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Bareis N, Tepper MC, Wang R, Tang F, Olfson M, Dixon LB, Kimhy D, Wall MM, Medalia A, Finnerty MT, Anderson A, Smith TE. Engagement of individuals with serious mental illness in outpatient mental health services and telehealth use during the COVID-19 pandemic. Psychiatry Res 2023; 329:115497. [PMID: 37778232 PMCID: PMC10842636 DOI: 10.1016/j.psychres.2023.115497] [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: 07/01/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Questions remain regarding whether the transition and continued use of telehealth was associated with changes in treatment engagement among patients with serious mental illness (SMI). Using NYS Medicaid claims, we identified 116,497 individuals with SMI receiving outpatient mental health services from September 1, 2019-February 28, 2021 and a comparison cohort of 101,995 from September 1, 2017-February 28, 2019 to account for unmeasured and seasonal variation. We characterized engagement in three 6-month increments (T0-T1-T2) using clinically meaningful measures of high, partial, low, and none. Subgroup differences were compared, and telehealth users were compared to those with only in-person visits. Engagement, as characterized, was largely maintained during COVID. The 19.0 % with only in-person visits during COVID had different characteristics than telehealth users. Telehealth use was greater among younger people by T2 (33.1 %), women (57.7 %), non-Hispanic White people (38.9 %), and those with MDD (18.0 %), but lower among non-Hispanic Black people, in NYC, and those with schizophrenia or SUD. Most telehealth users were highly engaged (77.1 %); most using only in-person services had low engagement (47.5 %). The shift to telehealth preserved access to many outpatient services for this SMI population. Exploring reasons for not using telehealth may identify opportunities to increase care access.
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Affiliation(s)
- Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA.
| | - Miriam C Tepper
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | - Rui Wang
- New York State Office of Mental Health, New York, USA
| | - Fei Tang
- New York State Office of Mental Health, New York, USA
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Melanie M Wall
- Mailman School of Public Health, Columbia University, New York, USA
| | - Alice Medalia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | | | | | - Thomas E Smith
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA; New York State Office of Mental Health, New York, USA
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Kimhy D, Ospina LH, Beck-Felts K, Lister A, Omene C, Bodenhausen G, Mittal V. Psychiatric and affective predictors of negative racial attitudes. Psychiatry Res 2023; 327:115376. [PMID: 37531817 DOI: 10.1016/j.psychres.2023.115376] [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: 04/03/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
Negative Racial Attitudes (NRA) have been identified as major contributors to discrimination and inequalities. Previous studies of predictors of NRA have focused largely on socioeconomic, socialization, social attitudes, and personality characteristics. Yet, the potential links of psychiatric and affective indicators to NRA have received little scientific inquiry. Three-hundred-and-two participants completed measures of explicit, covert, and implicit NRA, along with indices of psychotic-like experiences (PLEs), mood symptoms, affective processing, social attitudes, and personality characteristics. Explicit and covert NRA were significantly correlated with difficulty identifying and describing feelings, use of suppression to regulate emotion, and the PLEs domains of perceptual abnormalities, bizarre experiences, and persecutory ideation, along with social attitudes and personality characteristics. Implicit NRA was not associated with any indicators. Next, employing hierarchical multiple linear regression analyses, the affective and psychiatric indicators accounted 5.2% and 10.4% of the explicit and covert NRA variance, respectively, controlling for previously identified predictors including demographics, social attitudes, and personality characteristics. Our results point to newly identified predictors of NRA including difficulties identifying and describing emotions, use of suppression to regulate emotions, as well as PLEs, specifically perceptual abnormalities. We discuss the implications of the findings to the development and adaptation of anti-racism interventions.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; MIRECC, The James J. Peters VA Medical Center, Bronx, NY, United States.
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Amanda Lister
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Coral Omene
- Rutgers Cancer Institute of New Jersey, Rutgers - The State University of New Jersey, New Brunswick, NJ, United States
| | - Galen Bodenhausen
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Vijay Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
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Phalen P, Kimhy D, Jobes D, Bennett M. Emotional distress and dysregulation as treatment targets to reduce suicide in psychosis: a scoping review. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01675-x. [PMID: 37597022 DOI: 10.1007/s00406-023-01675-x] [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: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
There is a pressing need for effective treatments that address the high rate of suicide observed among people with psychosis. In this scoping review we highlight two suicidogenic treatment targets that have been relatively neglected in people with psychotic disorders: emotional distress and emotion dysregulation. We review the research on these constructs in psychosis and their relationship to suicide in this population, and then make clinical recommendations based on research findings. Emotional distress and emotional dysregulation may be promising treatment targets for suicide among people with psychosis.
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Affiliation(s)
- Peter Phalen
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA.
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, USA
- Education and Clinical Center, James J. Peters VA Medical Center, Mental Illness Research, New York, NY, USA
| | - David Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Melanie Bennett
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA
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Stefancic A, Rogers RT, Styke S, Xu X, Buchsbaum R, Nossel I, Cabassa LJ, Stroup TS, Kimhy D. Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians. JMIR Ment Health 2022; 9:e41482. [PMID: 36331539 PMCID: PMC9675009 DOI: 10.2196/41482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. OBJECTIVE This qualitative study sought clinicians' input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. METHODS Following the app's initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app's design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. RESULTS The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers' clinical judgment (eg, need for clinically relevant information), and organizations' mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention's scope, concerns regarding dilution of the intervention's core components, and concerns about increasing patient burden while using the app. CONCLUSIONS FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients-the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. TRIAL REGISTRATION ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - R Tyler Rogers
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Sarah Styke
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Xiaoyan Xu
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ilana Nossel
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, United States
| | - T Scott Stroup
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, United States.,New York Mental Illness Research Education and Clinical Center, The James J Peters Veteran's Affairs Medical Center, Bronx, NY, United States
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Ospina LH, Beck-Felts K, Ifrah C, Lister A, Messer S, Russo SJ, Gross JJ, Kimhy D. Inflammation and emotion regulation: Findings from the MIDUS II study. Brain Behav Immun Health 2022; 26:100536. [PMID: 36247835 PMCID: PMC9563642 DOI: 10.1016/j.bbih.2022.100536] [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: 04/25/2022] [Revised: 08/31/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022] Open
Abstract
Emotion regulation (ER) strategies are thought to contribute to mental as well as physical health outcomes. Two common ER strategies include expressive suppression, or inhibition of emotional expression, and cognitive reappraisal, which involves changing how to think about an emotion-eliciting event in order to change its emotional impact. Recent reports have hypothesized that one potential way in which ER may be linked to health outcomes is via the immune system. However, information on this putative link is scarce. The present study aims to explore whether peripheral inflammatory biomarkers are associated with individual differences in ER-strategy use. Participants (n = 117) from the Midlife in the United States II (MIDUS II) study completed the Emotion Regulation Questionnaire (ERQ), and provided a blood sample for immune biomarker extraction including interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), E-selectin, Intercellular Adhesion Molecule-1 (ICAM-1), and fibrinogen. Results showed higher levels of expressive suppression were associated with decreased IL-10, TNF-α, and ICAM-1 levels (controlling for age, sex, BMI, total prescribed medications, and depressive symptoms). Consistent with these findings, hierarchical regression results identified TNF-α as a significant predictor of expressive suppression use. In contrast, no inflammatory markers were associated with predicted use of cognitive reappraisal. Our findings suggest a link between inflammation and specific ER-strategy use. Future research should consider the effects of pro-vs. anti-inflammatory cytokines on adaptive ER and subsequent mental and physical health.
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Affiliation(s)
- Luz H. Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chloe Ifrah
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amanda Lister
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sylvie Messer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott J. Russo
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA
- Corresponding author. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
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6
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Joe P, Clemente JC, Piras E, Wallach DS, Robinson-Papp J, Boka E, Remsen B, Bonner M, Kimhy D, Goetz D, Hoffman K, Lee J, Ruby E, Fendrich S, Gonen O, Malaspina D. An integrative study of the microbiome gut-brain-axis and hippocampal inflammation in psychosis: Persistent effects from mode of birth. Schizophr Res 2022; 247:101-115. [PMID: 34625336 PMCID: PMC8980116 DOI: 10.1016/j.schres.2021.09.019] [Citation(s) in RCA: 4] [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: 06/30/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/20/2022]
Abstract
The mechanism producing psychosis appears to include hippocampal inflammation, which could be associated with the microbiome-gut-brain-axis (MGBS). To test this hypothesis we are conducting a multidisciplinary study, herein described. The procedures are illustrated with testing of a single subject and group level information on the impact of C-section birth are presented. METHOD Study subjects undergo research diagnostic interviews and symptom assessments to be categorized into one of 3 study groups: psychosis, nonpsychotic affective disorder or healthy control. Hippocampal volume and metabolite concentrations are assessed using 3-dimensional, multi-voxel H1 Magnetic Resonance Imaging (MRSI) encompassing all gray matter in the entire hippocampal volume. Rich self-report information is obtained with the PROMIS interview, which was developed by the NIH Commons for research in chronic conditions. Early trauma is assessed and cognition is quantitated using the MATRICS. The method also includes the most comprehensive autonomic nervous system (ANS) battery used to date in psychiatric research. Stool and oral samples are obtained for microbiome assessments and cytokines and other substances are measured in blood samples. RESULTS Group level preliminary data shows that C-section birth is associated with higher concentrations of GLX, a glutamate related hippocampal neurotransmitter in psychotic cases, worse symptoms in affective disorder cases and smaller hippocampal volume in controls. CONCLUSION Mode of birth appears to have persistent influences through adulthood. The methodology described for this study will define pathways through which the MGBA may influence the risk for psychiatric disorders.
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Affiliation(s)
- Peter Joe
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA.
| | - Jose C Clemente
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - Enrica Piras
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - David S Wallach
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | | | - Emeka Boka
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Brooke Remsen
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - Mharisi Bonner
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - David Kimhy
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Deborah Goetz
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Kevin Hoffman
- Perelman School of Medicine, University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Jakleen Lee
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - Eugene Ruby
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Sarah Fendrich
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA; Perelman School of Medicine, University of Pennsylvania, Center for Health Care Incentives & Behavioral Economics, Philadelphia, PA, USA
| | - Oded Gonen
- NYU Langone Medical Center, Department of Radiology, New York, NY, USA
| | - Dolores Malaspina
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
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7
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,NY MIRECC, The James J. Peters VA Medical Center, Bronx, New York
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, New York, New York.,Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York
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8
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Damme KSF, Gupta T, Ristanovic I, Kimhy D, Bryan AD, Mittal VA. Exercise Intervention in Individuals at Clinical High Risk for Psychosis: Benefits to Fitness, Symptoms, Hippocampal Volumes, and Functional Connectivity. Schizophr Bull 2022; 48:1394-1405. [PMID: 35810336 PMCID: PMC9673264 DOI: 10.1093/schbul/sbac084] [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: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Individuals at clinical high risk for psychosis (CHR-p) are less fit than nonclinical peers and show hippocampal abnormalities that relate to clinical symptoms. Exercise generates hippocampal neurogenesis that may ameliorate these hippocampal abnormalities and related cognitive/clinical symptoms. This study examines the impact of exercise on deficits in fitness, cognitive deficits, attenuated psychotic symptoms, hippocampal volumes, and hippocampal connectivity in individuals at CHR-p. STUDY DESIGN In a randomized controlled trial, 32 individuals at CHR-p participated in either an exercise (n = 17) or waitlist (no exercise) (n = 15) condition. All participants were sedentary at use and absent of current antipsychotic medication, psychosis diagnoses, or a substance use disorder. The participants completed a series of fitness, cognitive tasks, clinical assessments, and an MRI session preintervention and postintervention. The exercise intervention included a high-intensity interval exercise (80% of VO2max) with 1-minute high-intensity intervals (95% of VO2max) every 10 minutes) protocol twice a week over 3 months. STUDY RESULTS The exercise intervention was well tolerated (83.78% retention; 81.25% completion). The exercising CHR-p group showed that improved fitness (pre/post-d = 0.53), increased in cognitive performance (pre/post-d = 0.49), decrease in positive symptoms (pre/post-d = 1.12) compared with the waitlist group. Exercising individuals showed stable hippocampal volumes; waitlist CHR-p individuals showed 3.57% decreased hippocampal subfield volume. Exercising individuals showed that increased exercise-related hippocampal connectivity compared to the waitlist individuals. CONCLUSIONS The exercise intervention had excellent adherence, and there were clear signs of mechanism engagement. Taken together, evidence suggests that high-intensity exercise can be a beneficial therapeutic tool in the psychosis risk period.
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Affiliation(s)
- Katherine S F Damme
- To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Rd.Evanston, IL 60208, USA; tel: 402-890-3606, e-mail:
| | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
| | - David Kimhy
- Department of Psychology, Northwestern University, Evanston, IL, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,MIRECC, The James J. Peters VA Medical Center, Bronx, NY, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA,Institute for Neuroscience, University of Colorado, Boulder, CO, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA,Institute for Cognitive Science, University of Colorado, Boulder, CO, USA,Department of Psychiatry, Northwestern University, Chicago, IL, USA,Medical Social Sciences, Northwestern University, Chicago, IL, USA,Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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9
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Neppala GK, Terkuhle I, Wagner A, Lepow L, Shaik RB, Freed R, Kimhy D, Pietrzak RH, Velthorst E, Feder A, Ivanov I, Parvaz MA. Social Isolation-Mediated Exacerbation of Negative Affect in Young Drinkers during the COVID-19 Pandemic. Brain Sci 2022; 12:brainsci12020214. [PMID: 35203977 PMCID: PMC8870361 DOI: 10.3390/brainsci12020214] [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: 12/20/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
Emerging research on psychological adjustment during the COVID-19 outbreak has suggested that young people may be particularly vulnerable to increases in negative affect during the pandemic. However, the association between alcohol use in youth and change in negative affect during this unprecedented time is not clear. Using an online survey, this study obtained scores on negative affect (before and during the COVID-19 pandemic), pandemic-related stress, change in drinking frequency, and traits including resilience, impulsivity and anhedonia, from a sample of drinkers and non-drinkers, up to the age of 21. Young drinkers experienced a greater increase in negative affect during the pandemic compared to non-drinkers, and this differential rise in negative affect was mediated by the pandemic-related stress of social isolation. Young drinkers also experienced a decrease in alcohol use during the pandemic, but this was not associated with a change in negative affect. Interestingly, young drinkers with greater resilience and lower anhedonia reported less increase in negative affect during the COVID-19 pandemic. Taken together, these results show that the greater increase in negative affect that young drinkers experienced during the COVID-19 pandemic, compared to their non-drinking counterparts, was mediated by pandemic-related social isolation. Moreover, greater resilience and lower anhedonia may have served as protective factors for mitigating the social isolation-induced worsening of negative affect in young drinkers during the pandemic. These findings may inform future studies investigating potential indicators of maladaptive affective responses to public health crises in vulnerable adolescent populations.
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Affiliation(s)
- Gopi K. Neppala
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Isabel Terkuhle
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Ariella Wagner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Lauren Lepow
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Riaz B. Shaik
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Rachel Freed
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Robert H. Pietrzak
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA;
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06520, USA
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Iliyan Ivanov
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
| | - Muhammad A. Parvaz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (G.K.N.); (I.T.); (A.W.); (L.L.); (R.B.S.); (R.F.); (D.K.); (E.V.); (A.F.); (I.I.)
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence:
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10
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Damme KSF, Sloan RP, Bartels MN, Ozsan A, Ospina LH, Kimhy D, Mittal VA. Psychosis risk individuals show poor fitness and discrepancies with objective and subjective measures. Sci Rep 2021; 11:9851. [PMID: 33972634 PMCID: PMC8110757 DOI: 10.1038/s41598-021-89301-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Exercise is a promising intervention for individuals at clinical high-risk for psychosis (CHR). However, these youth may not be reliable reporters on fitness. There have been no investigations that utilized objective fitness assessment in this population. The present study objectively characterizes the level of fitness in CHR youth, compares the accuracy of self-report measures to objective fitness indices, and explores clinical factors that may influence the accuracy of self-reported measures of fitness. Forty CHR individuals completed an exercise survey and objective indices of fitness (i.e., VO2max and BMI). Forty healthy volunteers completed objective indices of fitness and a structured clinical interview ruling out the presence of psychiatric illness. CHR youth showed greater BMI and lowered VO2max compared to healthy volunteers. In the CHR group, self-report items (perceived fitness) did not reflect objective indices of fitness, whereas specific exercise behaviors (intensity of exercise) showed stronger correlations with objective fitness measurements. Exploratory analyses suggested that symptoms (grandiosity and avolition) related to errors in self-perception. Results indicate that CHR individuals are less fit than controls as indexed by objective measures of fitness and that it is important to consider unique population clinical characteristics when employing self-report data.
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Affiliation(s)
- Katherine S F Damme
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL, 60208, USA.
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston/Chicago, IL, USA.
| | - Richard P Sloan
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Rehabilitation Medicine, Montefiore Medical Center, New York, NY, USA
| | - Alara Ozsan
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL, 60208, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- MIRECC, The James J. Peters VA Medical Center, Bronx, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL, 60208, USA
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston/Chicago, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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11
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Edwards ER, Rose NLJ, Gromatsky M, Feinberg A, Kimhy D, Doucette JT, Goodman M, McClure MM, Perez-Rodriguez MM, New AS, Hazlett EA. Alexithymia, Affective Lability, Impulsivity, and Childhood Adversity in Borderline Personality Disorder. J Pers Disord 2021; 35:114-131. [PMID: 33650890 DOI: 10.1521/pedi_2021_35_513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Long-standing theories of borderline personality disorder (BPD) suggest that symptoms develop at least in part from childhood adversity. Emotion dysregulation may meaningfully mediate these effects. The current study examined three factors related to emotion dysregulation-alexithymia, affective lability, and impulsivity-as potential mediators of the relation between childhood adversity and BPD diagnosis in 101 individuals with BPD and 95 healthy controls. Path analysis compared three distinct models informed by the literature. Results supported a complex mediation model wherein (a) alexithymia partially mediated the relation of childhood adversity to affective lability and impulsivity; (b) affective lability mediated the relation of childhood adversity to BPD diagnosis; and (c) affective lability and impulsivity mediated the relation of alexithymia to BPD diagnosis. Findings suggest that affective lability and alexithymia are key to understanding the relationship between childhood adversity and BPD. Interventions specifically targeting affective lability, impulsivity, and alexithymia may be particularly useful for this population.
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Affiliation(s)
- Emily R Edwards
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York
| | - Nina L J Rose
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Molly Gromatsky
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York
| | - Abigail Feinberg
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Kimhy
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John T Doucette
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Marianne Goodman
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret M McClure
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychology, Fairfield University, Fairfield, Connecticut
| | | | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin A Hazlett
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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12
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Mittal VA, Firth J, Kimhy D. Combating the Dangers of Sedentary Activity on Child and Adolescent Mental Health During the Time of COVID-19. J Am Acad Child Adolesc Psychiatry 2020; 59:1197-1198. [PMID: 32860908 PMCID: PMC7448948 DOI: 10.1016/j.jaac.2020.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 11/25/2022]
Abstract
Although the impact of the coronavirus disease 2019 (COVID-19) pandemic, subsequent quarantine, and social distancing on physical activity has been covered extensively, there has been limited focus on the resulting sedentary behavior1 on existing and emerging psychopathology. This is particularly disconcerting regarding children and adolescents, who rely on the ability to play to meet developmental milestones and who require more exercise than adults. Youth populations have been significantly disrupted by school closures and home confinement and are in developmental periods that overlap with the emergence of serious mental illness. Therefore, it is important to consider the mental health consequences for youths, and also explore ways to combat sedentary activity for this vulnerable population.
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Affiliation(s)
- Vijay A. Mittal
- Northwestern University, Evanston, Illinois,Correspondence to Vijay A. Mittal, PhD, Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL 60208
| | - Joseph Firth
- University of Manchester, United Kingdom, and Western Sydney University, Westmead, Australia
| | - David Kimhy
- Icahn School of Medicine at Mount Sinai, New York, and James J. Peters VA Medical Center, Bronx, New York
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13
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Beck-Felts K, Goodman M, Ospina LH, Wall M, McEvoy J, Jarskog LF, Ballon JS, Bartels MN, Buchsbaum R, Sloan RP, Stroup TS, Kimhy D. Suicide Reduction in Schizophrenia via Exercise (SUnRISE): study protocol for a multi-site, single-blind, randomized clinical trial of aerobic exercise for suicide risk reduction in individuals with schizophrenia. Trials 2020; 21:871. [PMID: 33087170 PMCID: PMC7579916 DOI: 10.1186/s13063-020-04788-z] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Suicide risk among individuals with schizophrenia (SZ) is intractably high, with over 40% of individuals attempting to take their own lives during their lifetime and an estimated 5-10% completing suicide. At present, available pharmacological and psychotherapeutic treatments offer limited risk reduction benefits, and thus, there remains an urgent need to explore novel interventions that will ameliorate this risk. Aerobic exercise (AE) has been shown to improve a number of predictors of suicide risk (e.g., depressed mood, sleeping difficulties). As individuals with SZ display a highly sedentary lifestyle, AE may reduce suicide risk. METHODS Employing a multi-site, single-blind, randomized clinical trial design, we will examine the impact of AE on risk for suicide and related variables in individuals with SZ. Participants will be randomized to one of two 12-week exercise interventions: AE or a stretching and toning (ST) control intervention. Primary outcome measures will include suicide risk (Columbia Suicide Severity Rating Scale, C-SSRS) and aerobic fitness (VO2max), along with additional measures of suicide risk, mood, emotion regulation, sleep, cognition, and physical activity, with assessments completed at baseline and after 6 and 12 weeks of interventions. DISCUSSION It is hypothesized that AE will reduce suicide risk among individuals with SZ. This study may offer support for a more efficacious treatment method for this population in addition to the pre-existing pharmacological and psychotherapeutic treatment regimens. TRIAL REGISTRATION Clinicaltrials.gov, NCT03270098 . Registered on September 1, 2017.
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Affiliation(s)
- Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | | | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - Melanie Wall
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Joseph McEvoy
- Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, GA, USA
| | - Lars F Jarskog
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | - Richard P Sloan
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
- MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
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14
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Kogan S, Ospina LH, Mittal VA, Kimhy D. The impact of inflammation on neurocognition and risk for psychosis: a critical review. Eur Arch Psychiatry Clin Neurosci 2020; 270:793-802. [PMID: 31620871 PMCID: PMC7160015 DOI: 10.1007/s00406-019-01073-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/16/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
Neurocognitive difficulties are highly prevalent among people with schizophrenia and have been linked to increased inflammation, as well as dysfunction and disability. Poor neurocognitive functioning has also been documented in individuals at clinical high risk for psychosis (CHR) and a burgeoning literature point to alterations in inflammation markers in this population. However, there is limited information regarding the putative link between inflammation and neurocognition in CHR individuals, and the potential role of inflammation in the development of cognitive difficulties and psychosis. As previous reports indicate that early treatment in schizophrenia is associated with better outcomes, there is an urgent need to identify neurobiological mechanisms underlying cognitive deterioration and psychosis in CHR individuals to provide them with care prior to significant cognitive and functional declines. To address this gap in the literature, we review and summarize the relevant literatures on inflammation and neurocognitive dysfunction in schizophrenia and CHR individuals, point to remaining gaps, and suggest directions for future research.
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Affiliation(s)
- Sophia Kogan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Luz H. Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 1230, New York, NY, 10029, USA. .,Mental Illness Research Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA.
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15
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Hoffman KW, Lee JJ, Corcoran CM, Kimhy D, Kranz TM, Malaspina D. Considering the Microbiome in Stress-Related and Neurodevelopmental Trajectories to Schizophrenia. Front Psychiatry 2020; 11:629. [PMID: 32719625 PMCID: PMC7350783 DOI: 10.3389/fpsyt.2020.00629] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Early life adversity and prenatal stress are consistently associated with an increased risk for schizophrenia, although the exact pathogenic mechanisms linking the exposures with the disease remain elusive. Our previous view of the HPA stress axis as an elegant but simple negative feedback loop, orchestrating adaptation to stressors among the hypothalamus, pituitary, and adrenal glands, needs to be updated. Research in the last two decades shows that important bidirectional signaling between the HPA axis and intestinal mucosa modulates brain function and neurochemistry, including effects on glucocorticoid hormones and brain-derived neurotrophic factor (BDNF). The intestinal microbiome in earliest life, which is seeded by the vaginal microbiome during delivery, programs the development of the HPA axis in a critical developmental window, determining stress sensitivity and HPA function as well as immune system development. The crosstalk between the HPA and the Microbiome Gut Brain Axis (MGBA) is particularly high in the hippocampus, the most consistently disrupted neural region in persons with schizophrenia. Animal models suggest that the MGBA remains influential on behavior and physiology across developmental stages, including the perinatal window, early childhood, adolescence, and young adulthood. Understanding the role of the microbiome on critical risk related stressors may enhance or transform of understanding of the origins of schizophrenia and offer new approaches to increase resilience against stress effects for preventing and treating schizophrenia.
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Affiliation(s)
- Kevin W. Hoffman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jakleen J. Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Centers (MIRECC), New York, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Centers (MIRECC), New York, NY, United States
| | - Thorsten M. Kranz
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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16
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Ifrah C, Ospina LH, Shagalow S, Beck-Felts K, Kimhy D. Cognitive insight and autonomic regulation during daily functioning in individuals with schizophrenia. Schizophr Res 2020; 218:300-301. [PMID: 32178930 DOI: 10.1016/j.schres.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Chloe Ifrah
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shaina Shagalow
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
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17
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Kimhy D, Lister A, Liu Y, Vakhrusheva J, Delespaul P, Malaspina D, Ospina LH, Mittal VA, Gross JJ, Wang Y. The impact of emotion awareness and regulation on psychotic symptoms during daily functioning. NPJ Schizophr 2020; 6:7. [PMID: 32210232 PMCID: PMC7093537 DOI: 10.1038/s41537-020-0096-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Received: 07/24/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
Emotion regulation (ER) difficulties are ubiquitous among individuals with schizophrenia and have been hypothesized to contribute to stress sensitivity and exacerbation of psychotic symptoms in this population. However, the evidence supporting this link is equivocal, potentially due to previous studies' reliance on retrospective assessments of ER and psychosis, as well as lack of consideration of putative moderators such as emotion awareness. To address these limitations, we employed experience sampling method using mobile electronic devices to investigate the links between momentary in vivo use of ER strategies (mER), emotion awareness, and psychotic symptoms during daily functioning. Fifty-four individuals with schizophrenia completed assessment of mER and psychotic symptoms, along with traditional retrospective measures of ER and symptoms. Use of mER suppression predicted significant increases in momentary experiences of thought insertion, mind reading, auditory and visual hallucinations. Use of mER reappraisal predicted significant increases in momentary experiences of suspiciousness, thought insertion, and mind reading. Emotion awareness, driven primarily by difficulties identifying feelings, moderated the impact of ER on psychotic symptoms. There were no associations between retrospective measures of ER and symptoms. Our results indicate that, among individuals with schizophrenia, emotion awareness significantly impacts the relationship between use of ER and exacerbations in psychotic symptoms during the course of daily functioning. Our results highlight the need to incorporate emotion awareness and regulation difficulties into the development of treatment models and interventions for psychosis. In addition, our results underscore the need to employ in vivo, high time-resolution assessment methods to study dynamic clinical phenomena such as ER and psychotic symptoms.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
| | - Amanda Lister
- New York State Psychiatric Institute, New York, NY, USA
| | - Ying Liu
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Philippe Delespaul
- Departments of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Chicago, IL, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University, New York, NY, USA
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18
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Vakhrusheva J, Khan S, Chang R, Hansen M, Ayanruoh L, Gross J, Kimhy D. Lexical analysis of emotional responses to "real-world" experiences in individuals with schizophrenia. Schizophr Res 2020; 216:272-278. [PMID: 31839556 PMCID: PMC7239730 DOI: 10.1016/j.schres.2019.11.045] [Citation(s) in RCA: 4] [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] [Received: 05/05/2019] [Revised: 08/30/2019] [Accepted: 11/24/2019] [Indexed: 01/22/2023]
Abstract
Abnormalities in emotion perception, expression, and experience are considered a core component of schizophrenia. Previous laboratory studies have demonstrated that while individuals with schizophrenia report levels of positive emotions comparable to healthy individuals in response to positive stimuli, they also report co-occurring negative emotions in response to such stimuli. However, it is unknown whether this response pattern extends to "real world" naturalistic environments. To examine this question, we employed an experience sampling method (ESM) approach using mobile electronic devices to collect information up to 10 times/day over a two-day period from 53 individuals with schizophrenia and 19 non-clinical controls. As part of each experience sample, participants completed brief open-ended responses and answered questions about their emotional responses to three recent events (neutral, positive, and negative). Additionally, participants completed diagnostic and clinical measures. Lexical analyses were used to analyze ESM-based word production and characterize emotion word use. Compared to non-clinical controls, individuals with schizophrenia reported similar levels of positive emotion, but significantly higher negative emotion, which was associated with increased negative symptoms. The schizophrenia group used more anxiety words in response to negative and neutral events, and more anger words in response to positive events. Increased use of anger words was linked with elevations in positive symptoms as well as symptoms of depression, while use of sadness words was linked with anhedonia. Our findings support the co-activation of negative emotion hypothesis documented in laboratory settings and provide evidence of its ecological validity. Implications for functioning and future directions are discussed.
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Affiliation(s)
- J. Vakhrusheva
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - S. Khan
- New York State Psychiatric Institute, New York, NY
| | - R. Chang
- New York State Psychiatric Institute, New York, NY
| | - M. Hansen
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - L. Ayanruoh
- New York State Psychiatric Institute, New York, NY
| | - J.J. Gross
- Department of Psychiatry & Behavioral Science, Stanford University, Stanford, CA
| | - D. Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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19
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Kraus MS, Gold JM, Barch DM, Walker TM, Chun CA, Buchanan RW, Csernansky JG, Goff DC, Green MF, Jarskog LF, Javitt DC, Kimhy D, Lieberman JA, McEvoy JP, Mesholam-Gately RI, Seidman LJ, Ball MP, Kern RS, McMahon RP, Robinson J, Marder SR, Keefe RSE. The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures. Schizophr Res Cogn 2019; 19:100161. [PMID: 31832342 PMCID: PMC6889798 DOI: 10.1016/j.scog.2019.100161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/24/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
Abstract
In comparison to batteries of standard neuropsychological tests, cognitive neuroscience tests may offer a more specific assessment of discrete neurobiological processes that may be aberrant in schizophrenia. However, more information regarding psychometric properties and correlations with standard neuropsychological tests and functional measures is warranted to establish their validity as treatment outcome measures. The N-back and AX-Continuous Performance Task (AX-CPT) are two promising cognitive neuroscience tests designed to measure specific components of working memory and contextual processing respectively. In the current study, we report the psychometric properties of multiple outcome measures from these two tests as well as their correlations with standard neuropsychological measures and functional capacity measures. The results suggest that while the AX-CPT and N-back display favorable psychometric properties, they do not exhibit greater sensitivity or specificity with functional measures than standard neurocognitive tests.
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Affiliation(s)
- Michael S Kraus
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States of America
| | - Trina M Walker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | | | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - John G Csernansky
- Department of Psychiatry, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America
| | - Donald C Goff
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Michael F Green
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, United States of America
| | - Daniel C Javitt
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jeffrey A Lieberman
- Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, United States of America
| | - Joseph P McEvoy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - M Patricia Ball
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Robert S Kern
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Robert P McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James Robinson
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - Stephen R Marder
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
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20
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Abstract
BACKGROUND Disturbances in trait emotions are a predominant feature in schizophrenia. However, less is known about (a) differences in trait emotion across phases of the illness such as the clinical high-risk (CHR) phase and (b) whether abnormalities in trait emotion that are associated with negative symptoms are driven by primary (i.e. idiopathic) or secondary (e.g. depression, anxiety) factors. AIMS To examine profiles of trait affective disturbance and their clinical correlates in individuals with schizophrenia and individuals at CHR for psychosis. METHOD In two studies (sample 1: 56 out-patients diagnosed with schizophrenia and 34 demographically matched individuals without schizophrenia (controls); sample 2: 50 individuals at CHR and 56 individuals not at CHR (controls)), participants completed self-report trait positive affect and negative affect questionnaires, clinical symptom interviews (positive, negative, disorganised, depression, anxiety) and community-based functional outcome measures. RESULTS Both clinical groups reported lower levels of positive affect (specific to joy among individuals with schizophrenia) and higher levels of negative affect compared with controls. For individuals with schizophrenia, links were found between positive affect and negative symptoms (which remained after controlling for secondary factors) and between negative affect and positive symptoms. For individuals at CHR, links were found between both affect dimensions and both types of symptom (which were largely accounted for by secondary factors). CONCLUSIONS Both clinical groups showed some evidence of reduced trait positive affect and elevated trait negative affect, suggesting that increasing trait positive affect and reducing trait negative affect is an important treatment goal across both populations. Clinical correlates of these emotional abnormalities were more integrally linked to clinical symptoms in individuals with schizophrenia and more closely linked to secondary influences such as depression and anxiety in individuals at CHR. DECLARATION OF INTEREST None.
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Affiliation(s)
- Claire I Yee
- Postdoctoral Fellow, Department of Psychology and School of Education and Social Policy, Northwestern University, USA
| | - Gregory P Strauss
- Assistant Professor, Department of Psychology, University of Georgia, USA
| | - Daniel N Allen
- Director of Clinical Training, Department of Psychology, University of Nevada, USA
| | - Claudia M Haase
- Assistant Professor, School of Education and Social Policy, Northwestern University, USA
| | - David Kimhy
- Associate Professor, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA
| | - Vijay A Mittal
- Associate Professor, Department of Psychology, Northwestern University, USA
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21
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Kogan S, Ospina LH, Kimhy D. Inflammation in individuals with schizophrenia - Implications for neurocognition and daily function. Brain Behav Immun 2018; 74:296-299. [PMID: 30218782 PMCID: PMC6805148 DOI: 10.1016/j.bbi.2018.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/08/2018] [Accepted: 09/11/2018] [Indexed: 12/18/2022] Open
Abstract
Individuals with schizophrenia display substantial deficits in neurocognition, resulting in poor daily functioning and disability. Recent reports have suggested that neurocognitive dysfunction in this population is linked to increased inflammation. However, there is paucity of evidence supporting this link, as well as lack of information about the putative link of inflammation to daily functioning. We examined neurocognition (MCCB) and daily functioning (SLOF), as well as inflammatory markers (TNF-α, IL-6, IL-1β, and IL-12p70) in 41 individuals with schizophrenia. Poor neurocognition was significantly associated with increased peripheral TNF-α and IL-12p70 (r = -0.44 and r = -0.38, respectively, controlling for BMI, depression and antipsychotic medication). Notably, difficulties with daily functioning were significantly associated with increased peripheral TNF-α (r = -0.51) and a trend with increased IL-12p70. Our findings support previous hypotheses linking neurocognitive impairment to increased inflammation in individuals with schizophrenia. Our results extend these associations in this population, linking inflammation to poor daily functioning in this population.
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Affiliation(s)
- Sophia Kogan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Luz H. Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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22
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Kimhy D, Vakhrusheva J, Bartels M, Ballon J, Castrén E, Sloan R. 11.2 THE IMPACT OF AEROBIC EXERCISE ON COGNITIVE FUNCTIONING AND BIOMARKERS OF COGNITIVE CHANGE IN INDIVIDUALS WITH SCHIZOPHRENIA. Schizophr Bull 2018. [PMCID: PMC5887709 DOI: 10.1093/schbul/sby014.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Individuals with schizophrenia (SZ) display substantial cognitive deficits across multiple domains. These deficits have been identified as major determinants of poor functioning and disability, representing a serious public health concern and an important target for interventions. At present, available treatments offer only minimal to limited benefits to ameliorate these deficits. Thus, there remains an urgent need to identify novel treatments for cognitive deficits in people with SZ. Emerging evidence from studies of animals, clinical and non-clinical populations suggest that Aerobic Exercise (AE) is efficacious in improving cognition via up-regulation of Brain-Derived Neurotrophic Factor (BDNF). Yet, the impact of AE on cognition and daily-functioning, and the role of BDNF, have not been investigated in schizophrenia. Additionally, limited information is available on the putative link between inflammation markers to cognitive functioning. Methods Employing a single-blind RCT design, 33 individuals with schizophrenia were randomized to receive “treatment as usual” (n=17; TAU) or attend a 12-week, 3 times-per-week, 60-minutes AE program (n=16) utilizing active-play video-games (Xbox-360 Kinect) and traditional AE equipment. Results At baseline, cognitive functioning was associated with serum BDNF (r=.51, p=.01), along with TNF-alpha (r=-.38, p=.03), IL-12 (r=-.36, p=.04) and IL-6 (r=-.33, p=.06). Twenty-six participants completed the study (79%). Following the intervention, the AE participants improved their cognitive functioning (MCCB) by 15.1% (vs. -2.0% in the TAU group; p=.03). Hierarchical multiple-regression analyses indicated changes in AF and serum BDNF predicted 25.4% and 14.6% of the cognitive improvement, respectively. Additionally, changes in aerobic fitness (VO2peak ml/kg/min) correlated with informant-reported improvements in work-related daily-functioning skills (SLOF; r=.51, p=.01). Fidelity with target training intensity, was correlated with cognitive improvement (r=.70, p=.02). Discussion The results indicate AE is effective in enhancing cognitive and daily functioning skills in people with schizophrenia and provide support for the impact of AE-related BDNF up-regulation on cognition. Additional studies are needed to establish the link between inflammation markers and cognitive functioning and the potential impact of AE on this putative pathway. Overall, low aerobic fitness represents a modifiable risk-factor for cognitive dysfunction in schizophrenia for which AE training offer a relatively safe, non-stigmatizing, and side-effect-free intervention.
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23
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Shoval A, Armstrong HF, Vakhrusheva J, Ballon JS, Bartels MN, Kimhy D. The Impact of Hypomania on Aerobic Capacity and Cardiopulmonary Functioning-A Case Report. Front Psychiatry 2018; 9:729. [PMID: 30622490 PMCID: PMC6308140 DOI: 10.3389/fpsyt.2018.00729] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Hypomanic episodes are characterized by increased goal-directed behavior and psychomotor agitation. While the affective, cognitive, and behavioral manifestations of such episodes are well-documented, their physiological influence on aerobic capacity and cardiopulmonary functioning are unknown. Methods: We describe a case report of an individual with schizophrenia who experienced a hypomanic episode while serving as a control participant (wait list) in a single-blind, randomized clinical trial examining the impact of aerobic exercise (AE) on neurocognition in people schizophrenia. As part of the trial, participants completed two scheduled clinical assessments and cardiopulmonary exercise tests (VO2max) at baseline and 12 weeks later at end of study. All participants received standard psychiatric care during the trial. Following a baseline assessment in which he displayed no evidence of mood lability, the subject returned on Week-12 for his scheduled follow-up assessment displaying symptoms of hypomania. He was able to complete the follow-up assessment, as well as third assessment 2 weeks later (Week-14) when his hypomanic symptoms ebbed. Results: While not engaging in AE, the subject's aerobic capacity, as indexed by VO2max, increased by 33% from baseline to Week-12. In comparison, participants engaged in the aerobic exercise training increased their aerobic capacity on average by 18%. In contrast, participants in the control group displayed a small decline (-0.5%) in their VO2max scores. Moreover, the subject's aerobic capacity increased even further by Week-14 (49% increase from baseline), despite the ebbing of his hypomania symptoms at that time. These changes were accompanied by increases in markers of aerobic fitness including peak heart rate, respiratory exchange rate, peak minute ventilation, watts, and peak systolic blood pressure. Resting systolic and diastolic blood pressure, and peak diastolic blood pressure remained unchanged. Conclusions: Our findings suggest that hypomania produce substantial increase in aerobic capacity and that such elevations may remain sustained following the ebbing of hypomanic symptoms. Such elevations may be attributed to increased mobility and goal-directed behavior associated with hypomania, as individuals in hypomanic states may ambulate more frequently, for longer duration, and/or at higher intensity. Our results provide a first and unique view into the impact of hypomania on aerobic capacity and cardiopulmonary functioning.
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Affiliation(s)
- Aura Shoval
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States
| | - Hilary F Armstrong
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States
| | - Julia Vakhrusheva
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, CA, United States
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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24
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Redman SL, Corcoran CM, Kimhy D, Malaspina D. Effects of early trauma on psychosis development in clinical high-risk individuals and stability of trauma assessment across studies: a review. Arch Psychol (Chic) 2017; 1:28. [PMID: 29400347 PMCID: PMC5791764] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Early trauma (ET), though broadly and inconsistently defined, has been repeatedly linked to numerous psychological disturbances, including various developmental stages of psychotic disorders. The prodromal phase of psychosis highlights a unique and relevant population that provides insight into the critical periods of psychosis development. As such, a relatively recent research focus on individuals at clinical high risk (CHR) for psychosis reveals robust associations of early life trauma exposures with prodromal symptoms and function in these cohorts. While prevalence rates of ET in CHR cohorts remain consistently high, methodological measures of traumatic experiences vary across studies, presenting potential problems for reliability and validity of results. This review aims to 1) highlight the existing evidence identifying associations of ET, of multiple forms, with both symptom severity and transition rates to psychosis in CHR individuals, 2) present data on the variability among trauma assessments and its implications for conclusions about its relationship with clinical variables, 3) describe cognitive deficits common in CHR cohorts, including perceptual and neurocognitive impairments, and their neural correlates, that may modify the relationship of ET to symptoms, and 4) propose future directions for standardization of trauma assessment in CHR cohorts to better understand its clinical and cognitive correlates.
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Affiliation(s)
- Samantha L. Redman
- Corresponding Author: Samantha Redman, Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 53 E 96 Street, New York, NY 10128, phone: 212-659-8756,
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25
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Brucato G, Masucci M, Arndt LY, Ben-David S, Colibazzi T, Corcoran CM, Crumbley AH, Crump FM, Gill KE, Kimhy D, Lister A, Schobel SA, Yang LH, Lieberman JA, Girgis RR. Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort. Psychol Med 2017; 47:1923-1935. [PMID: 28249639 PMCID: PMC5893280 DOI: 10.1017/s0033291717000319] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 12/11/2022]
Abstract
BACKGROUND DSM-5 proposes an Attenuated Psychosis Syndrome (APS) for further investigation, based upon the Attenuated Positive Symptom Syndrome (APSS) in the Structured Interview for Psychosis-Risk Syndromes (SIPS). SIPS Unusual Thought Content, Disorganized Communication and Total Disorganization scores predicted progression to psychosis in a 2015 NAPLS-2 Consortium report. We sought to independently replicate this in a large single-site high-risk cohort, and identify baseline demographic and clinical predictors beyond current APS/APSS criteria. METHOD We prospectively studied 200 participants meeting criteria for both the SIPS APSS and DSM-5 APS. SIPS scores, demographics, family history of psychosis, DSM Axis-I diagnoses, schizotypy, and social and role functioning were assessed at baseline, with follow-up every 3 months for 2 years. RESULTS The conversion rate was 30% (n = 60), or 37.7% excluding participants who were followed under 2 years. This rate was stable across time. Conversion time averaged 7.97 months for 60% who developed schizophrenia and 15.68 for other psychoses. Mean conversion age was 20.3 for males and 23.5 for females. Attenuated odd ideas and thought disorder appear to be the positive symptoms which best predict psychosis in a logistic regression. Total negative symptom score, Asian/Pacific Islander and Black/African-American race were also predictive. As no Axis-I diagnosis or schizotypy predicted conversion, the APS is supported as a distinct syndrome. In addition, cannabis use disorder did not increase risk of conversion to psychosis. CONCLUSIONS NAPLS SIPS findings were replicated while controlling for clinical and demographic factors, strongly supporting the validity of the SIPS APSS and DSM-5 APS diagnosis.
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Affiliation(s)
- G. Brucato
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - M.D. Masucci
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - L. Y. Arndt
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - S. Ben-David
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - T. Colibazzi
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - C. M. Corcoran
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | | | - F. M. Crump
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - K. E. Gill
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - D. Kimhy
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - A. Lister
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | | | - L. H. Yang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - J. A. Lieberman
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - R. R. Girgis
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
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26
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Kimhy D, Wall MM, Hansen MC, Vakhrusheva J, Choi CJ, Delespaul P, Tarrier N, Sloan RP, Malaspina D. Autonomic Regulation and Auditory Hallucinations in Individuals With Schizophrenia: An Experience Sampling Study. Schizophr Bull 2017; 43:754-763. [PMID: 28177507 PMCID: PMC5472124 DOI: 10.1093/schbul/sbw219] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 11/13/2022]
Abstract
Auditory Hallucinations (AH) cause substantial suffering and dysfunction, yet remain poorly understood and modeled. Previous reports have linked AH to increases in negative emotions, suggesting a role for the autonomic nervous system (ANS) in underlying this link. Employing an Experience Sampling Method (ESM) approach, 40 individuals with schizophrenia completed a 36-hour ambulatory assessment of AH and cardiac autonomic regulation. Participants carried mobile electronic devices that prompted them to report 10 times/d the severity of their momentary AH, along with a Holter monitor that continuously recorded their cardiac autonomic regulation. The clocks of the devices and monitors were synchronized, allowing for high time-resolution temporal linking of the AH and concurrent autonomic data. Power spectral analysis was used to determine the relative vagal (parasympathetic) contribution to autonomic regulation during 5 minutes prior to each experience sample. The participants also completed interview-based measures of AH (SAPS; PSYRATS). The ESM-measured severity of AH was significantly correlated with the overall SAPS-indexed AH severity, along with the PSYRATS-indexed AH frequency, duration, loudness, degree of negative content, and associated distress. A mixed-effect regression model indicated that momentary increases in autonomic arousal, characterized by decreases in vagal input, significantly predicted increases in ESM-measured AH severity. Vagal input averaged over the 36-hour assessment displayed a small but significant inverse correlation with the SAPS-indexed AH. The results provide preliminary support for a link between ANS regulation and AH. The findings also underscore the highly dynamic nature of AH and the need to utilize high time-resolution methodologies to investigate AH.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | | | | | - C. Jean Choi
- New York State Psychiatric Institute, New York, NY
| | - Philippe Delespaul
- Departments of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Nicholas Tarrier
- Department of Psychology, University of Manchester, Manchester, UK
| | - Richard P. Sloan
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Dolores Malaspina
- Department of Psychiatry & Child Psychiatry, New York University Medical Center, New York, NY
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27
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Mourik K, Decrescenzo P, Brucato G, Gill KE, Arndt L, Kimhy D, Keilp JG, Girgis RR. Various neurocognitive deficits and conversion risk in individuals at clinical high risk for psychosis. Early Interv Psychiatry 2017; 11:250-254. [PMID: 26663764 PMCID: PMC5030118 DOI: 10.1111/eip.12296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/12/2015] [Accepted: 10/22/2015] [Indexed: 12/26/2022]
Abstract
AIM Individuals at clinical high risk for psychosis (CHR) exhibit neurocognitive deficits in multiple domains. The aim of this study is to investigate whether several components of neurocognition are predictive of conversion to psychosis. METHODS Fifty-two CHR individuals were assessed with the Structured Interview for Psychosis Risk Syndromes and completed a battery of neurocognitive tests at baseline including measures of executive functioning, attention, working memory, processing speed and reaction time. Neurocognitive functioning at baseline was scored based on an external normative control group. Most subjects were followed for 2.5 years to determine conversion status. RESULTS Significant differences in neurocognitive functioning between CHR individuals and the control group were present in all domains. Twenty-six per cent of the participants converted to psychosis within 9.8 (standard deviation = 8.0) months on average (median 9 months), but there were no significant differences in neurocognition converters and non-converters. CONCLUSIONS Individuals at CHR have deficits in neurocognitive functioning, but such deficits do not appear to be related to conversion risk.
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Affiliation(s)
- Kees Mourik
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Paula Decrescenzo
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Gary Brucato
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Kelly E Gill
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Leigh Arndt
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - David Kimhy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - John G Keilp
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Ragy R Girgis
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
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28
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Kimhy D, Gill KE, Brucato G, Vakhrusheva J, Arndt L, Gross JJ, Girgis RR. The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis. Psychol Med 2016; 46:2907-2918. [PMID: 27050714 DOI: 10.1017/s0033291716000490] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Social functioning (SF) difficulties are ubiquitous among individuals at clinical high risk for psychosis (CHR), but it is not yet clear why. One possibility is suggested by the observation that effective SF requires adaptive emotion awareness and regulation. Previous reports have documented deficits in emotion awareness and regulation in individuals with schizophrenia, and have shown that such deficits predicted SF. However, it is unknown whether these deficits are present prior to the onset of psychosis or whether they are linked to SF in CHR individuals. METHOD We conducted a cross-sectional comparison of emotion awareness and regulation in 54 individuals at CHR, 87 with schizophrenia and 50 healthy controls (HC). Then, within the CHR group, we examined links between emotion awareness, emotion regulation and SF as indexed by the Global Functioning Scale: Social (Cornblatt et al. 2007). RESULTS Group comparisons indicated significant differences between HC and the two clinical groups in their ability to identify and describe feelings, as well as the use of suppression and reappraisal emotion-regulation strategies. Specifically, the CHR and schizophrenia groups displayed comparable deficits in all domains of emotion awareness and emotion regulation. A hierarchical multiple regression analysis indicated that difficulties describing feelings accounted for 23.2% of the SF variance. CONCLUSIONS The results indicate that CHR individuals display substantial emotion awareness and emotion-regulation deficits, at severity comparable with those observed in individuals with schizophrenia. Such deficits, in particular difficulties describing feelings, predate the onset of psychosis and contribute significantly to poor SF in this population.
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Affiliation(s)
- D Kimhy
- Department of Psychiatry,Columbia University,New York, NY,USA
| | - K E Gill
- Department of Psychology,The Catholic University of America,Washington, DC,USA
| | - G Brucato
- Department of Psychiatry,Columbia University,New York, NY,USA
| | - J Vakhrusheva
- Department of Psychiatry,Columbia University,New York, NY,USA
| | - L Arndt
- New York State Psychiatric Institute,New York, NY,USA
| | - J J Gross
- Department of Psychology,Stanford University,Stanford, CA,USA
| | - R R Girgis
- Department of Psychiatry,Columbia University,New York, NY,USA
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29
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Armstrong HF, Bartels MN, Paslavski O, Cain D, Shoval HA, Ballon JS, Khan S, Sloan RP, Kimhy D. The impact of aerobic exercise training on cardiopulmonary functioning in individuals with schizophrenia. Schizophr Res 2016; 173:116-7. [PMID: 26976498 DOI: 10.1016/j.schres.2016.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Hilary F Armstrong
- Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Orest Paslavski
- Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Darnell Cain
- Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hannah A Shoval
- Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Samira Khan
- New York State Psychiatric Institute, New York, NY, USA
| | - Richard P Sloan
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - David Kimhy
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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30
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Kimhy D. Cognitive-Behavioral Therapy for Olfactory Hallucinations and Associated Delusions: A Case Report. Am J Psychother 2016; 70:117-23. [PMID: 27052609 DOI: 10.1176/appi.psychotherapy.2016.70.1.117] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Olfactory hallucinations (OH) are experienced by a substantial minority of people with schizophrenia, often leading to social anxiety, depression and suffering. Yet, despite their prevalence and clinical significance, OH in schizophrenia are under-researched and poorly understood, with scarce information about potential treatments. To address this gap in the literature, the author describes a case report of successfully using Cognitive-Behavioral Therapy for psychosis (CBTp) to address OH, related delusions, as well as mood and social functioning difficulties in a male patient with schizophrenia. The results provide preliminary support for the feasibility and effectiveness of using CBTp to address OH and related delusions in individuals with schizophrenia.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, NY, USA
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31
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Abstract
Schizophrenia is characterized by extensive neurocognitive deficits, which are linked to greater disability, poorer functional outcome, and have been suggested to impact daily functioning more than clinical symptoms. Aerobic exercise (AE) has emerged as a potential intervention. This review examines the impact of AE on brain structure and function along with neurocognitive performance in individuals with schizophrenia. Preliminary evidence indicates that AE can increase hippocampal volume and cortical thickness, in addition to exerting a neuroprotective effect against hippocampal volume decrease and cortical thinning. There is also evidence that AE is able to significantly increase serum brain-derived neurotrophic factor (BDNF) levels, which are implicated in neurogenesis, neuroplasticity, and cognitive improvement. Finally, evidence suggests that AE plays a significant role in improving overall cognition, including improvements in processing speed, working memory, and visual learning. The authors discuss the implications of the findings and provide recommendations for future research and areas of inquiry.
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Affiliation(s)
- Julia Vakhrusheva
- Department of Psychiatry Westchester Division, Weill Cornell Medical College, Outpatient Department, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Brielle Marino
- Department of Psychiatry Westchester Division, Weill Cornell Medical College, Outpatient Department, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - David Kimhy
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Kimhy D, Lauriola V, Bartels MN, Armstrong HF, Vakhrusheva J, Ballon JS, Sloan RP. Aerobic exercise for cognitive deficits in schizophrenia - The impact of frequency, duration, and fidelity with target training intensity. Schizophr Res 2016; 172:213-5. [PMID: 26852401 DOI: 10.1016/j.schres.2016.01.055] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/25/2016] [Accepted: 01/29/2016] [Indexed: 12/21/2022]
Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
| | - Vincenzo Lauriola
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Hilary F Armstrong
- Department of Rehabilitation & Regenerative Medicine, Columbia University, New York, NY, United States
| | - Julia Vakhrusheva
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Richard P Sloan
- Department of Psychiatry, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States
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Kimhy D, Khan S, Ayanrouh L, Chang RW, Hansen MC, Lister A, Ballon JS, Vakhrusheva J, Armstrong HF, Bartels MN, Sloan RP. Use of Active-Play Video Games to Enhance Aerobic Fitness in Schizophrenia: Feasibility, Safety, and Adherence. Psychiatr Serv 2016; 67:240-3. [PMID: 26423100 DOI: 10.1176/appi.ps.201400523] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 11/30/2022]
Abstract
OBJECTIVE Active-play video games have been used to enhance aerobic fitness in various clinical populations, but their use among individuals with schizophrenia has been limited. METHODS Feasibility, acceptability, safety, and adherence data were obtained for use of aerobic exercise (AE) equipment by 16 individuals with schizophrenia during a 12-week AE program consisting of three one-hour exercise sessions per week. Equipment included exercise video games for Xbox 360 with Kinect motion sensing devices and traditional exercise equipment. RESULTS Most participants (81%) completed the training, attending an average of 79% of sessions. The proportion of time spent playing Xbox (39%) exceeded time spent on any other type of equipment. When using Xbox, participants played 2.24±1.59 games per session and reported high acceptability and enjoyment ratings, with no adverse events. CONCLUSIONS Measures of feasibility, acceptability, adherence, and safety support the integration of active-play video games into AE training for people with schizophrenia.
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Affiliation(s)
- David Kimhy
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Samira Khan
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Lindsey Ayanrouh
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Rachel W Chang
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Marie C Hansen
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Amanda Lister
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Jacob S Ballon
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Julia Vakhrusheva
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Hilary F Armstrong
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Matthew N Bartels
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Richard P Sloan
- Dr. Kimhy, Dr. Ballon, Dr. Vakhrusheva, and Dr. Sloan are with the Department of Psychiatry and Ms. Armstrong is with the Department of Rehabilitation and Regenerative Medicine, Columbia University, New York (e-mail: ). Dr. Kimhy, Dr. Ballon, and Dr. Sloan are also with the New York State Psychiatric Institute, New York, where Ms. Khan, Ms. Ayanrouh, Ms. Chang, Ms. Hansen, and Ms. Lister are affiliated. Dr. Bartels is with the Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Crowley OV, Kimhy D, McKinley PS, Burg MM, Schwartz JE, Lachman ME, Tun PA, Ryff CD, Seeman TE, Sloan RP. Vagal Recovery From Cognitive Challenge Moderates Age-Related Deficits in Executive Functioning. Res Aging 2015; 38:504-25. [PMID: 26303063 DOI: 10.1177/0164027515593345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Decline in executive functioning (EF) is a hallmark of cognitive aging. We have previously reported that faster vagal recovery from cognitive challenge is associated with better EF. This study examined the association between vagal recovery from cognitive challenge and age-related differences in EF among 817 participants in the Midlife in the U.S. study (aged 35-86). Cardiac vagal control was measured as high-frequency heart rate variability. Vagal recovery moderated the association between age and EF (β = .811, p = .004). Secondary analyses revealed that older participants (aged 65-86) with faster vagal recovery had superior EF compared to their peers who had slower vagal recovery. In contrast, among younger (aged 35-54) and middle-aged (aged 55-64) participants, vagal recovery was not associated with EF. We conclude that faster vagal recovery from cognitive challenge is associated with reduced deficits in EF among older, but not younger individuals.
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Affiliation(s)
| | - David Kimhy
- Division of Cognitive Neuroscience, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Paula S McKinley
- Division of Behavioral Medicine, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Matthew M Burg
- Division of General Medicine, Columbia University School of Medicine, New York, NY, USA Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph E Schwartz
- Division of General Medicine, Columbia University School of Medicine, New York, NY, USA
| | | | - Patricia A Tun
- Department of Psychology, Brandeis University, Waltham, MA, USA
| | - Carol D Ryff
- Department of Psychology, University of Wisconsin, Madison, WI, USA
| | - Teresa E Seeman
- Division of Geriatrics, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Richard P Sloan
- Division of Behavioral Medicine, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Kimhy D, Vakhrusheva J, Bartels MN, Armstrong HF, Ballon JS, Khan S, Chang RW, Hansen MC, Ayanruoh L, Lister A, Castrén E, Smith EE, Sloan RP. The Impact of Aerobic Exercise on Brain-Derived Neurotrophic Factor and Neurocognition in Individuals With Schizophrenia: A Single-Blind, Randomized Clinical Trial. Schizophr Bull 2015; 41:859-68. [PMID: 25805886 PMCID: PMC4466187 DOI: 10.1093/schbul/sbv022] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [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: 01/10/2023]
Abstract
Individuals with schizophrenia display substantial neurocognitive deficits for which available treatments offer only limited benefits. Yet, findings from studies of animals, clinical and nonclinical populations have linked neurocognitive improvements to increases in aerobic fitness (AF) via aerobic exercise training (AE). Such improvements have been attributed to up-regulation of brain-derived neurotrophic factor (BDNF). However, the impact of AE on neurocognition, and the putative role of BDNF, have not been investigated in schizophrenia. Employing a proof-of-concept, single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive standard psychiatric treatment (n = 17; "treatment as usual"; TAU) or attend a 12-week AE program (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed assessments of AF (indexed by VO2 peak ml/kg/min), neurocognition (MATRICS Consensus Cognitive Battery), and serum-BDNF before and after and 12-week period. Twenty-six participants (79%) completed the study. At follow-up, the AE participants improved their AF by 18.0% vs a -0.5% decline in the TAU group (P = .002) and improved their neurocognition by 15.1% vs -2.0% decline in the TAU group (P = .031). Hierarchical multiple regression analyses indicated that enhancement in AF and increases in BDNF predicted 25.4% and 14.6% of the neurocognitive improvement variance, respectively. The results indicate AE is effective in enhancing neurocognitive functioning in people with schizophrenia and provide preliminary support for the impact of AE-related BDNF up-regulation on neurocognition in this population. Poor AF represents a modifiable risk factor for neurocognitive dysfunction in schizophrenia for which AE training offer a safe, nonstigmatizing, and side-effect-free intervention.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY; New York State Psychiatric Institute, New York, NY;
| | | | - Matthew N. Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Hilary F. Armstrong
- Department of Rehabilitation & Regenerative Medicine, Columbia University, New York, NY
| | - Jacob S. Ballon
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Samira Khan
- New York State Psychiatric Institute, New York, NY
| | | | | | | | | | - Eero Castrén
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Edward E. Smith
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Richard P. Sloan
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
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Blum LH, Vakhrusheva J, Saperstein A, Khan S, Chang RW, Hansen MC, Zemon V, Kimhy D. Depressed mood in individuals with schizophrenia: A comparison of retrospective and real-time measures. Psychiatry Res 2015; 227:318-23. [PMID: 25895490 PMCID: PMC4430399 DOI: 10.1016/j.psychres.2015.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/27/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Abstract
Depressed mood is prevalent among individuals with schizophrenia, leading to difficulties in functioning. Typically, depressed mood is evaluated using retrospective assessments during which individuals are asked to recall their mood during the past week or month. However, as individuals with schizophrenia may display memory difficulties, the results of such assessments may be biased, potentially leading to inaccurate clinical characterizations and/or suboptimal treatment. Our aim was to assess the potential impact of long-term memory on depressed mood in individuals with schizophrenia. Employing an Experience Sampling Method (ESM) approach, 51 individuals with schizophrenia and 22 healthy controls rated their momentary emotions up to 10 times/day over a two-day period, along with retrospective measures of depressed mood, long-term memory, quality of life, social functioning, and symptoms. ESM assessment of real-time depressed mood demonstrated discriminant and convergent validity. Among the schizophrenia group, there was a significant correlation between the real-time and retrospective measures of depressed mood. However, once variance due to long-term memory was controlled, the relationship between the real-time and retrospective measure was no longer significant. The findings suggest that a real-time measure of depressed mood may allow overcoming some of the limitations associated with long-term memory difficulties common among individuals with schizophrenia.
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Affiliation(s)
- Lisa H. Blum
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,Corresponding author at: Lisa Blum, Ph.D., c/o David Kimhy, Ph.D., Division of Cognitive Neuroscience, Department of Psychiatry, Unit #55, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. Tel.: 212 543 6817; fax: 212 543 6176.
| | | | - Alice Saperstein
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Samira Khan
- New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Vance Zemon
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - David Kimhy
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
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Kimhy D, Vakhrusheva J, Bartels MN, Armstrong HF, Ballon JS, Khan S, Chang RW, Hansen MC, Ayanruoh L, Smith EE, Sloan RP. Aerobic fitness and body mass index in individuals with schizophrenia: Implications for neurocognition and daily functioning. Psychiatry Res 2014; 220:784-91. [PMID: 25219618 PMCID: PMC4258141 DOI: 10.1016/j.psychres.2014.08.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [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: 06/19/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 11/15/2022]
Abstract
Previous reports indicate that among healthy individuals low aerobic fitness (AF) and high body-mass index (BMI) predict poor neurocognition and daily-functioning. It is unknown whether these associations extend to disorders characterized by poor neurocognition, such as schizophrenia. Therefore, we compared AF and BMI in individuals with schizophrenia and non-clinical controls, and then within the schizophrenia group we examined the links between AF, BMI, neurocognition and daily-functioning. Thirty-two individuals with schizophrenia and 64 gender- and age-matched controls completed assessments of AF (indexed by VO2max) and BMI. The former also completed measures of neurocognition, daily-functioning and physical activity. The schizophrenia group displayed significantly lower AF and higher BMI. In the schizophrenia group, AF was significantly correlated with overall neurocognition (r=0.57), along with executive functioning, working memory, social cognition, and processing speed. A hierarchical regression analysis indicated that AF accounted for 22% of the neurocognition variance. Furthermore, AF was significantly correlated with overall daily-functioning (r=0.46). In contrast, BMI displayed significant inverse correlations with neurocognition, but no associations to daily-functioning. AF was significantly correlated physical activity. The authors discuss the potential use of AF-enhancing interventions to improve neurocognitive and daily-functioning in schizophrenia, along with putative neurobiological mechanisms underlying these links, including Brain-Derived Neurotrophic Factor.
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Affiliation(s)
- David Kimhy
- Division of Cognitive Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Julia Vakhrusheva
- Division of Cognitive Neuroscience, Department of Psychiatry, Columbia University, New York, NY, USA
| | - Matthew N. Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Hilary F. Armstrong
- Department of Rehabilitation & Regenerative Medicine, Columbia University, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jacob S. Ballon
- Division of Cognitive Neuroscience, Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Samira Khan
- New York State Psychiatric Institute, New York, NY, USA
| | | | | | | | - Edward E. Smith
- Division of Cognitive Neuroscience, Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Richard P. Sloan
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Medicine, Department of Psychiatry, Columbia University, New York, NY, USA
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Kimhy D, Vakhrusheva J, Liu Y, Wang Y. Use of mobile assessment technologies in inpatient psychiatric settings. Asian J Psychiatr 2014; 10:90-5. [PMID: 25042959 PMCID: PMC4105698 DOI: 10.1016/j.ajp.2014.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 03/10/2014] [Revised: 04/02/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
Mobile electronic devices (i.e., PDAs, cellphones) have been used successfully as part of research studies of individuals with severe mental illness living in the community. More recently, efforts have been made to incorporate such technologies into outpatient treatments. However, few attempts have been made to date to employ such mobile devices among hospitalized psychiatric patients. In this article, we evaluate the potential use of such devices in inpatient psychiatric settings using 33 hospitalized patients with schizophrenia. Employing an Experience Sampling Method approach, we provide support for the feasibility of using such devices, along with examples of potentially clinically-relevant information that can be obtained using such technologies, including assessment of fluctuations in the severity of psychotic symptoms and negative mood in relation to social context, unit location, and time of day. Following these examples, we discuss issues related to the potential use of mobile electronic devices by patients hospitalized at inpatient psychiatric settings including issues related to patients' compliance, assessment schedules, questionnaire development, confidentiality issues, as well as selection of appropriate software/hardware. Finally, we delineate some issues and areas of inquiry requiring additional research and development.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Ying Liu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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Kimhy D, Vakhrusheva J, Khan S, Chang RW, Hansen MC, Ballon JS, Malaspina D, Gross JJ. Emotional granularity and social functioning in individuals with schizophrenia: an experience sampling study. J Psychiatr Res 2014; 53:141-8. [PMID: 24561000 PMCID: PMC4000561 DOI: 10.1016/j.jpsychires.2014.01.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 01/22/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
Previous research has shown that healthy individuals who fail to differentiate among emotional states (i.e., those with low emotional granularity; EG) have poorer social functioning (SF) than those with high EG. It is unknown, however, whether these associations extend to clinical disorders characterized by impaired SF, such as schizophrenia. In the present study, we compared SF and EG in individuals with schizophrenia and healthy controls, and then, within the schizophrenia group, we examined the links between EG and SF. Employing an Experience Sampling Method approach, 77 individuals with schizophrenia and 27 healthy controls rated their momentary emotions (sadness, anxiety, anger, and happiness) up to 10 times/day over a two-day period using mobile electronic devices. For each participant, we then calculated the within-subject average correlations among the momentary emotion ratings, producing two EG indices - EGIall for all emotions and EGIneg for negative ones. A subsample of participants with schizophrenia also completed self-report, interview, and ability-based measures of SF. Compared to healthy controls, individuals with schizophrenia displayed significantly poorer SF and lower EGIall, but comparable EGIneg. Within the schizophrenia group, hierarchical multiple regression analyses indicated that EGIall, but not EGIneg, significantly predicted social dysfunction after controlling for emotional awareness, symptoms, and emotional intensity and variability. Our findings indicate that individuals with schizophrenia have a relatively intact ability to differentiate among negative emotions in everyday life. However, they experience significant difficulties differentiating between positive and negative emotions, and this may contribute to their social difficulties.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Samira Khan
- New York State Psychiatric Institute, New York, NY
| | | | | | - Jacob S. Ballon
- Department of Psychiatry, Columbia University, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Dolores Malaspina
- Department of Psychiatry, New York University Medical Center, New York, NY
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA
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Kimhy D, Jobson-Ahmed L, Ben-David S, Ramadhar L, Malaspina D, Corcoran CM. Cognitive insight in individuals at clinical high risk for psychosis. Early Interv Psychiatry 2014; 8:130-7. [PMID: 23343417 PMCID: PMC3640765 DOI: 10.1111/eip.12023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 12/07/2011] [Accepted: 11/10/2012] [Indexed: 11/30/2022]
Abstract
AIM Reduced cognitive insight has been associated with psychotic symptoms, in particular with the presence of delusions; however, there is little information about whether such reductions are present in at-risk individuals prior to the onset of threshold psychotic symptoms. METHOD We conducted a cross-sectional comparison of cognitive insight (as indexed by the Beck Cognitive Insight Scale) in 62 help-seeking individuals at clinical high risk for psychosis, Fifty-nine individuals with schizophrenia-spectrum disorders and 37 healthy controls (HC). In patients, we evaluated associations of insight with positive symptoms, including later transition to psychosis in high-risk patients. RESULTS Individuals with schizophrenia reported significantly higher self-certainty scores than the at-risk patients and HCs, with the at-risk patients scoring intermediate to the individuals with schizophrenia and controls. Similarly, individuals with schizophrenia scored significantly higher on self-reflectiveness, with no differences between the at-risk patients and controls. In individuals with schizophrenia, delusions were significantly correlated with self-certainty. In at-risk patients, cognitive insight was not associated with positive symptom severity and did not differentiate those at-risk patients who later developed psychosis from those who did not. However, post hoc analyses suggested that at-risk patients with marked unusual thought content (approaching threshold psychosis) had lower self-reflectiveness; whereas those with high suspiciousness had significantly higher self-certainty. CONCLUSIONS The findings are discussed in the context of normal developmental processes occurring during adolescence, their putative links to neurobiological functioning, and their implications for treatment and future research.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, New York, USA; Center of Prevention and Evaluation, New York State Psychiatric Institute, New York, New York, USA
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Haglund M, Cabaniss D, Kimhy D, Corcoran CM. A case report of cognitive behavioural therapy for social anxiety in an ultra-high risk patient. Early Interv Psychiatry 2014; 8:176-80. [PMID: 23734668 PMCID: PMC3887124 DOI: 10.1111/eip.12053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/21/2012] [Accepted: 03/23/2013] [Indexed: 11/30/2022]
Abstract
AIM Psychological treatments such as cognitive behavioural therapy (CBT) may have efficacy in young people at ultra-high risk (UHR) for psychosis. Case reports can illuminate the obstacles and challenges, and potential trajectory of symptom changes, observed with this treatment. METHODS This is a detailed case report of a young adult at UHR for psychosis who received manualized CBT for accompanying social anxiety. RESULTS Cognitive deficits and suspiciousness created initial challenges for successful implementation of CBT. Engagement in treatment occurred with slowing of pace and simplification of material, and modelling of social interaction. Treatment of social anxiety was accompanied by decreases in suspiciousness, conceptual disorganization, and social anhedonia, and increase in range of affect. CONCLUSIONS Adaptation of manualized CBT to accommodate cognitive deficits and suspiciousness in UHR patients may improve engagement. CBT focused on social anxiety can lead to improvement across symptom domains in UHR patients.
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Affiliation(s)
- Margaret Haglund
- Department of Psychiatry, New York State Psychiatric Institute at Columbia University, New York, New York, USA
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Kimhy D, Tarrier N, Essock S, Malaspina D, Cabannis D, Beck AT. Cognitive Behavioral Therapy for Psychosis - Training Practices and Dissemination in the United States. Psychosis 2013; 5. [PMID: 24187582 DOI: 10.1080/17522439.2012.704932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cognitive-Behavioral Therapy for psychosis (CBTp) is an evidence-based treatment for psychosis-related disorders. However, despite the strong evidence-base and inclusion in national treatment guidelines, CBTp remains poorly disseminated in the US. It is proposed that this state is a product of lack of CBTp knowledge among clinical training leaders along with limited availability of training opportunities. METHOD We surveyed training directors in US psychiatry residency and clinical psychology doctoral programs to characterize the penetration of CBTp training and to assess their familiarity with basic CBTp facts. RESULTS Directors displayed limited knowledge of CBTp effectiveness, with only 50% of psychiatry and 40% of psychology directors believing that CBTp is efficacious. Only 10% of psychiatry and 30% of psychology directors were aware that the CBTp evidence-base is based on meta-analyses. While 45% of all directors reported that their program offer CBTp training, trainees received limited training - 4 hours of didactics, 21 hours of treatment, and 12 hours of supervision. CONCLUSIONS CBTp dissemination in the US is characterized by training directors' minimal awareness of the CBTp evidence-base along with training opportunities that are so limited, as to be unlikely to be adequate to provide CBTp effectively, hence unlikely to improve patients' psychoses.
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Affiliation(s)
- D Kimhy
- Department of Psychiatry, Columbia University, New York, NY ; New York State Psychiatric Institute, New York, NY
| | - N Tarrier
- Department of Psychology, Institute of Psychiatry, King's College, London, United Kingdom
| | - S Essock
- Department of Psychiatry, Columbia University, New York, NY ; New York State Psychiatric Institute, New York, NY
| | - D Malaspina
- Department of Psychiatry, New York University Medical Center, New York, NY
| | - D Cabannis
- Department of Psychiatry, Columbia University, New York, NY ; New York State Psychiatric Institute, New York, NY
| | - A T Beck
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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Kimhy D, Crowley OV, McKinley PS, Burg MM, Lachman ME, Tun PA, Ryff CD, Seeman TE, Sloan RP. The association of cardiac vagal control and executive functioning--findings from the MIDUS study. J Psychiatr Res 2013; 47:628-35. [PMID: 23434176 PMCID: PMC3594003 DOI: 10.1016/j.jpsychires.2013.01.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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: 08/13/2012] [Revised: 11/27/2012] [Accepted: 01/18/2013] [Indexed: 12/13/2022]
Abstract
Cardiac vagal control (CVC), an index of parasympathetic contribution to cardiac regulation, has been linked to enhanced executive functioning (EF). However, findings to date have been based on small or unique samples. Additionally, previous studies assessed the CVC-EF link only during rest or recovery period from a cognitive challenge, but not during both states. In the present study, data on 817 socioeconomically diverse participants were obtained from the Midlife Development in the United States (MIDUS) study. As part of this study, participants completed cognitive tests, including EF, along with laboratory-based measures of CVC during rest and following recovery from a cognitive challenge. Regression analyses adjusting for respiratory rate revealed no effect of CVC at rest or during recovery on a global index of EF. However, exploratory post-hoc analyses of the components of the global EF index revealed a significant association between faster vagal recovery and better attention-switching and response inhibition abilities, as indexed by faster reaction time to the mixed SGST. This association remained significant after controlling for demographic, clinical (BMI, diseases and medications altering cardiac autonomic functioning, etc.), and health behavior covariates (Beta = .148, p = .010). Our findings suggest that future studies may need to investigate the links of CVC to specific EF abilities, rather than global measures of EF. Additionally, our results highlight the importance of assessing CVC during both rest and recovery from a cognitive challenge. The authors discuss the putative neurobiological underpinning of this link, as well as suggestions for future basic and clinical research.
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Affiliation(s)
- D Kimhy
- Division of Cognitive Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
| | - OV Crowley
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University, New York, NY, New York State Psychiatric Institute, New York, NY
| | - PS McKinley
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University, New York, NY, New York State Psychiatric Institute, New York, NY
| | - MM Burg
- Division of General Medicine, Columbia University School of Medicine, New York, NY, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - ME Lachman
- Department of Psychology, Brandeis University, Waltham, MA
| | - PA Tun
- Department of Psychology, Brandeis University, Waltham, MA
| | - CD Ryff
- Department of Psychology, University of Wisconsin, Madison, WI
| | - TE Seeman
- Division of Geriatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - RP Sloan
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University, New York, NY, New York State Psychiatric Institute, New York, NY
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DeVylder J, Ben-David S, Schobel S, Kimhy D, Malaspina D, Corcoran C. Temporal association of stress sensitivity and symptoms in individuals at clinical high risk for psychosis. Psychol Med 2013; 43:259-268. [PMID: 22651857 PMCID: PMC3716006 DOI: 10.1017/s0033291712001262] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Increased sensitivity and exposure to stress are associated with psychotic symptoms in schizophrenia and its risk states, but little is known about the co-evolution of stress sensitivity and exposure with positive and other symptoms in a clinical high-risk (CHR) cohort. METHOD A combined cross-sectional and longitudinal design was used to examine the associations over time of stress sensitivity and exposure (i.e. life events) with 'prodromal' symptoms in a cohort of 65 CHR patients assessed quarterly for up to 4 years, and at baseline in 24 healthy controls similar in age and gender. RESULTS Impaired stress tolerance was greater in patients, in whom it was associated over time with positive and negative symptoms, in addition to depression, anxiety and poor function. By contrast, life events were comparable in patients and controls, and bore no association with symptoms. In this treated cohort, there was a trajectory of improvement in stress tolerance, symptoms and function over time. CONCLUSIONS Impaired stress tolerance was associated with a wide range of 'prodromal' symptoms, consistent with it being a core feature of the psychosis risk state. Self-reported life events were not relevant as a correlate of clinical status. As in other treated CHR cohorts, most patients improved over time across symptom domains.
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Affiliation(s)
- J.E. DeVylder
- Columbia University School of Social Work, New York, NY, USA
| | - S. Ben-David
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - S.A. Schobel
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - D. Kimhy
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - D. Malaspina
- Department of Psychiatry, New York University, New York, NY, USA
| | - C.M. Corcoran
- Department of Psychiatry, Columbia University, New York, NY, USA
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Abstract
AIM A biased attributional style, in which negative events are attributed to external and personal causes, is associated with paranoid delusions in schizophrenia. It is not known whether this biased attributional style also characterizes individuals at clinical risk for psychosis or if it is associated with their emergent paranoia. METHODS Thirty-three clinical high-risk patients and 15 age- and gender-similar controls were assessed with the Internal, Personal, and Situational Attributions Questionnaire for externalizing and personalizing attributional biases and for potential correlates with suspiciousness and other symptoms. RESULTS Both patients and controls had a similar external-personalizing attributional style that was unrelated to symptoms, including suspiciousness. CONCLUSIONS Consistent with other studies, a biased attributional style was not associated with subthreshold paranoia. Therefore, a biased attributional style is likely not a trait that contributes to emergent paranoid delusions but is instead a state-dependent correlate of paranoid delusions.
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Affiliation(s)
- Jordan E Devylder
- School of Social Work, Division of Cognitive Neuroscience, New York State Psychiatric Institute, New York, NY 10027, USA.
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Kimhy D, Vakhrusheva J, Jobson-Ahmed L, Tarrier N, Malaspina D, Gross JJ. Emotion awareness and regulation in individuals with schizophrenia: Implications for social functioning. Psychiatry Res 2012; 200:193-201. [PMID: 22749227 PMCID: PMC3469754 DOI: 10.1016/j.psychres.2012.05.029] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [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: 01/10/2012] [Revised: 04/24/2012] [Accepted: 05/25/2012] [Indexed: 11/16/2022]
Abstract
Successful social functioning requires adaptive forms of emotion awareness and regulation. However, despite well-documented deficits in social functioning in individuals with schizophrenia, little is known about emotion awareness and regulation in this population. Therefore, we compared emotion awareness and regulation in individuals with schizophrenia and healthy controls, and then, within the schizophrenia group, we examined their impact on social functioning. Forty-four individuals with schizophrenia and 20 healthy controls completed measures of emotion awareness, emotion regulation, and social functioning, in addition to control measures, including neurocognitive functioning. Compared to controls, individuals with schizophrenia displayed significant deficits describing and identifying their emotions and used significantly less reappraisal and more suppression to regulate their emotions. Among the schizophrenia group, better social functioning was associated with the ability to identify, and in particular to describe emotions, better emotion management, as well as greater use of reappraisal and less use of suppression. A hierarchical multiple regression analysis indicated that, after controlling for age and neurocognition, difficulties describing feelings accounted for 35% of the social functioning variance. The present study highlights the importance of emotion awareness and regulation in schizophrenia, pointing to their substantial influence on social functioning above and beyond the impact of neurocognitive functioning.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY 10032 , USA.
| | | | | | - Nicholas Tarrier
- Department of Psychology, Institute of Psychiatry, King's College, London, UK
| | - Dolores Malaspina
- Department of Psychiatry, New York University Medical Center, New York, NY, USA
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
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Abstract
Mobile assessment techniques have been used for nearly 3 decades in mental health research, including in investigations of individuals with schizophrenia and other severe disorders. This article reviews the benefits of these data collection strategies relative to traditional self-report or clinician-administered measures administered in hospital or laboratory settings. A detailed discussion of the technical decisions facing researchers in the field is then presented, covering study design issues, questionnaire content development, and choices in hardware and software selection. Following these points, sample recruitment and retention strategies are discussed, as well as the main statistical issues that are necessary to consider in the exploitation of repeated measures data generated by this methodology.
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Affiliation(s)
- David Kimhy
- Division of Cognitive Neuroscience, Department of Psychiatry, Columbia University, New York, NY
| | - Inez Myin-Germeys
- Division of Mental Health, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jasper Palmier-Claus
- School of Community Based Medicine, the University of Manchester, Manchester, UK
| | - Joel Swendsen
- To whom correspondence should be addressed; tel: (33)05-57-57-10-10, fax: (33)05-56-90-14-21, e-mail:
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Javitt DC, Buchanan RW, Keefe RSE, Kern R, McMahon RP, Green MF, Lieberman J, Goff DC, Csernansky JG, McEvoy JP, Jarskog F, Seidman LJ, Gold JM, Kimhy D, Nolan KS, Barch DS, Ball MP, Robinson J, Marder SR. Effect of the neuroprotective peptide davunetide (AL-108) on cognition and functional capacity in schizophrenia. Schizophr Res 2012; 136:25-31. [PMID: 22169248 DOI: 10.1016/j.schres.2011.11.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [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: 08/15/2011] [Revised: 10/31/2011] [Accepted: 11/03/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cognitive dysfunction is a key predictor of functional disability in schizophrenia. Davunetide (AL-108, NAP) is an intranasally administered peptide currently being developed for treatment of Alzheimer's disease and related disorders. This study investigates effects of davunetide on cognition in schizophrenia. METHOD Sixty-three subjects with schizophrenia received davunetide at one of two different doses (5, 30 mg) or placebo for 12 weeks in a multicenter, double-blind, parallel-group randomized clinical trial. The MATRICS Consensus Cognitive Battery (MCCB) assessed cognitive effects. The UCSD Performance-based Skills Assessment (UPSA) and the Schizophrenia Cognition Rating Scale (SCoRS) assessed functional capacity. Subjects continued their current antipsychotic treatment during the trial. RESULTS There were no significant differences in MCCB change between davunetide and placebo over the three treatment arms (p=.45). Estimated effect-size (d) values were .34 and .21 favoring the 5 and 30 mg doses vs. placebo, respectively. For UPSA, there was a significant main effect of treatment across study arms (p=.048). Between-group effect size (d) values were.74 and .48, favoring the 5 and 30 mg doses, respectively. No significant effects were observed on the SCoRS or on symptom ratings. No significant side effects or adverse events were observed. CONCLUSION Davunetide was well tolerated. Effects of davunetide on MCCB-rated cognition were not significant relative to placebo. In contrast, a significant beneficial effect was detected for the UPSA. Based upon effect-size considerations, sample sizes of at least 45-50 subjects/group would be required to obtain significant effects on both MCCB and UPSA, providing guidance for continued clinical development in schizophrenia.
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Affiliation(s)
- Daniel C Javitt
- Nathan Kline Institute for Psychiatry Research, Orangeburg, NY, United States.
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Antonius D, Kimhy D, Harkavy-Friedman J, Crystal S, Goetz R, Malaspina D. Paternal age related schizophrenia and cardiac autonomic regulation profiles. Schizophr Res 2011; 127:273-5. [PMID: 21036543 PMCID: PMC3053092 DOI: 10.1016/j.schres.2010.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 12/19/2022]
Affiliation(s)
- Daniel Antonius
- Department of Psychiatry, Institute for Social and Psychiatric Initiatives (InSPIRES), New York University School of Medicine, 550 First Avenue, NBV 22N10, New York, NY
| | - David Kimhy
- Department of Psychiatry, Columbia University, NYS Psychiatric Institute, 1051 Riverside Drive, New York, NY
| | - Jill Harkavy-Friedman
- Department of Psychiatry, Columbia University, NYS Psychiatric Institute, 1051 Riverside Drive, New York, NY
| | - Sarah Crystal
- Department of Psychiatry, Institute for Social and Psychiatric Initiatives (InSPIRES), New York University School of Medicine, 550 First Avenue, NBV 22N10, New York, NY
| | - Ray Goetz
- Department of Psychiatry, Institute for Social and Psychiatric Initiatives (InSPIRES), New York University School of Medicine, 550 First Avenue, NBV 22N10, New York, NY, Department of Psychiatry, Columbia University, NYS Psychiatric Institute, 1051 Riverside Drive, New York, NY
| | - Dolores Malaspina
- Department of Psychiatry, Institute for Social and Psychiatric Initiatives (InSPIRES), New York University School of Medicine, 550 First Avenue, NBV 22N10, New York, NY
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Corcoran CM, Kimhy D, Parrilla-Escobar MA, Cressman VL, Stanford AD, Thompson J, David SB, Crumbley A, Schobel S, Moore H, Malaspina D. The relationship of social function to depressive and negative symptoms in individuals at clinical high risk for psychosis. Psychol Med 2011; 41:251-261. [PMID: 20444306 PMCID: PMC3376746 DOI: 10.1017/s0033291710000802] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [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: 01/15/2023]
Abstract
BACKGROUND Social dysfunction is a hallmark symptom of schizophrenia which commonly precedes the onset of psychosis. It is unclear if social symptoms in clinical high-risk patients reflect depressive symptoms or are a manifestation of negative symptoms. METHOD We compared social function scores on the Social Adjustment Scale-Self Report between 56 young people (aged 13-27 years) at clinical high risk for psychosis and 22 healthy controls. The cases were also assessed for depressive and 'prodromal' symptoms (subthreshold positive, negative, disorganized and general symptoms). RESULTS Poor social function was related to both depressive and negative symptoms, as well as to disorganized and general symptoms. The symptoms were highly intercorrelated but linear regression analysis demonstrated that poor social function was primarily explained by negative symptoms within this cohort, particularly in ethnic minority patients. CONCLUSIONS Although this study demonstrated a relationship between social dysfunction and depressive symptoms in clinical high-risk cases, this association was primarily explained by the relationship of each of these to negative symptoms. In individuals at heightened risk for psychosis, affective changes may be related to a progressive decrease in social interaction and loss of reinforcement of social behaviors. These findings have relevance for potential treatment strategies for social dysfunction in schizophrenia and its risk states and predict that antidepressant drugs, cognitive behavioral therapy and/or social skills training may be effective.
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Affiliation(s)
- C M Corcoran
- Centre of Prevention and Evaluation, Department of Psychiatry, New York State Psychiatric Institute at Columbia University, New York, NY 10032, USA.
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