suicidal thoughts and behaviors (i.e., suicide-focused) for adults and their suicide-related outcomes. Methods: Following the PRISMA-ScR guidelines, a literature search using PubMed, Cochrane Library, and PsycINFO to identify relevant records published between 2000 and 2021 as well as a review of reference lists from relevant records was conducted. Results: There were 14 records identified with 12 unique suicide-focused group therapies. Even with variable methodological designs, sample sizes (M = 136, SD = 98), and population targeted, all records showed reductions in suicide-related outcomes by the end of the therapy; although most were not powered to determine effectiveness. Limitations: This review only included records written in English and excluded support groups that were led by peers as the focus was on therapy groups and gray literature. Conclusions: There are few evaluated therapy groups that explicitly address suicidal thoughts and behaviors. Available data indicate suicide-focused group therapy are generally feasible, acceptable, and may reduce suicidal-related outcomes. This is encouraging for future research; recommendations to include randomized controlled trials of the efficacy of suicide-focused group therapy are discussed.
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Affiliation(s)
- Samantha A Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Blaire C Ehret
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Colin A Depp
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
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28
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Lenze EJ, Voegtle M, Miller JP, Ances BM, Balota DA, Barch D, Depp CA, Diniz BS, Eyler LT, Foster ER, Gettinger TR, Head D, Hershey T, Klein S, Nichols JF, Nicol GE, Nishino T, Patterson BW, Rodebaugh TL, Schweiger J, Shimony JS, Sinacore DR, Snyder AZ, Tate S, Twamley EW, Wing D, Wu GF, Yang L, Yingling MD, Wetherell JL. Effects of Mindfulness Training and Exercise on Cognitive Function in Older Adults: A Randomized Clinical Trial. JAMA 2022; 328:2218-2229. [PMID: 36511926 PMCID: PMC9856438 DOI: 10.1001/jama.2022.21680] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Episodic memory and executive function are essential aspects of cognitive functioning that decline with aging. This decline may be ameliorable with lifestyle interventions. OBJECTIVE To determine whether mindfulness-based stress reduction (MBSR), exercise, or a combination of both improve cognitive function in older adults. DESIGN, SETTING, AND PARTICIPANTS This 2 × 2 factorial randomized clinical trial was conducted at 2 US sites (Washington University in St Louis and University of California, San Diego). A total of 585 older adults (aged 65-84 y) with subjective cognitive concerns, but not dementia, were randomized (enrollment from November 19, 2015, to January 23, 2019; final follow-up on March 16, 2020). INTERVENTIONS Participants were randomized to undergo the following interventions: MBSR with a target of 60 minutes daily of meditation (n = 150); exercise with aerobic, strength, and functional components with a target of at least 300 minutes weekly (n = 138); combined MBSR and exercise (n = 144); or a health education control group (n = 153). Interventions lasted 18 months and consisted of group-based classes and home practice. MAIN OUTCOMES AND MEASURES The 2 primary outcomes were composites of episodic memory and executive function (standardized to a mean [SD] of 0 [1]; higher composite scores indicate better cognitive performance) from neuropsychological testing; the primary end point was 6 months and the secondary end point was 18 months. There were 5 reported secondary outcomes: hippocampal volume and dorsolateral prefrontal cortex thickness and surface area from structural magnetic resonance imaging and functional cognitive capacity and self-reported cognitive concerns. RESULTS Among 585 randomized participants (mean age, 71.5 years; 424 [72.5%] women), 568 (97.1%) completed 6 months in the trial and 475 (81.2%) completed 18 months. At 6 months, there was no significant effect of mindfulness training or exercise on episodic memory (MBSR vs no MBSR: 0.44 vs 0.48; mean difference, -0.04 points [95% CI, -0.15 to 0.07]; P = .50; exercise vs no exercise: 0.49 vs 0.42; difference, 0.07 [95% CI, -0.04 to 0.17]; P = .23) or executive function (MBSR vs no MBSR: 0.39 vs 0.31; mean difference, 0.08 points [95% CI, -0.02 to 0.19]; P = .12; exercise vs no exercise: 0.39 vs 0.32; difference, 0.07 [95% CI, -0.03 to 0.18]; P = .17) and there were no intervention effects at the secondary end point of 18 months. There was no significant interaction between mindfulness training and exercise (P = .93 for memory and P = .29 for executive function) at 6 months. Of the 5 prespecified secondary outcomes, none showed a significant improvement with either intervention compared with those not receiving the intervention. CONCLUSIONS AND RELEVANCE Among older adults with subjective cognitive concerns, mindfulness training, exercise, or both did not result in significant differences in improvement in episodic memory or executive function at 6 months. The findings do not support the use of these interventions for improving cognition in older adults with subjective cognitive concerns. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02665481.
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Affiliation(s)
- Eric J. Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Michelle Voegtle
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - J. Philip Miller
- Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - David A. Balota
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Deanna Barch
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Colin A. Depp
- VA San Diego Healthcare System Mental Health Division, San Diego, California
- Department of Psychiatry, University of California, San Diego
| | - Breno Satler Diniz
- The University of Connecticut Center on Aging & Department of Psychiatry, University of Connecticut School of Medicine, Farmington
| | - Lisa T. Eyler
- VA San Diego Healthcare System Mental Health Division, San Diego, California
- Department of Psychiatry, University of California, San Diego
| | - Erin R. Foster
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Torie R. Gettinger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Denise Head
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Tamara Hershey
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Samuel Klein
- Department of Medicine and Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri
| | - Jeanne F. Nichols
- Herbert Wertheim School of Public Health, University of California, San Diego
| | - Ginger E. Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Tomoyuki Nishino
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Bruce W. Patterson
- The University of Connecticut Center on Aging & Department of Psychiatry, University of Connecticut School of Medicine, Farmington
| | - Thomas L. Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Julie Schweiger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - David R. Sinacore
- Department of Physical Therapy, High Point University, High Point, North Carolina
| | - Abraham Z. Snyder
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Susan Tate
- Health Sciences, University of California, San Diego
| | - Elizabeth W. Twamley
- Department of Psychiatry, University of California, San Diego
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
| | - David Wing
- Herbert Wertheim School of Public Health, University of California, San Diego
| | - Gregory F. Wu
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Lei Yang
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Michael D. Yingling
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System Mental Health Division, San Diego, California
- Department of Psychiatry, University of California, San Diego
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29
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Morgan O, Strassnig MT, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Accuracy of immediate self-assessment of neurocognitive test performance: Associations with psychiatric diagnosis and longitudinal psychotic symptoms. J Psychiatr Res 2022; 156:594-601. [PMID: 36372002 PMCID: PMC9899150 DOI: 10.1016/j.jpsychires.2022.10.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/16/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Participants with schizophrenia (SCZ) and bipolar disorder (BD) have challenges in self-evaluation of their cognitive and functional abilities, referred to as introspective accuracy (IA). Although psychotic symptoms are commonly found to be uncorrelated with cognitive performance, many models of the development of delusions focus on failures in self-assessment and responses biases during momentary monitoring. We performed a single 4-test cognitive assessment on 240 participants (schizophrenia n = 126; bipolar disorder n = 114) and asked them to make a judgment about their performance immediately after completion of each task. We related performance and these judgments to results of Ecological Momentary Assessments (EMA) of the momentary occurrence of psychotic symptoms (Voices, paranoid ideas, other delusions) collected over up to 90 surveys over a 30 days prior to the single cognitive assessment. We examined test performance and the accuracy of self-assessment at that assessment, looking at diagnostic differences in performance and mis-estimation of performance. Participants with bipolar disorder had better cognitive performance, but there were no differences in mis-estimation. Analyses of the correlation between cognitive performance and self-assessment were all significant and better cognitive performance predicted reduced errors in self-assessment. Examination of the 30-day course of psychotic symptoms and IA could only be performed in participants with schizophrenia, revealing correlations between more common occurrences of all three psychotic symptoms and increased absolute values for IA errors. These data are consistent with theories of cognitive response biases and the formation of delusions.
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Affiliation(s)
- Orly Morgan
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL, 33136, USA
| | - Martin T Strassnig
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL, 33136, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert A Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL, 33136, USA; Research Service, Miami VA Healthcare System, Miami, FL, USA.
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Martinuzzi LJ, Strassnig MT, Depp CA, Moore RC, Ackerman R, Pinkham AE, Harvey PD. A closer look at avolition in schizophrenia and bipolar disorder: Persistence of different types of activities over time. Schizophr Res 2022; 250:188-195. [PMID: 36436498 PMCID: PMC9810384 DOI: 10.1016/j.schres.2022.11.019] [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: 09/14/2021] [Revised: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Avolition is associated cross-diagnostically with extensive functional impairment. Participants with schizophrenia and bipolar disorder (BD) engage in fewer productive activities than healthy controls, with more sedentary activities such as sitting. We examined the temporal variability in activities of participants with schizophrenia and bipolar disorder, focusing on persistence of activities and the likelihood of performing more than one activity at a time. METHODS 101 participants with schizophrenia and 76 participants with BD were sampled 3 times per day for 30 days utilizing Ecological Momentary Assessment surveys. Each survey queried current activities along with questions about who they were with and if they were home or away and moods. We separated activities into productive, unproductive, or passive recreational categories. RESULTS Participants with schizophrenia and bipolar disorder reported one activity on most surveys, with that activity commonly being passive or unproductive. No participant reported engaging in more than one productive activity. Productive activities were more likely to occur away from home, with 17 % of surveys from home reporting productive activities. All three activities were persistent, but passive and unproductive activities were more likely than productive activities to be persistent at home. Negative mood states predicted unproductive and passive activities in BD participants only. DISCUSSION The low numbers of activities, combined with persistence of unproductive and passive activities highlights the impact of avolition. Most persistent activities reflected sedentary behavior. People with schizophrenia or bipolar disorder may benefit from interventions targeting leaving home more often to improve their general levels of functioning and overall health.
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Affiliation(s)
| | - Martin T Strassnig
- Department of Psychiatry, University of Miami Miller School of Medicine, USA
| | - Colin A Depp
- Department of Psychiatry UCSD Medical Center, USA; San Diego VA Healthcare System, USA
| | | | - Robert Ackerman
- Department of Psychology, University of Texas at Dallas, USA
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, USA; Department of Psychiatry, UT Southwestern Medical Center, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
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Harvey PD, Depp CA, Rizzo AA, Strauss GP, Spelber D, Carpenter LL, Kalin NH, Krystal JH, McDonald WM, Nemeroff CB, Rodriguez CI, Widge AS, Torous J. Technology and Mental Health: State of the Art for Assessment and Treatment. Am J Psychiatry 2022; 179:897-914. [PMID: 36200275 DOI: 10.1176/appi.ajp.21121254] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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
Technology is ubiquitous in society and is now being extensively used in mental health applications. Both assessment and treatment strategies are being developed and deployed at a rapid pace. The authors review the current domains of technology utilization, describe standards for quality evaluation, and forecast future developments. This review examines technology-based assessments of cognition, emotion, functional capacity and everyday functioning, virtual reality approaches to assessment and treatment, ecological momentary assessment, passive measurement strategies including geolocation, movement, and physiological parameters, and technology-based cognitive and functional skills training. There are many technology-based approaches that are evidence based and are supported through the results of systematic reviews and meta-analyses. Other strategies are less well supported by high-quality evidence at present, but there are evaluation standards that are well articulated at this time. There are some clear challenges in selection of applications for specific conditions, but in several areas, including cognitive training, randomized clinical trials are available to support these interventions. Some of these technology-based interventions have been approved by the U.S. Food and Drug administration, which has clear standards for which types of applications, and which claims about them, need to be reviewed by the agency and which are exempt.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Colin A Depp
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Albert A Rizzo
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Gregory P Strauss
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - David Spelber
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Linda L Carpenter
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Ned H Kalin
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - John H Krystal
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - William M McDonald
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Charles B Nemeroff
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Carolyn I Rodriguez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Alik S Widge
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - John Torous
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
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Chalker SA, Parrish EM, Martinez Ceren CS, Depp CA, Ilgen MA, Goodman M, Twamley EW, Doran N. Crisis service utilization following completion of a suicide safety plan for Veterans with and without affective and nonaffective psychosis. J Psychiatr Res 2022; 154:219-223. [PMID: 35961177 DOI: 10.1016/j.jpsychires.2022.07.034] [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: 05/12/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Psychosis is associated with increased suicide risk. Safety planning is a suicide prevention practice that is associated with decreased suicidal behavior and psychiatric hospitalizations. A common feature of safety planning is listing of crisis line numbers. The primary purpose of this study was to compare Veterans with and without psychosis who completed a safety plan in terms of their next year crisis service use, including Veterans Crisis Line (VCL) calls, and suicidal behavior. METHODS Data were drawn from the VA San Diego's electronic medical record system for (N = 1602) safety plans from 2018 to 2021. Clinical records of crisis services and suicide attempt/death were recorded for one year after the safety plan. RESULTS Following completion of a safety plan, Veterans with psychosis were more likely to have a next year psychiatric hospitalization (OR = 4.1), emergency department visit (OR = 2.3), and psychiatric emergency clinic visit (OR = 2.2) than those without psychosis. In contrast, there were no group differences in likelihood of calling the VCL. CONCLUSIONS Veterans with psychosis who recently completed a safety plan do not show elevated rates of VCL use that are commensurate with increases in crisis service use. Interventions for this high-risk group may focus on understanding the motivation and ability to call the VCL as ways to enhance safety planning.
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Affiliation(s)
- Samantha A Chalker
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA.
| | - Emma M Parrish
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | | | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Mark A Ilgen
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA
| | | | - Elizabeth W Twamley
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Neal Doran
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
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Abstract
BACKGROUND Cognitive tasks delivered during ecological momentary assessment (EMA) may elucidate the short-term dynamics and contextual influences on cognition and judgements of performance. This paper provides initial validation of a smartphone task of facial emotion recognition in serious mental illness. METHODS A total of 86 participants with psychotic disorders (non-affective and affective psychosis), aged 19-65, were administered in-lab 'gold standard' affect recognition, neurocognition, and symptom assessments. They subsequently completed 10 days of the mobile facial emotion recognition task, assessing both accuracy and self-assessed performance, along with concurrent EMA of psychotic symptoms and mood. Validation focused on task adherence and predictors of adherence, gold standard convergent validity, and symptom and diagnostic group variation. RESULTS The mean rate of adherence to the task was 79%; no demographic or clinical variables predicted adherence. Convergent validity was observed with in-lab measures of facial emotion recognition, and no practice effects were observed on the mobile facial emotion recognition task. EMA reports of more severe voices, sadness, and paranoia were associated with worse performance, whereas mood more strongly associated with self-assessed performance. CONCLUSION The mobile facial emotion recognition task was tolerated and demonstrated convergent validity with in-lab measures of the same construct. Social cognitive performance, and biased judgements previously shown to predict function, can be evaluated in real-time in naturalistic environments.
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Affiliation(s)
- Colin A Depp
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Snigdha Kamarsu
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Tess F Filip
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Emma M Parrish
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Eric L Granholm
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Samantha Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Raeanne C Moore
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Amy Pinkham
- The University of Texas at Dallas, Dallas, TX, USA
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Perez MM, Tercero BA, Durand F, Gould F, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Revisiting how People with Schizophrenia Spend Their Days: Associations of lifetime milestone Achievements with Daily Activities examined with Ecological Momentary Assessment. Psychiatry Res Commun 2022; 2:100060. [PMID: 36118412 PMCID: PMC9477426 DOI: 10.1016/j.psycom.2022.100060] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Milestone achievements are reduced in people with schizophrenia and are lower in comparison to people with bipolar disorder. However, it is not clear what the implications are for engagement in momentary activities based on milestone achievements. Further, some recent research has suggested that psychotic symptoms are associated with challenges in self-assessment of activities, but there is less information about the correlations of milestone achievements and ongoing psychotic symptoms. We examined momentary activities and symptoms as a function of lifetime milestone achievement in 102 individuals with schizophrenia and 71 with bipolar disorder. Ecological Momentary Assessment (EMA) was used to sample daily activities and concurrent symptoms 3 times per day for 30 days. Each survey asked the participant where they were, who they were with, and what they were doing, as well as sampling the concurrent presence of psychotic symptoms. Not being financially responsible for their residence was associated with engaging in fewer productive activities. Participants who never had a relationship were more commonly home and alone and engaged in fewer social interactions. A lifetime history of employment was correlated with engaging in more productive activities, including at home. More common momentary psychosis was seen in participants who failed to achieve each of the functional milestones. Lifetime milestone achievements were associated with greater frequencies of productive behaviors and with fewer momentary experiences of psychosis, suggesting that psychotic symptoms may have importance for sustaining disability that would be challenging to detect without momentary information.
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Affiliation(s)
- Michelle M. Perez
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Bianca A. Tercero
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | | | - Felicia Gould
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Robert A. Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
- Research Service, Miami VA Healthcare System, Miami, FL, USA
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Romanowska S, Best MW, Bowie CR, Depp CA, Patterson TL, Penn DL, Pinkham AE, Harvey PD. Examining the association of life course neurocognitive ability with real-world functioning in schizophrenia-spectrum disorders. Schizophr Res Cogn 2022; 29:100254. [PMID: 35521291 PMCID: PMC9062312 DOI: 10.1016/j.scog.2022.100254] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/27/2022] Open
Abstract
There is considerable variability in neurocognitive functioning within schizophrenia-spectrum disorders, and neurocognitive performance ranges from severe global impairment to normative performance. Few investigations of neurocognitive clusters have considered the degree to which deterioration relative to premorbid neurocognitive abilities is related to key illness characteristics. Moreover, while neurocognition and community functioning are strongly related, understanding of the sources of variability in the association between these two domains is also limited; it is unknown what proportion of participants would over-perform or under-perform the level of functioning expected based on current neurocognitive performance vs. lifelong attainment. This study examined data from 954 outpatients with schizophrenia-spectrum disorders across three previous studies. Neurocognition, community functioning, and symptoms were assessed. Neurocognitive subgroups were created based on current neurocognition, estimated premorbid IQ, and degree of deterioration from premorbid using z-score cut-offs; functional subgroups were created with cluster analysis based on the Specific Level of Functioning Scale and current neurocognition. The sample was neurocognitively heterogeneous; 65% displayed current neurocognitive impairment and 84% experienced some level of deterioration. Thirty percent of our sample was relatively higher functioning despite significant neurocognitive impairment. Individuals with better community functioning, regardless of neurocognitive performance, had lower symptom severity compared to those with worse functioning. These results highlight the variability in neurocognition and its role in functioning. Understanding individual differences in neurocognitive and functional profiles and the interaction between prior and current cognitive functioning can guide individualized treatment and selection of participants for clinical treatment studies.
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Affiliation(s)
- Sylvia Romanowska
- Department of Psychological Science, University of Toronto Scarborough, Toronto, ON, Canada
| | - Michael W Best
- Department of Psychological Science, University of Toronto Scarborough, Toronto, ON, Canada
| | | | - Colin A Depp
- Department of Psychiatry, UCSD Medical Center, La Jolla, CA, United States.,San Diego VA Healthcare System, San Diego, CA, United States
| | - Thomas L Patterson
- Department of Psychiatry, UCSD Medical Center, La Jolla, CA, United States
| | - David L Penn
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, Dallas, TX, United States.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami VA Healthcare System, United States
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Harvey CD, C Moore R, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. The association of momentary sad moods, concurrent productive behaviour, and global functional outcomes: a 30-day ecological momentary assessment study of people with bipolar illness. Cogn Neuropsychiatry 2022; 27:342-355. [PMID: 35499098 DOI: 10.1080/13546805.2022.2070464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/03/2022]
Abstract
BACKGROUND Previous weekly sampling studies found that persistent sad moods are associated with disability in bipolar illness. However, those data were collected retrospectively. We examined the momentary quality of activities (productive, unproductive, and passive recreation) in an ecological momentary assessment (EMA) study and related sadness at each survey to quality of momentary activities and overall everyday functioning. METHODS Participants with bipolar illness (N = 91) were sampled three times per day for 30 days. Each survey queried participants as to where they were, with whom, what they were doing, and their mood state. Activities were characterised according to predetermined criteria and related to momentary sadness. Observer ratings of everyday functioning were related to daily reports of sadness and activities. RESULTS Sadness was associated with the quality of activities. Momentary reports of unproductive activities were associated with the most sadness (p < .001), followed by passive recreation, and productive activities. Momentary sadness and momentary unproductive activities correlated with observer ratings of competence in work, everyday activities, and social outcomes (p < .001). Using both predictors led to the best model. CONCLUSIONS This study on the course of sad moods in people with bipolar illness to EMA found that momentary sadness correlatesdwith the quality of concurrent activities and that both sadness and the quality of everyday activities predicted observer ratings of everyday functioning. Although we cannot determine the causal direction, these findings support the hypothesis that momentary sadness leads to reductions in productive activities and impairments in everyday functioning.
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Affiliation(s)
| | | | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA.,San Diego VA Medical Center, La Jolla, CA
| | | | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX.,University of Texas Southwestern Medical Center, Dallas, TX
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL.,Bruce W. Carter VA Medical Center, Miami, FL
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Klaus F, Peek E, Quynh A, Sutherland AN, Selvam D, Moore RC, Depp CA, Eyler LT. Mobile survey engagement by older adults is high during multiple phases of the COVID-19 pandemic and is predicted by baseline and structural factors. Front Digit Health 2022; 4:920706. [PMID: 36082232 PMCID: PMC9445303 DOI: 10.3389/fdgth.2022.920706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Digital surveys, such as mobile phone ecological momentary assessment (EMA), bear the potential to assess and target individual wellbeing in a personalized, real-time approach and allow for interaction in situations when in-person contact is not possible, such as during the coronavirus pandemic. While the use of digital technology might especially benefit research in older adults who find themselves in circumstances of reduced mobility, little is known about their barriers to adherence. We investigated baseline and structural factors that predict study withdrawal and adherence from daily smartphone EMA self-report surveys in the StayWELL Study. The StayWELL study is a longitudinal, observational study on the relationship between social restrictions during the coronavirus pandemic and mental well-being in 95 community-dwelling older aged adults (67–87 years) who were participants in a randomized clinical trial using EMA. Withdrawal was associated with less research staff changes and less likely in participants that reached the study mid-point. No baseline characteristics predicted withdrawal. Main reasons for withdrawal were communication issues, i.e. staff not being able to contact participants. We found an adherence rate of 82% and no fatigue effects. Adherence was predicted by education status, study participation duration, reaching the study midpoint and time between study start and enrollment. COVID infections or supporting people in the household was not related to adherence. To conclude, it is feasible to conduct an EMA study in older people without impacting engagement during a pandemic. Furthermore, personal characteristics and smartphone operating system (Android vs. iOS) used did not relate to engagement, allowing for a broad distribution of digital health technologies. Our study adds information on single predictive variables relevant for adherence and withdrawal from EMA smartphone surveys in older people that can inform the design of future digital EMA research to maximize engagement and reliability of study results.
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Affiliation(s)
- Federica Klaus
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- Correspondence: Federica Klaus
| | - Elizabeth Peek
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Avery Quynh
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Ashley N. Sutherland
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), La Jolla, CA, United States
| | - Divya Selvam
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Raeanne C. Moore
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Colin A. Depp
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), La Jolla, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), La Jolla, CA, United States
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Moore RC, Ackerman RA, Russell MT, Campbell LM, Depp CA, Harvey PD, Pinkham AE. Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment. Front Digit Health 2022; 4:946685. [PMID: 35990012 PMCID: PMC9390883 DOI: 10.3389/fdgth.2022.946685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
It is critical to intervene early in the mild cognitive impairment (MCI) stage of the Alzheimer's disease trajectory, but traditional cognitive testing methods are costly, burdensome, and difficult to access. We examined adherence and validity data to a 30-day self-administered ecological momentary cognitive testing protocol among a sample of older adults with MCI and cognitively normal controls to evaluate feasibility, tolerability, and initial validity in comparison to standard neuropsychological tests. Participants included 48 participants with MCI (Mean age = 72 years, SD = 7 years) and 46 demographically-matched cognitively normal (NC) control participants (Mean age = 70 years, SD = 7 years). Participants completed traditional neuropsychological testing to determine MCI status, followed by 30 days of remote ecological momentary cognitive testing. Ecological momentary assessment (EMA) surveys were administered 3 times per day for 30 days (possible total = 90), and mobile cognitive tests were administered every other day (for a total of 15 administrations). Mobile cognitive tests included the Variable Difficulty List Memory Test (VLMT; measure of learning and memory), Memory Matrix (measure of visual working memory), and the Color Trick Test (measure of executive function). EMA and mobile cognitive test adherence, fatigue effects, mobile cognitive test performance and group differences, and psychometrics (reliability, convergent validity, ceiling effects, and practice effects) were examined. Overall mean-level adherence to the mobile cognitive tests was 85% and did not differ by MCI status. The reliability of stable between-person individual differences for the VLMT and Memory Matrix were very high. Moreover, although the reliability of within-person change for Memory Matrix was adequate, the corresponding reliability for VLMT was somewhat low. Averaged performance on the mobile cognitive tests was correlated with lab-based tests measuring the same construct. Participants with MCI performed worse than NCs on the VLMT and Color Trick Test, and there was no evidence of fatigue effects for these two tests. These findings support the feasibility and potential for ecological momentary cognitive testing to support clinical trials and for measuring cognitive changes over time in persons with increased risk for Alzheimer's disease such as those with MCI.
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Affiliation(s)
- Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Correspondence: Raeanne C. Moore
| | - Robert A. Ackerman
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Madisen T. Russell
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Laura M. Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Colin A. Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Philip D. Harvey
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States
| | - Amy E. Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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Moore RC, Parrish EM, Van Patten R, Paolillo E, Filip TF, Bomyea J, Lomas D, Twamley EW, Eyler LT, Depp CA. Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study. J Med Internet Res 2022; 24:e36665. [PMID: 35904876 PMCID: PMC9377465 DOI: 10.2196/36665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/25/2022] [Accepted: 05/29/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND As smartphone technology has become nearly ubiquitous, there is a growing body of literature suggesting that ecological momentary cognitive testing (EMCT) offers advantages over traditional pen-and-paper psychological assessment. We introduce a newly developed platform for the self-administration of cognitive tests in ecologically valid ways. OBJECTIVE The aim of this study is to develop a Health Insurance Portability and Accountability Act-compliant EMCT smartphone-based platform for the frequent and repeated testing of cognitive abilities in everyday life. This study examines the psychometric properties of 7 mobile cognitive tests covering domains of processing speed, visual working memory, recognition memory, and response inhibition within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses. METHODS A total of 45 persons with BD and 21 demographically comparable healthy volunteer participants (aged 18-65 years) completed smartphone-based EMCTs 3 times daily for 14 days. Each EMCT session lasted approximately 1.5 minutes. Only 2 to 3 tests were administered in any given session, no test was administered more than once per day, and alternate test versions were administered in each session. RESULTS The mean adherence to the EMCT protocol was 69.7% (SD 20.5%), resulting in 3965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. The average performances on most EMCTs were moderately to strongly correlated with the National Institutes of Health Toolbox Cognition Battery. Practice effects were observed in 5 tests, with significant differences in practice effects by BD status in 3 tests. CONCLUSIONS Although additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment of cognitive performance in real-world contexts in BD.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Emma M Parrish
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Ryan Van Patten
- Psychiatry and Human Behavior, Brown University, Providence, RI, United States
- Providence VA Medical Center, Providence, RI, United States
| | - Emily Paolillo
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Tess F Filip
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Jessica Bomyea
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Derek Lomas
- Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
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Gohari E, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Momentary severity of psychotic symptoms predicts overestimation of competence in domains of everyday activities and work in schizophrenia: An ecological momentary assessment study. Psychiatry Res 2022; 310:114487. [PMID: 35245835 PMCID: PMC9119309 DOI: 10.1016/j.psychres.2022.114487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/29/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Schizophrenia participants generate self-reports of their competencies that differ from objective information. They may base their reports on momentary moods or experiences rather than objective data. Theories of delusion formation implicate overconfidence during self-assessment as a cause. METHODS Ecological momentary assessment (EMA) was used to sample activities and experiences in 101 participants with schizophrenia up to 3 times a day for 30 days. Each survey asked where and with whom they were, what they were doing, and moods and psychotic symptoms they were experiencing. Self-reports and observer ratings of competence in work and everyday activities were collected. RESULTS Being home was associated with self-reports of better functioning in activities and work skills (p<.001) and being alone correlated with better self-reported functioning in activities (p<.001). Participants who reported more occurrences of hearing voices, paranoid ideation, and other psychotic symptoms reported their functioning as better (p<.001). IMPLICATIONS Schizophrenia was marked by a disconnect between momentary activities and self-assessments. Being home more was associated with better self-reported functioning on tasks that are only performed away from home. Psychotic symptoms were associated with overestimation, consistent with previous theories positing that overconfidence and suspension of plausibility assessment may be associated with psychotic experiences.
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Affiliation(s)
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Robert A Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 United States; Research Service, Miami VA Healthcare System, Miami, FL, United States.
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41
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Russell MT, Funsch KM, Springfield CR, Ackerman RA, Depp CA, Harvey PD, Moore RC, Pinkham AE. Validity of remote administration of the MATRICS Consensus Cognitive Battery for individuals with severe mental illness. Schizophr Res Cogn 2022; 27:100226. [PMID: 34934639 PMCID: PMC8655110 DOI: 10.1016/j.scog.2021.100226] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 10/25/2022]
Abstract
The MATRICS Consensus Cognitive Battery (MCCB) is a gold-standard tool for assessing cognitive functioning in individuals with severe mental illness. This study is an initial examination of the validity of remote administration of 4 MCCB tests measuring processing speed (Trail Making Test: Part A, Animal Fluency), working memory (Letter-Number Span), and verbal learning and memory (Hopkins Verbal Learning Test-Revised). We conducted analyses on individuals with bipolar disorder (BD) and schizophrenia-spectrum disorders (SCZ), as well as healthy volunteers, who were assessed in-person (BD = 80, SCZ = 116, HV = 14) vs. remotely (BD = 93, SCZ = 43, HV = 30) to determine if there were significant differences in performance based on administration format. Additional analyses tested whether remote and in-person assessment performance was similarly correlated with symptom severity, cognitive and social cognitive performance, and functional outcomes. Individuals with BD performed significantly better than those with SCZ on all MCCB subtests across administration format. Animal Fluency did not differ by administration format, but remote participants performed significantly worse on Trail Making and HVLT-R. On the Letter-Number Span task, individuals with bipolar disorder performed significantly better when participating remotely. Finally, patterns of correlations with related constructs were largely similar between administration formats. Thus, results suggest that remote administration of some of the MCCB subtests may be a valid alternative to in-person testing, but more research is necessary to determine why some tasks were affected by administration format.
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Affiliation(s)
- Madisen T Russell
- Department of Psychology, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX 75080, United States of America
| | - Kensie M Funsch
- Department of Psychology, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX 75080, United States of America
| | - Cassi R Springfield
- Department of Psychology, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX 75080, United States of America
| | - Robert A Ackerman
- Department of Psychology, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX 75080, United States of America
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States of America.,Research Service, Bruce W. Carter VA Medical Center, Miami, FL 33136, United States of America
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX 75080, United States of America
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Badal VD, Lee EE, Daly R, Parrish EM, Kim HC, Jeste DV, Depp CA. Dynamics of Loneliness Among Older Adults During the COVID-19 Pandemic: Pilot Study of Ecological Momentary Assessment With Network Analysis. Front Digit Health 2022; 4:814179. [PMID: 35199099 PMCID: PMC8859335 DOI: 10.3389/fdgth.2022.814179] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has had potentially severe psychological implications for older adults, including those in retirement communities, due to restricted social interactions, but the day-to-day experience of loneliness has received limited study. We sought to investigate sequential association, if any, between loneliness, activity, and affect. METHODS We used ecological momentary assessment (EMA) with dynamic network analysis to investigate the affective and behavioral concomitants of loneliness in 22 residents of an independent living sector of a continuing care retirement community (mean age 80.2; range 68-93 years). RESULTS Participants completed mean 83.9% of EMA surveys (SD = 16.1%). EMA ratings of loneliness were moderately correlated with UCLA loneliness scale scores. Network models showed that loneliness was contemporaneously associated with negative affect (worried, anxious, restless, irritable). Negative (but not happy or positive) mood tended to be followed by loneliness and then by exercise or outdoor physical activity. Negative affect had significant and high inertia (stability). CONCLUSIONS The data suggest that EMA is feasible and acceptable to older adults. EMA-assessed loneliness was moderately associated with scale-assessed loneliness. Network models in these independent living older adults indicated strong links between negative affect and loneliness, but feelings of loneliness were followed by outdoor activity, suggesting adaptive behavior among relatively healthy adults.
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Affiliation(s)
- Varsha D Badal
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Rebecca Daly
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Emma M Parrish
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Ho-Cheol Kim
- AI and Cognitive Software, International Business Machines (IBM) Research-Almaden, San Jose, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA, United States
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Keller AV, Clark JMR, Muller-Cohn CM, Jak AJ, Depp CA, Twamley EW. Suicidal ideation in Iraq and Afghanistan veterans with mental health conditions at risk for homelessness. Am J Orthopsychiatry 2021; 92:103-108. [PMID: 34914414 DOI: 10.1037/ort0000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Suicide prevention among Veterans is a national priority. Overlap exists between conditions that may increase risk for suicide (e.g., mental health conditions, financial stressors, lack of social support) and homelessness among Veterans. We examined predictors of variance in suicidal ideation (SI) among 58 Iraq/Afghanistan Veterans at risk for homelessness who were receiving residential mental health treatment. Participants were classified as SI nonendorsers (n = 36) or SI endorsers (n = 22), based on their Patient Health Questionnaire-9 (PHQ-9) responses. Independent t tests and chi-square tests were used to examine group differences on baseline demographic variables, neuropsychological measures, and emotional/physical health symptom measures. Compared to nonendorsers, SI endorsers were significantly younger and reported less Veterans Affairs (VA) disability income, less total monthly income, less physical pain, lower quality of life overall and in the psychological health domain, lower community reintegration satisfaction, and more severe anxiety. Groups did not significantly differ on cognitive measures. A subsequent logistic regression revealed that only younger age uniquely predicted variance in SI endorsement. Younger age may be a particularly important factor to consider when assessing suicide risk in Veterans at risk for homelessness. Identifying predictors of variance in SI may help inform future treatment and suicide prevention efforts for Veterans at risk for homelessness. Future longitudinal research examining predictors of suicidality is warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Amber V Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
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44
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Jones SE, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Daily Ecological Momentary Assessments of happy and sad moods in people with schizophrenia and bipolar disorders: What do participants who are never sad think about their activities and abilities? Schizophr Res Cogn 2021; 26:100202. [PMID: 34189061 PMCID: PMC8219985 DOI: 10.1016/j.scog.2021.100202] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 10/26/2022]
Abstract
OBJECTIVES People with schizophrenia have challenges in their self-assessments of everyday functioning and those who report no sadness also tend to overestimate their everyday functional abilities. While previous studies were cross-sectional, this study related longitudinal assessments of sadness to self-reports of abilities in domains of everyday functioning and cognitive abilities. METHODS 71 people with bipolar illness (BPI) were compared to 102 people with schizophrenia (SCZ). Participants were sampled 3 times per day for 30 days with a smartphone-based Ecological Momentary Assessment (EMA) survey. Each survey asked where they were, with whom they were, what they were doing, and if they were sad. Performance based assessments of executive functioning, social competence, and everyday activities were collected after the EMA period, at which time the participants and observers were asked to provide ratings of three different domains of everyday functioning and neurocognitive ability. RESULTS 18% of participants with SCZ reported that they were never sad on any one of the 90 EMA surveys. Reports of never being sad were associated with overestimated functioning compared to observers and SCZ participants who reported that they were never sad were more commonly home and alone than both SCZ participants who reported occasional sadness and participants with BPI. These participants reported being significantly happier than all people in the study. IMPLICATIONS Reporting that you were never sad was associated with overestimation of everyday functioning and cognitive abilities. Although participants who were never sad did not perform more poorly on objective measures than those were occasionally sad, their self-assessed functioning was significantly elevated. These data suggest that negative symptoms constructs such as reduced emotional experience need to consider reduced ability to subjectively evaluate emotional experience as a feature of negative symptoms.
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Affiliation(s)
- Sara E. Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Colin A. Depp
- UCSD Health Sciences Center, La Jolla, CA, USA
- San Diego VA Medical Center, La Jolla, CA, USA
| | | | - Amy E. Pinkham
- University of Texas at Dallas, Richardson, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA
- Bruce W. Carter VA Medical Center, Miami, FL, USA
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45
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Ehret BC, Treichler EBH, Ehret PJ, Chalker SA, Depp CA, Perivoliotis D. Designed and created for a veteran by a veteran: A pilot study of caring cards for suicide prevention. Suicide Life Threat Behav 2021; 51:872-881. [PMID: 33998035 DOI: 10.1111/sltb.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/25/2020] [Revised: 12/14/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This pilot study investigates feasibility and acceptability of Caring Cards, a suicide prevention intervention inspired by Caring Contacts and the Recovery Model, where Veteran peers create cards that are sent to Veterans recently discharged from a VA psychiatric hospitalization for suicide risk. METHODS Caring Cards consists of: (1) a weekly outpatient group where Veterans (card makers) create cards, and (2) sending cards to recently discharged Veterans (card recipients). Feasibility for card makers was measured by attendance; acceptability (satisfaction) was examined. Card recipients were sent one caring card, one week post-discharge. Feasibility for recipients was measured by the percentage of Veterans that met eligibility and follow-up response rate; acceptability (satisfaction) was examined. RESULTS Caring Cards is feasible and acceptable. The outpatient group had a higher attendance rate (81%) compared with other clinic groups. The percentage of eligible card recipients was 61%. Of these, 69% were reached for follow-up and 50% provided follow-up responses. Card makers and recipients both expressed positive experiences with Caring Cards. CONCLUSION Caring Cards is a low-intensity, feasible, and acceptable intervention with potential benefits for both Veteran card makers and recipients. Additional research is needed to determine the efficacy of Caring Cards as a suicide prevention intervention.
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Affiliation(s)
- Blaire C Ehret
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Emily B H Treichler
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Los Angeles, VA, USA
| | - Phillip J Ehret
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA
| | - Samantha A Chalker
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Dimitri Perivoliotis
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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46
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Miller ML, Strassnig MT, Bromet E, Depp CA, Jonas K, Lin W, Moore RC, Patterson TL, Penn DL, Pinkham AE, Kotov RA, Harvey PD. Performance-based assessment of social skills in a large sample of participants with schizophrenia, bipolar disorder and healthy controls: Correlates of social competence and social appropriateness. Schizophr Res 2021; 236:80-86. [PMID: 34425381 PMCID: PMC10857848 DOI: 10.1016/j.schres.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/25/2021] [Revised: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Performance-based assessments of social skills have detected impairments in people with severe mental illness and are correlated with functional outcomes in people with schizophrenia and bipolar disorder. The most common of these assessments, the Social Skills Performance Assessment (SSPA), has two communication scenarios and items measuring both social competence and appropriateness. As real-world competence and appropriateness appear to have different correlates, we hypothesized that SSPA Items measuring competence and appropriateness would be distinct and have different correlations with other outcomes. METHODS We aggregated data from 557 people with schizophrenia, 106 with bipolar disorder, and 378 well controls from 4 separate research studies. All participants were assessed with both SSPA scenarios and other performance based and clinician-rated measures. A single expert rated the SSPA interactions for competence and appropriateness while blind to participant diagnoses. RESULTS Participants with bipolar disorder and schizophrenia performed more poorly on every item of the SSPA than healthy controls. Items measuring social competence and appropriateness in communication were intercorrelated across scenarios, as were elements of socially competent communication, although the items measuring competence did not correlate substantially with appropriateness. Items assessing social competence, but not social appropriateness, correlated with better cognitive and functional performance and residential and financial independence. DISCUSSION Social competence and social appropriateness were distinct elements of performance-based social skills with potential differences in their functional correlates. As both social competence and appropriateness impact functional outcomes, improvement in the measurement and treatment of appropriate communication seems to be an important goal.
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Affiliation(s)
- Michelle L Miller
- Department of Psychiatry, University of Miami Miller School of Medicine, USA
| | - Martin T Strassnig
- Department of Psychiatry, University of Miami Miller School of Medicine, USA
| | - Evelin Bromet
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | - Colin A Depp
- Department of Psychiatry UCSD Medical Center, USA; San Diego VA Healthcare System, USA
| | - Katherine Jonas
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | - Wenxuan Lin
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | | | | | - David L Penn
- Department of Psychology, University of North Carolina at Chapel Hill, USA; School of Psychology, Australian Catholic University, Australia
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, USA; Department of Psychiatry, UT Southwestern Medical Center, USA
| | - Roman A Kotov
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
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47
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Jones SE, Moore RC, Pinkham AE, Depp CA, Granholm E, Harvey PD. A cross-diagnostic study of Adherence to Ecological Momentary Assessment: Comparisons across study length and daily survey frequency find that early adherence is a potent predictor of study-long adherence. ACTA ACUST UNITED AC 2021; 29-30. [PMID: 34541425 DOI: 10.1016/j.pmip.2021.100085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/27/2022]
Abstract
Background Ecological momentary assessment (EMA) offers a highly valid strategy to assess everyday functioning in people with severe mental illness. Adherence is generally good, but several questions regarding the impact of study length, daily density of sampling, and symptom severity on adherence remain. Methods EMA adherence in two separate studies was examined. One sampled participants with schizophrenia (n=106) and healthy controls (n=76) 7 times per day for 7 days and the other sampled participants with schizophrenia (n=104) and participants with bipolar illness (n=76) 3 times per day for 30 days. Participants were asked where they were, who they were with, what they were doing and how they were feeling in both studies. The impact of rates of very early adherence on eventual adherence was investigated across the samples, and adherence rates were examined for associations with mood state and most common location when answering surveys. Results Median levels of adherence were over 80% across the samples, and the 10th percentile for adherence was approximately 45% of surveys answered. Early adherence predicted study-long adherence quite substantially in every sample. Mood states did not correlate with adherence in the patient samples and being home correlated with adherence in only the bipolar sample. Implications Adherence was quite high and was not correlated with the length of the study or the density of sampling per study day. There was a tendency for bipolar participants who were more commonly away from home to answer fewer surveys but overall adherence for the bipolar patients was quite high. These data suggest that early nonadherence is a potential predictor of eventual nonadherence and study noncompletion.
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Affiliation(s)
- Sara E Jones
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX.,University of Texas Southwestern Medical Center, Dallas TX
| | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA.,San Diego VA Medical Center La Jolla, CA
| | - Eric Granholm
- UCSD Health Sciences Center, La Jolla, CA.,San Diego VA Medical Center La Jolla, CA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL.,Bruce W. Carter VA Medical Center, Miami, FL
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48
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Bomyea JA, Parrish EM, Paolillo EW, Filip TF, Eyler LT, Depp CA, Moore RC. Relationships between daily mood states and real-time cognitive performance in individuals with bipolar disorder and healthy comparators: A remote ambulatory assessment study. J Clin Exp Neuropsychol 2021; 43:813-824. [PMID: 34493155 DOI: 10.1080/13803395.2021.1975656] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Neuropsychological impairments are observed in individuals with Bipolar Disorder (BD), yet knowledge of how cognitive deficits unfold in real-time remains limited. Given intraindividual variability in mood observed in people with BD, and the potential for mood and cognition to be mutually influential, we employed ambulatory assessment technologies to examine potential contemporaneous (same survey) and lagged (next survey) relationships of congition and mood. METHODS Outpatients with BD (n = 46) or no psychiatric disorders (heathy volunteers [HV]; n = 20) completed in-laboratory neurobehavioral assessments and 14 days of smartphone-administered mobile cognitive tests and ratings of affective variables. Linear mixed-effects models were used to analyze real-time relationships between mobile cognitive test performance and mood. RESULTS On in-laboratory tests, participants with BD showed worse cognitive performance than HVs as well as mild depression severity; mood and cognitive performance were unrelated. On mobile cognitive tests and surveys, participants with BD showed somewhat worse cognitive performance and ratings of lower energy and greater sadness relative to HV participants. Among those with BD, mania and sadness earlier in the day related to worse processing speed and better working memory performance, respectively, on the next survey. In contrast, same survey ratings of greater stress related to better working memory, and greater happiness related to better processing speed. CONCLUSIONS Real-time assessments of mood and cognition provide incremental information beyond what can be gleaned from laboratory assessments. Understanding how these affect-related changes in processing speed emerge and play out in daily life may provide clinically useful information for treatment planning.
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Affiliation(s)
- Jessica A Bomyea
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Emma M Parrish
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Sdsu/uc San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily W Paolillo
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Sdsu/uc San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Tess F Filip
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lisa T Eyler
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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49
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Kaufmann CN, Lee EE, Wing D, Sutherland AN, Christensen C, Ancoli-Israel S, Depp CA, Yoon HK, Soontornniyomkij B, Eyler LT. Correlates of poor sleep based upon wrist actigraphy data in bipolar disorder. J Psychiatr Res 2021; 141:385-389. [PMID: 34329990 PMCID: PMC8722119 DOI: 10.1016/j.jpsychires.2021.06.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/26/2020] [Revised: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Wrist-worn actigraphy can objectively measure sleep, and has advantages over self-report, particularly for people with Bipolar Disorder (BD) for whom self-reports might be influenced by affect. Clinically useful data reduction approaches are needed to explore these complex data. METHODS We created a composite score of sleep metrics in BD based on 51 BD and 80 healthy comparison (HC) participants. Subjects wore an actigraph for up to 14 consecutive 24-h periods, and we assessed total sleep time (TST), wake after sleep onset (WASO), percent sleep (PS), and number of awakenings (NA). We focused on participants who had at least 5 nights of actigraphy data. We computed z-scores for within-person means of sleep measures for BD subjects versus HCs, which were averaged to create a composite measure. We correlated this composite with participant characteristics, and used LASSO regression to identify sleep measures best explaining variability in identified correlates. RESULTS Sleep measures and the composite did not differ between BDs and HCs; however, there was considerable variability in z-scores among those with BD. In BDs, the composite score was higher in women (t(49) = 2.28, p = 0.027) and those who were employed (t(34) = 2.34, p = 0.025), and positively correlated with medication load (r = 0.41, p = 0.003) while negatively correlated with Young Mania Rating Scale (YMRS; r = -0.35, p = 0.030). In LASSO regression, TST and NA best explained medication load while PS best explained employment and YMRS. CONCLUSION While a composite score of sleep metrics may provide useful information about sleep quality globally, our findings suggest that selection of theory-driven sleep measures may be more clinically meaningful.
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Affiliation(s)
- Christopher N. Kaufmann
- Division of Epidemiology and Data Science in Gerontology, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL,Corresponding Author: Christopher N. Kaufmann, PhD, MHS, Assistant Professor, Division of Epidemiology and Data Science in Gerontology, Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL 32603, P: 323-528-2786,
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA,San Diego VA Healthcare System, La Jolla, CA, USA
| | - David Wing
- Center for Wireless and Population Health Systems, University of California San Diego, La Jolla, CA, USA
| | | | | | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA,San Diego VA Healthcare System, La Jolla, CA, USA
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | | | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
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50
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Kamalyan L, Yang JA, Pope CN, Paolillo EW, Campbell LM, Tang B, Marquine MJ, Depp CA, Moore RC. Increased Social Interactions Reduce the Association Between Constricted Life-Space and Lower Daily Happiness in Older Adults With and Without HIV: A GPS and Ecological Momentary Assessment Study. Am J Geriatr Psychiatry 2021; 29:867-879. [PMID: 33293248 PMCID: PMC8134622 DOI: 10.1016/j.jagp.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/16/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Older persons with human immunodeficiency virus (HIV) (PWH) are particularly susceptible to life-space restrictions. The aims of this study included: 1) using global positioning system (GPS) derived indicators as an assessment of time spent at home among older adults with and without HIV; 2) using ecological momentary assessment (EMA) to examine real-time relationships between life-space, mood (happiness, sadness, anxious), fatigue, and pain; and 3) determining if number of daily social interactions moderated the effect of life-space on mood. METHODS Eighty-eight older adults (PWH n = 54, HIV-negative n = 34) completed smartphone-based EMA surveys assessing mood, fatigue, pain, and social interactions four times per day for two weeks. Participants' smartphones were GPS enabled throughout the study. Mixed-effects regression models analyzed concurrent and lagged associations among life-space and behavioral indicators of health. RESULTS PWH spent more of their time at home (79% versus 70%, z = -2.08; p = 0.04) and reported lower mean happiness (3.2 versus 3.7; z = 2.63; p = 0.007) compared to HIV-negative participants. Controlling for covariates, more daily social interactions were associated with higher ratings of real-time happiness (b = 0.12; t = 5.61; df = 1087.9; p< 0.001). Similar findings were seen in lagged analyses: prior day social interactions (b = 0.15; t = 7.3; df = 1024.9; p < 0.0001) and HIV status (b = -0.48; t = -2.56; df = 1026.8; p = 0.01) attenuated the effect of prior day time spent at home on happiness. CONCLUSION Accounting for engagement in social interactions reduced the significant effect of time spent at home and lower happiness. Interventions targeting social isolation within the context of constricted life-space may be beneficial for increasing positive mood in older adults, and especially relevant to older PWH.
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Affiliation(s)
- Lily Kamalyan
- Department of Psychiatry, University of California, San Diego, San Diego, CA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Jiue-An Yang
- Qualcomm Institute/Calit2, University of California, San Diego, San Diego, CA
| | - Caitlin N. Pope
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY
| | - Emily W. Paolillo
- Department of Psychiatry, University of California, San Diego, San Diego, CA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Laura M. Campbell
- Department of Psychiatry, University of California, San Diego, San Diego, CA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - María J. Marquine
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, San Diego, CA.,VA San Diego Healthcare System, San Diego, CA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA
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