An EEG-Based Neuroplastic Approach to Predictive Coding in People With Schizophrenia or Traumatic Brain Injury

Despite different etiologies, people with schizophrenia (SCZ) or with traumatic brain injury (TBI) both show aberrant neuroplasticity. One neuroplastic mechanism that may be affected is prediction error coding. We used a roving mismatch negativity (rMMN) paradigm which uses different lengths of standard tone trains and is optimized to assess predictive coding. Twenty-five SCZ, 22 TBI (mild to moderate), and 25 healthy controls were assessed. We used a frequency-deviant rMMN in which the number of standards preceding the deviant was either 2, 6, or 36. We evaluated repetition positivity to the standard tone immediately preceding a deviant tone (repetition positivity [RP], to assess formation of the memory trace), deviant negativity to the deviant stimulus (deviant negativity [DN], which reflects signaling of a prediction error), and the difference wave between the 2 (the MMN). We found that SCZ showed reduced DN and MMN compared with healthy controls and with people with mild to moderate TBI. We did not detect impairments in any index (RP, DN, or MMN) in people with TBI compared to controls. Our findings suggest that prediction error coding assessed with rMMN is aberrant in SCZ but intact in TBI, though there is a suggestion that severity of head injury results in poorer prediction error coding.

Neurophysiological indices of face processing in people with psychosis and their siblings: An event-related potential study

People with schizophrenia experience difficulties with social interactions. One contributor to these social deficits is dysfunction in processing facial features and facial emotional expressions. However, it is not known whether face processing deficits are evident in those with other psychotic disorders or in those genetically at-risk for psychosis (i.e., first-degree relatives of those with psychosis). We assessed event-related potentials (ERPs) during a facial and emotion processing task in 100 people with a diagnosis of schizophrenia or another psychotic condition (PSY), 32 of their siblings (SIB) and 45 healthy comparison participants (CTL). In separate blocks, participants identified the sex (male or female) or emotion (happy, angry, neutral) of faces. In a comparison condition, participants indicated whether buildings had one or two floors. ERPs were examined in two stages. First, we compared ERPs across the emotion, sex and building identification conditions. Second, we compared ERPs among the three different facial emotions. PSY exhibited significantly lower amplitudes over parietal-occipital regions between 111 and 151 ms when viewing faces but not buildings than CTL, consistent with a face-selective N170 ERP component deficit. The SIB group was intermediate for faces, but not significantly different than PSY or CTL. During emotion identification, all three groups showed increased N170 amplitudes to angry and happy versus neutral expressions, with no group differences. In follow up analyses, we examined differences between PSY with or without affective psychosis, and differences between those with schizophrenia versus other psychotic disorders; there were no significant differences in these analyses. Face processing deficits assessed with ERPs were observed in a group of diverse psychotic disorders, though deficits were not seen to be modulated by facial emotion expression. Additionally, N170 deficits are not evident in siblings of those with PSY.

Sustained mental health and functional responses to the COVID-19 pandemic in Black and White Veterans with psychosis or recent homelessness

The COVID-19 pandemic disproportionately impacted marginalized populations including Black Americans, people with serious mental illness, and individuals experiencing homelessness. Although the double disadvantage hypothesis would suggest that individuals with multiple minoritized statuses would experience worse psychosocial impacts from the pandemic, this may not be the case for vulnerable Black Veterans. The present study investigated the sustained mental health and functional responses to the pandemic in Black and White Veterans with psychosis or recent homelessness and in a control group of Veterans enrolled in the Department of Veterans Affairs healthcare services. Clinical interviews and questionnaires were administered remotely by telephone at five time points from May 2020 through July 2021, including a retrospective time point for March 2020 (i.e., before the pandemic started). Overall, there was a striking absence of systematic differences by race in the trajectories of psychiatric symptoms and functioning among Veterans during the study period. These findings are consistent with a report on initial responses to the pandemic that revealed only a few select differences by race among Veteran groups. The lack of racial disparities is inconsistent with the double disadvantage hypothesis. Although further investigation is needed, one possible interpretation is that the wrap-around services offered by the Veterans Health Administration may have mitigated expected differences by race among Veterans with psychosis or homelessness. Future research should continue to examine whether VA services mitigate disparities in mental health and psychosocial outcomes.

Social cognition and social motivation in schizophrenia and bipolar disorder: are impairments linked to the disorder or to being socially isolated?

BACKGROUND

People with schizophrenia on average are more socially isolated, lonelier, have more social cognitive impairment, and are less socially motivated than healthy individuals. People with bipolar disorder also have social isolation, though typically less than that seen in schizophrenia. We aimed to disentangle whether the social cognitive and social motivation impairments observed in schizophrenia are a specific feature of the clinical condition v. social isolation generally.

METHODS

We compared four groups (clinically stable patients with schizophrenia or bipolar disorder, individuals drawn from the community with self-described social isolation, and a socially connected community control group) on loneliness, social cognition, and approach and avoidance social motivation.

RESULTS

Individuals with schizophrenia (n = 72) showed intermediate levels of social isolation, loneliness, and social approach motivation between the isolated (n = 96) and connected control (n = 55) groups. However, they showed significant deficits in social cognition compared to both community groups. Individuals with bipolar disorder (n = 48) were intermediate between isolated and control groups for loneliness and social approach. They did not show deficits on social cognition tasks. Both clinical groups had higher social avoidance than both community groups.

CONCLUSIONS

The results suggest that social cognitive deficits in schizophrenia, and high social avoidance motivation in both schizophrenia and bipolar disorder, are distinct features of the clinical conditions and not byproducts of social isolation. In contrast, differences between clinical and control groups on levels of loneliness and social approach motivation were congruent with the groups' degree of social isolation.

An ERP Study of Face Processing in Schizophrenia, Bipolar Disorder, and Socially Isolated Individuals from the Community

People with schizophrenia (SCZ) and bipolar disorder (BD) have impairments in processing social information, including faces. The neural correlates of face processing are widely studied with the N170 ERP component. However, it is unclear whether N170 deficits reflect neural abnormalities associated with these clinical conditions or differences in social environments. The goal of this study was to determine whether N170 deficits would still be present in SCZ and BD when compared with socially isolated community members. Participants included 66 people with SCZ, 37 with BD, and 125 community members (76 "Community-Isolated"; 49 "Community-Connected"). Electroencephalography was recorded during a face processing task in which participants identified the gender of a face, the emotion of a face (angry, happy, neutral), or the number of stories in a building. We examined group differences in the N170 face effect (greater amplitudes for faces vs buildings) and the N170 emotion effect (greater amplitudes for emotional vs neutral expressions). Groups significantly differed in levels of social isolation (Community-Isolated > SCZ > BD = Community-Connected). SCZ participants had significantly reduced N170 amplitudes to faces compared with both community groups, which did not differ from each other. The BD group was intermediate and did not differ from any group. There were no significant group differences in the processing of specific emotional facial expressions. The N170 is abnormal in SCZ even when compared to socially isolated community members. Hence, the N170 seems to reflect a social processing impairment in SCZ that is separate from level of social isolation.

The impact of psychological strengths on Veteran populations' mental health trajectories during the COVID-19 pandemic

PURPOSE

Mental health trajectories during the COVID-19 pandemic have been examined in Veterans with tenuous social connections, i.e., those with recent homelessness (RHV) or a psychotic disorder (PSY), and in control Veterans (CTL). We test potential moderating effects on these trajectories by psychological factors that may help individuals weather the socio-emotional challenges associated with the pandemic (i.e., 'psychological strengths').

METHODS

We assessed 81 PSY, 76 RHV, and 74 CTL over 5 periods between 05/2020 and 07/2021. Mental health outcomes (i.e., symptoms of depression, anxiety, contamination concerns, loneliness) were assessed at each period, and psychological strengths (i.e., a composite score based on tolerance of uncertainty, performance beliefs, coping style, resilience, perceived stress) were assessed at the initial assessment. Generalized models tested fixed and time-varying effects of a composite psychological strengths score on clinical trajectories across samples and within each group.

RESULTS

Psychological strengths had a significant effect on trajectories for each outcome (ps < 0.05), serving to ameliorate changes in mental health symptoms. The timing of this effect varied across outcomes, with early effects for depression and anxiety, later effects for loneliness, and sustained effects for contamination concerns. A significant time-varying effect of psychological strengths on depressive symptoms was evident in RHV and CTL, anxious symptoms in RHV, contamination concerns in PSY and CTL, and loneliness in CTL (ps < 0.05).

CONCLUSION

Across vulnerable and non-vulnerable Veterans, presence of psychological strengths buffered against exacerbations in clinical symptoms. The timing of the effect varied across outcomes and by group.

Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders

Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks - two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) - in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (total R2 = 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.

Unconditional Cash Transfers and Association With Clinical Outcomes Among U.S. Veterans With Psychosis or Recent Homelessness

OBJECTIVE

Three rounds of stimulus checks were distributed to middle- and low-income U.S. adults during the COVID-19 pandemic. This 15-month longitudinal study examined rates of receipt of these stimulus checks, planned expenses, and associations with clinical outcomes among three veteran groups.

METHODS

In total, 158 veterans, consisting of 59 with a psychotic disorder, 49 recently homeless veterans, and a comparison group of 50 veterans without a history of psychosis or homelessness, were assessed five times between May 2020 and July 2021. Bivariate analyses were used to compare receipt of stimulus checks and planned expenses among the groups, and multivariable analyses examined how receipt of checks was related to mental health and substance use over time.

RESULTS

No group difference was found in receipt of stimulus checks, and 74%-84% of veterans reported receipt of more than one check. Most participants reported plans to use their stimulus checks to pay for bills, groceries, credit card debt, and rent or mortgage or to save the money. Over time, participants who received a greater number of stimulus checks reported significantly decreased symptoms of depression (B=-0.48) and anxiety (B=-0.84) and improved social functioning (B=0.24). For the recently homeless group, a greater number of stimulus checks received was associated with decreases in days of alcohol intoxication and drug use, but the reverse was found for the psychosis group.

CONCLUSIONS

Multiple short-term unconditional government cash transfers may improve mental and social functioning among vulnerable populations during major crises, a finding that contributes to the research literature and has policy implications for pandemic and emergency preparedness.

Neuroimaging of social motivation during winning and losing: Associations with social anhedonia across the psychosis spectrum

BACKGROUND

Individuals with psychosis spectrum disorders (PSD) have difficulty developing social relationships. This difficulty may reflect reduced response to social feedback involving functional alterations in brain regions that support the social motivation system: ventral striatum, orbital frontal cortex, insula, dorsal anterior cingulate cortex, and amygdala. Whether these alterations span PSD is unknown.

METHODS

71 individuals with PSD, 27 unaffected siblings, and 37 control participants completed a team-based fMRI task. After each trial, participants received performance feedback paired with the expressive face of a teammate or opponent. A 2 × 2 (win versus loss outcome x teammate versus opponent) repeated measures ANOVA by group was performed on activation in the five key regions of interest during receipt of feedback.

RESULTS

Across groups, three social motivation regions, ventral striatum, orbital frontal cortex, and amygdala, showed sensitivity to feedback (significant main effect of outcome), with greater activation during win versus loss trials, regardless of whether the feedback was from a teammate or opponent. In PSD, ventral striatum and orbital frontal cortex activation to win feedback was negatively correlated with social anhedonia scores.

CONCLUSIONS

Patterns of neural activation during social feedback were similar in PSD, their unaffected siblings, and healthy controls. Across the psychosis spectrum, activity in key social motivation regions during social feedback was associated with individual differences in social anhedonia.

Financial health and psychiatric symptoms among veterans with psychosis or recent homelessness during the COVID-19 pandemic

The COVID-19 pandemic disproportionately impacted the physical health of some vulnerable groups, but further study is needed to investigate the pandemic's impact on financial health and mental well-being. We analyzed data from 158 participants, consisting of 59 veterans with a psychotic disorder (PSY), 49 recently housed veterans (RHV), and a control group of 50 veterans (CTL) who were assessed five times from May 2020-July 2021. This study compared the financial health of these three groups and examined the relation between financial health and psychiatric symptoms. Although the CTL group reported significantly higher income and savings than the PSY and RHV groups, the CTL group reported greater negative financial shocks than the PSY group. The RHV group reported greater material hardship but greater propensity to plan for finances and less financial shocks than the PSY group. Across all three groups, there was a reduction in financial shocks over time and no group showed more change than another. Across time, material hardship, financial shocks, and propensity to plan for finances were each significantly associated with symptoms of major depression. Together, these findings suggest the COVID-19 pandemic did not greatly impact the financial health of PSY and RHV groups possibly because of their limited income and resilience to adversity. Financial health was related to mental health supporting the U.S. government's strategic plan to include financial empowerment services in efforts to improve mental health and reduce veteran suicide. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Aberrant reward processing to positive versus negative outcomes across psychotic disorders

Several studies of reward processing in schizophrenia have shown reduced sensitivity to positive, but not negative, outcomes although inconsistencies have been reported. In addition, few studies have investigated whether patients show a relative deficit to social versus nonsocial rewards, whether deficits occur across the spectrum of psychosis, or whether deficits relate to negative symptoms and functioning. This study examined probabilistic implicit learning via two visually distinctive slot machines for social and nonsocial rewards in 101 outpatients with diverse psychotic disorders and 48 community controls. The task consisted of two trial types: positive (optimal to choose a positive vs. neutral machine) and negative (optimal to choose a neutral vs. negative machine), with two reward conditions: social (faces) and nonsocial (money) reward conditions. A significant group X trial type interaction indicated that controls performed better on positive than negative trials, whereas patients showed the opposite pattern of better performance on negative than positive trials. In addition, both groups performed better for social than nonsocial stimuli, despite lower overall task performance in patients. Within patients, worse performance on negative trials showed significant, small-to-moderate correlations with motivation and pleasure-related negative symptoms and social functioning. The current findings suggest reward processing disturbances, particularly decreased sensitivity to positive outcomes, extend beyond schizophrenia to a broader spectrum of psychotic disorders and relate to important clinical outcomes.

The flickering spotlight of visual attention: Characterizing abnormal object-based attention in schizophrenia

Schizophrenia is associated with deficits in both object perception and visual attention. However, few studies in schizophrenia have investigated object-based attention, which is dissociable from other forms of visuospatial attention. Recent research in healthy populations has shown that the 'spotlight' of sustained visual attention flickers in a rhythmic, oscillatory fashion at specific frequencies in the 4-12 Hz range. In healthy samples, this oscillatory signature has been used to investigate spatiotemporal dynamics of object-based attention, showing that the attentional spotlight spreads to uncued locations within cued objects, and also periodically alternates focus between cued and uncued objects. In this study, we adapted a performance-based visual object cueing task to investigate object-based attention in individuals with a schizophrenia diagnosis and healthy controls. In controls, spatiotemporal patterns of object-based attention closely resembled those reported in previous studies of healthy individuals. In the schizophrenia group, the oscillatory signature of attention also appeared in the location of the cue and on uncued objects, similar to the effects in controls. Indeed, the oscillatory signature of attention at the spatial location of the cue was stronger in the schizophrenia group than in controls. However, attention did not spread across the cued object in schizophrenia; rather, attention appeared to remain hyperfocused at the spatial location of the cue. These findings provide the first evidence that visual attention has oscillatory characteristics in schizophrenia, as in the general population. The results also show that the fundamental process of attentional spreading which underlies object-based attention is abnormal in schizophrenia.

Socioeconomic challenges during the COVID-19 pandemic for Veterans with psychosis or recent homelessness

The COVID-19 pandemic and social distancing have directly impacted the socioeconomic well-being of most Americans. Veterans with psychosis (PSY) and Veterans who were recently housed (RHV) through a supportive housing programme may be especially vulnerable to experiencing negative socioeconomic effects of the pandemic. In this study, we investigated socioeconomic experiences and challenges during the pandemic in these two putatively vulnerable Veteran groups and in Veterans with no history of PSY or homeless (i.e., control Veterans, CTL). A total of 231 Veterans (81 PSY, 76 RHV, 64 CTL) participated in the baseline assessment, and 203 in the follow-up assessment (74 PSY, 63 RHV, 66 CTL). At both assessment points we obtained socioeconomic information, including personal finances, financial concerns, housing concerns, experience of material hardships, and employment status. All groups of Veterans reported socioeconomic challenges during the pandemic, but the pattern of effects differed across groups. Although RHV was in a similar position to the PSY group with respect to personal finances, they reported lower levels of financial well-being and were more prone to experiencing material hardships compared to the other two groups. CTL was most vulnerable to experiencing negative financial shocks. Contrary to expectations, PSY did not experience disproportionate material hardships compared to CTL. Veterans face significant socioeconomic challenges during the COVID-19 pandemic. However, RHV disproportionately experienced certain concerns and hardships, and these are a target for intervention by clinicians and service providers. PSY generally fared better than anticipated, possibly reflecting longstanding engagement with VA services that could serve to buffer the socioeconomic impact of the pandemic.

The impact of the COVID-19 pandemic on mental health and functional outcomes in Veterans with psychosis or recent homelessness: A 15-month longitudinal study

Background

The COVID-19 pandemic has had unprecedented effects on mental health and community functioning. Negative effects related to disruption of individuals’ social connections may have been more severe for those who had tenuous social connections prior to the pandemic. Veterans who have recently experienced homelessness (RHV) or have a psychotic disorder (PSY) are considered particularly vulnerable because many had poor social connections prior to the pandemic.

Methods

We conducted a 15-month longitudinal study between May 2020 –July 2021 assessing clinical (e.g., depression, anxiety) and community (e.g., social functioning, work functioning) outcomes. Eighty-one PSY, 76 RHV, and 74 Veteran controls (CTL) were interviewed over 5 assessment periods. We assessed changes in mental health and community functioning trajectories relative to pre-pandemic retrospective ratings and examined group differences in these trajectories.

Results

All groups had significantly increased symptoms of depression, anxiety, and concerns with contamination at the onset of the pandemic. However, RHV and PSY showed faster returns to their baseline levels compared to CTL, who took nearly 15 months to return to baseline. With regards to functioning, both RHV and PSY, but not CTL, had significant improvements in family and social networks over time. Work functioning worsened over time only in PSY, and independent living increased over time in both RHV and PSY but not CTL.

Conclusions

These results reveal that vulnerable Veterans with access to VA mental health and case management services exhibited lower negative impacts of the COVID-19 pandemic on mental health and community functioning than expected.

Reduced neural activity when anticipating social versus nonsocial rewards in schizophrenia: Preliminary evidence from an ERP study

Diminished social motivation is a core feature of schizophrenia that might reflect disturbances in social reward processing. It is not known whether these disturbances reflect anticipatory ("wanting") and/or consummatory ("liking") pleasure deficits. The primary aim of this study was to examine social versus nonsocial reward processing during these temporally distinct substages using event-related potential (ERP) components. Twenty-three schizophrenia participants and 20 healthy participants completed an incentive delay task with social (i.e., smiling expressions) and nonsocial (i.e., money) rewards. We measured two anticipatory ERPs (i.e., "wanting") (target anticipation: Contingent Negative Variation [CNV]; feedback anticipation: Stimulus Preceding Negativity [SPN]) and one consummatory ERP (i.e., "liking") (feedback receipt: P300). As a secondary aim, we examined correlations between the ERPs and interview-rated motivational negative symptoms and social functioning. Schizophrenia participants showed overall less target anticipation (blunted CNV) across all trials (social and nonsocial) than healthy participants. Importantly, schizophrenia participants exhibited less anticipation of social rewards relative to nonsocial rewards (SPN), whereas healthy participants showed similar anticipation for both reward types. Both groups showed similar responses to social and nonsocial reward receipt (P300). Furthermore, social reward anticipation during the incentive delay task was associated with more social approach behaviors in the real-world. Together, these findings provide preliminary evidence for intact social reward "liking" and impaired "wanting" in schizophrenia.

Intact differentiation of responses to socially-relevant emotional stimuli across psychotic disorders: An event-related potential (ERP) study

Event-related potential (ERP) studies of motivated attention in schizophrenia typically show intact sensitivity to affective vs. non-affective images depicting diverse types of content. However, it is not known whether this ERP pattern: 1) extends to images that solely depict social content, (2) applies across a broad sample with diverse psychotic disorders, and (3) relates to self-reported trait social anhedonia. We examined late positive potential (LPP) amplitudes to images involving people that were normatively pleasant (affiliative), unpleasant (threatening), or neutral in 97 stable outpatients with various psychotic disorders and 38 healthy controls. Both groups showed enhanced LPP to pleasant and unpleasant vs. neutral images to a similar degree, despite lower overall LPP in patients. Within the patients, there were no significant LPP differences among subgroups (schizophrenia vs. other psychotic disorders; affective vs. non-affective psychosis) for the valence effect (pleasant/unpleasant vs. neutral). Higher social anhedonia showed a small, significant relation to lower LPP to pleasant images across all groups. These findings suggest intact motivated attention to social images extends across psychotic disorder subgroups. Dimensional transdiagnostic analyses revealed a modest association between self-reported trait social anhedonia and an LPP index of neural sensitivity to pleasant affiliative images.

Racial differences in the psychosocial response to the COVID-19 pandemic in veterans with psychosis or recent homelessness

The COVID-19 pandemic continues to disproportionately impact people of color and individuals experiencing psychosis and homelessness. However, it is unclear whether there are differences by race in psychosocial responses to the pandemic in vulnerable populations. The double jeopardy hypothesis posits that multiply marginalized individuals would experience worse psychosocial outcomes. The present study investigated the clinical and functional initial responses to the pandemic in both Black (n = 103) and White veterans (n = 98) with psychosis (PSY), recent homelessness (RHV), and in a control group (CTL) enrolled in Department of Veterans Affairs (VA) healthcare services. Clinical interviews were administered via phone at two time points: baseline (mid-May through mid-August 2020) and follow-up (mid-August through September 2020). The baseline interview also included retrospective measures of pre-COVID status from January 2020. There were no significant differences between Black and White veterans in depression, anxiety, or loneliness. However, Black veterans did endorse more fears of contamination, F(1, 196.29) = 9.48, p = .002. Across all groups, Black veterans had better family integration compared to White veterans, F(1, 199.98) = 7.62, p = .006. There were no significant differences by race in social integration, work/role productivity, or independent living. In sum, there were few significant differences between Black and White veterans in initial psychosocial response to the pandemic. The lack of racial disparities might reflect the presence of VA's wrap-around services. The findings also highlight the robust nature of social support in Black veterans, even in the context of a global pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The viability of the frequency following response characteristics for use as biomarkers of cognitive therapeutics in schizophrenia

Deficits in early auditory information processing contribute to cognitive and psychosocial disability; this has prompted development of interventions that target low-level auditory processing, which may alleviate these disabilities. The frequency following response (FFR) is a constellation of event-related potential and frequency characteristics that reflect the processing of acoustic stimuli at the level of the brainstem and ascending portions of the auditory pathway. While FFR is a promising candidate biomarker of response to auditory-based cognitive training interventions, the psychometric properties of FFR in schizophrenia patients have not been studied. Here we assessed the psychometric reliability and magnitude of group differences across 18 different FFR parameters to determine which of these parameters demonstrate adequate internal consistency. Electroencephalography from 40 schizophrenia patients and 40 nonpsychiatric comparison subjects was recorded during rapid presentation of an auditory speech stimulus (6000 trials). Patients showed normal response amplitudes but longer latencies for most FFR peaks and lower signal-to-noise ratios (SNRs) than healthy subjects. Analysis of amplitude and latency estimates of peaks, however, indicated a need for a substantial increase in task length to obtain internal consistency estimates above 0.80. In contrast, excellent internal consistency (>0.95) was shown for FFR sustained responses. Only SNR scores reflecting the FFR sustained response yielded significant group differences and excellent internal consistency, suggesting that this measure is a viable candidate for use in clinical treatment studies. The present study highlights the use of internal consistency estimates to select FFR characteristics for use in future intervention studies interested in individual differences among patients.

Examining racial differences in community integration between black and white homeless veterans

Black Americans are overrepresented in Veteran and non-Veteran homeless populations. Community integration remains a problem for many Veterans after they obtain housing, and Black Veterans may encounter additional difficulties due to systemic racism. However, no prior study has specifically examined whether there are racial differences in community integration; similarly, no study has considered racial differences in psychosocial correlates of community integration in homeless Veterans. Knowledge of these factors could inform the development of culturally congruent rehabilitative interventions for Black Veterans. Semi-structured clinical interviews were administered to Black (N = 99) and White (N = 49) homeless Veterans to examine relations among psychiatric symptoms, motivation, and community integration domains (e.g., social integration, work productivity, and independent living). There were no significant racial differences in independent living or work productivity. Black Veterans had better social integration with family compared to White Veterans. In addition, psychiatric symptoms were more strongly correlated with social integration for Black than White Veterans. The association between motivation and work productivity was also stronger for Black Veterans. Recovery-oriented interventions could harness family connections and better target psychiatric symptoms to improve community integration for Black Veterans. Work productivity may improve from interventions aimed at enhancing motivation for Black Veterans.

Motivational and cognitive factors linked to community integration in homeless veterans: study 1 - individuals with psychotic disorders

BACKGROUND

Little is known about the determinants of community integration (i.e. recovery) for individuals with a history of homelessness, yet such information is essential to develop targeted interventions.

METHODS

We recruited homeless Veterans with a history of psychotic disorders and evaluated four domains of correlates of community integration: perception, non-social cognition, social cognition, and motivation. Baseline assessments occurred after participants were engaged in supported housing services but before they received housing, and again after 12 months. Ninety-five homeless Veterans with a history of psychosis were assessed at baseline and 53 returned after 12 months. We examined both cross-sectional and longitudinal relationships with 12-month community integration.

RESULTS

The strongest longitudinal association was between a baseline motivational measure and social integration at 12 months. We also observed cross-sectional associations at baseline between motivational measures and community integration, including social, work, and independent living. Cross-lagged panel analyses did not suggest causal associations for the motivational measures. Correlations with perception and non-social cognition were weak. One social cognition measure showed a significant longitudinal correlation with independent living at 12 months that was significant for cross-lagged analysis, consistent with a causal relationship and potential treatment target.

CONCLUSIONS

The relatively selective associations for motivational measures differ from what is typically seen in psychosis, in which all domains are associated with community integration. These findings are presented along with a partner paper (Study 2) to compare findings from this study to an independent sample without a history of psychotic disorders to evaluate the consistency in findings regarding community integration across projects.

Representation of sexual and gender minorities in psychiatric research

Representation of people who identify as members of sexual and gender minority (SGM) groups is lacking in psychiatric research. Few researchers openly identify as members of an SGM group, and those who do continue to face career obstacles. Separately, in the context of psychiatric research studies, little attention has been paid to how participants' SGM identities might intersect with other factors to influence each individual's experience of mental illness. In this brief commentary, we summarize these and related issues, then offer suggestions for how institutions, professional societies, labs, and individuals might help to improve SGM representation in psychiatric research.

Motivational and cognitive factors linked to community integration in homeless veterans: Study 2 - clinically diverse sample

BACKGROUND

In an initial study (Study 1), we found that motivation predicted community integration (i.e. functional recovery) 12 months after receiving housing in formerly homeless Veterans with a psychotic disorder. The current study examined whether the same pattern would be found in a broader, more clinically diverse, homeless Veteran sample without psychosis.

METHODS

We examined four categories of variables as potential predictors of community integration in non-psychotic Veterans: perception, non-social cognition, social cognition, and motivation at baseline (after participants were engaged in a permanent supported housing program but before receiving housing) and a 12-month follow-up. A total of 82 Veterans had a baseline assessment and 41 returned for testing after 12 months.

RESULTS

The strongest longitudinal association was between an interview-based measure of motivation (the motivation and pleasure subscale from the Clinical Assessment Interview for Negative Symptoms) at baseline and measures of social integration at 12 months. In addition, cross-lagged panel analyses were consistent with a causal influence of general psychiatric symptoms at baseline driving social integration at 12 months, and reduced expressiveness at baseline driving independent living at 12 months, but there were no significant causal associations with measures of motivation.

CONCLUSIONS

The findings from this study complement and reinforce those in Veterans with psychosis. Across these two studies, our findings suggest that motivational factors are associated at baseline and at 12 months and are particularly important for understanding and improving community integration in recently-housed Veterans across psychiatric diagnoses.

A comparison of stages of attention for social and nonsocial stimuli in schizophrenia: An ERP study

Social motivation disturbances have been long observed in people with schizophrenia, yet the underlying components that drive these impairments remain unclear. Social attention is one component of social motivation and involves stages of attentional orienting, alerting/sustained attention, and executive control. It is not known at which stage the breakdown in social attention occurs in schizophrenia. The present study examined the allocation of social versus nonsocial attention at multiple stages of processing using event related potential (ERP) components. Electroencephalography from 36 outpatients with schizophrenia and 20 healthy participants was recorded during a dot probe task while viewing social/nonsocial stimuli that assessed: (1) orienting (indexed by the N1pc), (2) sustained attention (Contingent Negative Variation, [CNV]), and (3) executive control of attention during target evaluation (P300). Additionally, we analyzed correlations between the ERPs and participants' reaction times (RT) to the targets. Schizophrenia participants oriented their attention equally to social and nonsocial stimuli (N1pc), showed greater sustained attention to social than nonsocial stimuli (i.e., larger CNV), and exerted greater executive control on social trials (i.e., larger P300) than nonsocial trials, similarly to healthy participants. However, schizophrenia participants showed diminished overall sustained attention (blunted CNV) during the task, compared with healthy participants. Furthermore, greater sustained attention (larger CNV) and greater executive control (larger P300) were associated with improved behavioral performance (faster RTs) for healthy participants, but not schizophrenia participants. Together, these findings suggest there is impaired sustained attention for both social and nonsocial stimuli in schizophrenia, and their attention may not correspond with their behavior.

Clinical and functional effects of the COVID-19 pandemic and social distancing on vulnerable veterans with psychosis or recent homelessness

The COVID-19 pandemic has upended the lives of everyone in the United States, negatively impacting social interactions, work, and living situations, and potentially exacerbating mental health issues in vulnerable individuals. Within the Department of Veterans Affairs (VA) healthcare system, two vulnerable groups include those with a psychotic disorder (PSY) and those who have recently experienced homelessness (recently housed Veterans, RHV). We conducted phone interviews with PSY (n = 81), RHV (n = 76) and control Veterans (CTL, n = 74) between mid-May - mid-August 2020 ("initial") and between mid-August - mid-October 2020 ("follow-up"). At the initial period, we also collected retrospective ratings relative to January 2020 ("pre-COVID-19"). We assessed clinical factors (e.g., depression, anxiety, loneliness) and community integration (e.g., social and role functioning). All groups reported worse clinical outcomes after the onset of the COVID-19 pandemic. However, PSY and RHV exhibited improvements in depression and anxiety from initial to follow up, whereas CTL continued to exhibit elevated levels. There was little change in community integration measures. Our results indicate that all groups reported increased mental health problems after the onset of the pandemic, but vulnerable Veterans were not disproportionately affected and had better mental health resilience (i.e., for depression and anxiety) as the pandemic progressed compared to CTL. This effect could be due to the availability and utilization of VA services for PSY and RHV (e.g., housing and financial support, medical and mental health services), which may have helped to mitigate the impact of the pandemic.

Structural and Functional Connectivity of Visual Cortex in Schizophrenia and Bipolar Disorder: A Graph-Theoretic Analysis

Visual processing abnormalities in schizophrenia (SZ) are poorly understood, yet predict functional outcomes in the disorder. Bipolar disorder (BD) may involve similar visual processing deficits. Converging evidence suggests that visual processing may be relatively normal at early stages of visual processing such as early visual cortex (EVC), but that processing abnormalities may become more pronounced by mid-level visual areas such as lateral occipital cortex (LO). However, little is known about the connectivity of the visual system in SZ and BD. If the flow of information to, from, or within the visual system is disrupted by reduced connectivity, this could help to explain perceptual deficits. In the present study, we performed a targeted analysis of the structural and functional connectivity of the visual system using graph-theoretic metrics in a sample of 48 SZ, 46 BD, and 47 control participants. Specifically, we calculated parallel measures of local efficiency for EVC and LO from both diffusion weighted imaging data (structural) and resting-state (functional) imaging data. We found no structural connectivity differences between the groups. However, there was a significant group difference in functional connectivity and a significant group-by-region interaction driven by reduced LO connectivity in SZ relative to HC, whereas BD was approximately intermediate to the other 2 groups. We replicated this pattern of results using a different brain atlas. These findings support and extend theoretical models of perceptual dysfunction in SZ, providing a framework for further investigation of visual deficits linked to functional outcomes in SZ and related disorders.

Effects of Transcranial Direct Current Stimulation on Visual Neuroplasticity in Schizophrenia

People with schizophrenia (SZ) exhibit visual processing abnormalities that affect their daily functioning and remediating these deficits might help to improve functioning. Transcranial direct current stimulation (tDCS) is a potential tool for perceptual enhancement for this purpose, though there are no reports of tDCS applied to visual cortex in SZ. In a within-subject, crossover design, we evaluated the effects of tDCS on visual processing in 27 SZ. All patients received anodal, cathodal, or sham stimulation over the central occipital region in 3 visits separated by 1 week. In each visit, a backward masking task and an electroencephalography measure of visual neuroplasticity were administered after tDCS. Neuroplasticity was assessed with visual evoked potentials before and after tetanizing visual high-frequency stimulation. Masking performance was significantly poorer in the anodal and cathodal conditions compared with sham. Both anodal and cathodal stimulation increased the amplitude of P1 but did not change the plasticity index. We found significant plasticity effects of tDCS for only one waveform for one stimulation condition (P2 for anodal tDCS) which did not survive correction for multiple comparisons. The reason for the lack of tDCS stimulation effects on plasticity may be because tDCS was not delivered simultaneously with the tetanizing visual stimulus. The present findings emphasize the need for more research on the relevant parameters for stimulation of visual processing regions in clinical populations.

People with schizophrenia do not show the normal benefits of social versus nonsocial attentional cues

OBJECTIVE

Schizophrenia is associated with impairments in social motivation. Social attention has been proposed as an underlying mechanism for social motivation. However, studies in schizophrenia have rarely examined social attention, and none of these studies examined the effects with rapidly presented stimuli.

METHOD

The current study examined whether individuals with schizophrenia have reduced social attention and whether reduced social attention was related to social motivation deficits (measured with the Clinical Assessment Interview for Negative Symptoms) and decreased social functioning (Role Functioning Scale). Thirty-seven outpatients with schizophrenia and 29 healthy participants completed a gaze cueing task with directional social cues (eye gaze) and nonsocial cues (arrows) at varying stimulus onset asynchronies.

RESULTS

As predicted, schizophrenia participants had reduced social attention relative to nonsocial attention, compared with healthy participants. Healthy participants were quicker to respond to social cues than nonsocial cues, but schizophrenia participants did not exhibit this same pattern. Schizophrenia participants showed higher accuracy when targets appeared in the same location as a directional cue (i.e., congruency) for nonsocial, but not social, cues. Contrary to expectations, reduced social attention was not significantly correlated with clinically rated social motivation deficits or decreased social functioning in the schizophrenia group.

CONCLUSION

These findings provide evidence for social attention deficits in schizophrenia, but without a clear mapping of its influence on social motivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Early Visual Processing Is Associated With Social Cognitive Performance in Recent-Onset Schizophrenia

BACKGROUND

Early-stage visual processing deficits are evident in chronic schizophrenia. Consistent with a cascade model of information processing, whereby early perceptual processes have downstream effects on higher-order cognition, impaired visual processing is associated with deficits in social cognition in this clinical population. However, the nature of this relationship in the early phase of illness is unknown. Here, we present data from a study of early visual processing and social cognitive performance in recent-onset schizophrenia (ROSz).

METHOD

Thirty-two people with ROSz and 20 healthy controls (HC) completed a visual backward masking task using stimuli of real world objects (Object Masking) to assess early-stage (i.e., 0-125 ms post-stimulus onset) visual processing. Subjects also completed two tasks of social cognition, one assessing relatively low-level processes of emotion identification (Emotion Biological Motion, EmoBio), and another assessing more complex, higher-order theory of mind abilities (The Awareness of Social Inference Test, TASIT). Group differences were tested with repeated measures ANOVAs and t-tests. Bivariate correlations and linear regressions tested the strength of associations between early-stage visual processing and social cognitive performance in ROSz.

RESULTS

For Object Masking, the mask interfered with object identification over a longer interval for ROSz than for HC [F (3.19, 159.35) = 8.51, p < 0.001]. ROSz were less accurate on the EmoBio task [t (50) = -3.36, p = 0.001] and on the TASIT compared to HC [F (1, 50) = 38.37, p < 0.001]. For the TASIT ROSz were disproportionately impaired on items assessing sarcasm detection [F (1, 50) = 4.30, p = 0.04]. In ROSz, better Object Masking performance was associated with better social cognitive performance [r EmoBio = 0.45, p < 0.01; r TASIT = 0.41, p < 0.02]. Regression analyses did not provide significant support for low-level social cognition mediating the relationship between visual processing and high-level social cognition.

CONCLUSION

Early-stage visual processing, low-level social cognition, and high-level social cognition were all significantly impaired in ROSz. Early-stage visual processing was associated with performance on the social cognitive tasks in ROSz, consistent with a cascade model of information processing. However, significant cascading effects within social cognition were not supported. These data suggest that interventions directed at early visual processing may yield downstream effects on social cognitive processes.

Reward processing in certain versus uncertain contexts in schizophrenia: An event-related potential (ERP) study

Disturbances in motivation are prominent in the clinical presentation of people with schizophrenia and might reflect a disturbance in reward processing. Recent advances in affective neuroscience have subdivided reward processing into distinct components, but there are two limitations of the prior work in schizophrenia. First, studies typically focus on only one component rather than on the unfolding of reward processing across multiple stages. Second, studies have not considered the impact of certainty effects, which represent an important contextual factor that impacts processing. We examined whether individuals with schizophrenia show the typical certainty effects across three phases of reward processing: cue evaluation, feedback anticipation, and feedback receipt. Electroencephalography from 74 healthy controls and 92 people with schizophrenia was recorded during a cued gambling task under conditions in which cues indicated forthcoming reward outcomes that were certain or uncertain. Controls demonstrated the expected certainty effects across each stage. Initial cue evaluation (cue P300) was intact in the schizophrenia group, but people with schizophrenia showed diminished certainty effects during feedback anticipation (stimulus-preceding negativity [SPN]) and receipt (feedback reward positivity [fRewP] and feedback P300). During feedback receipt, event-related potentials in people with schizophrenia were similar to controls for the uncertain context but larger than controls for the certain context. Essentially, people with schizophrenia appeared to process certain feedback as though it were uncertain. These findings show, for the first time, that the fundamental distinction between certain and uncertain contexts is altered in schizophrenia at a neural level. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluating visual neuroplasticity with EEG in schizophrenia outpatients

Deficient neuroplasticity has been implicated in schizophrenia and can be examined with non-invasive methods in humans. High frequency visual stimulation (HFS) induces neuroplastic changes in visual evoked potential (VEP) components, similar to the tetanizing electrical stimulation that induces synaptic long-term potentiation (LTP). While visual HFS paradigms have been used in schizophrenia, the use of a single visual stimulus has precluded demonstration of whether the plasticity effects are specific to the stimulus presented during HFS (i.e., input specific). Additionally, test-retest reliability of VEP plasticity effects, an important consideration for applications of HFS paradigms in schizophrenia clinical trials, remains unknown. Accordingly, we administered a visual HFS paradigm to 38 schizophrenia patients and 27 healthy controls at baseline and two-weeks later. VEPs were elicited by horizontal and vertical line gratings before and after HFS; only one orientation was tetanized with HFS. Using a mass univariate permutation approach, we identified an input-specific cluster across groups that was broadly distributed over parietal-occipital areas between 108 and 183 ms. However, the groups did not differ in terms of the strength of plasticity effect. The test-retest reliability of the input-specific plasticity effect was modest over two weeks, suggesting that this HFS paradigm requires further development before it could be used to track plasticity change in clinical trials. Moreover, while the current HFS paradigm induced significant input-specific neuroplasticity, it did not replicate prior studies showing deficient neuroplasticity in schizophrenia. Accordingly, demonstration of deficient visual LTP-like neuroplasticity in schizophrenia may depend on paradigm parameters that remain to be fully elucidated.

Resilience in homeless veterans: Clinical and cognitive correlates

OBJECTIVE

Resilience is broadly defined as the ability to respond adaptively to challenges or adversity. It is unclear which clinical and cognitive factors are most closely related to resilience. Also, the dimensions that comprise resilience may differ among different groups, such as those who are homeless. The purpose of this study was to understand the relationships between resilience and clinical, cognitive, and functional variables among homeless veterans and to determine independent predictors of resilience.

METHOD

One hundred homeless veterans completed measures of resilience, defeatist beliefs, negative symptoms, psychotic and mood symptoms, social and nonsocial cognition, and community functioning. We examined associations between resilience and clinical, cognitive, and functional measures. We performed regression analyses to determine independent contributions of the variables to resilience.

RESULTS

Resilience was correlated with negative symptoms, defeatist beliefs, depression/anxiety symptoms, and social cognition. There were no significant correlations with nonsocial cognition or psychotic symptoms. Stepwise multiple linear regression showed that defeatist beliefs, motivational negative symptoms, expressive negative symptoms, and depression/anxiety symptoms made independent contributions. Resilience was correlated with community functioning in the domains of work, independent living, and social and family relationships. History of psychosis moderated the relationship between resilience and defeatist beliefs, which was stronger in those who had experienced psychosis.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

These findings suggest that resilience is an important construct to consider in homeless veterans, is related to other clinical factors such as defeatist beliefs and negative symptoms, and could be a valuable treatment target with the goal of improving functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evidence for intact stimulus-specific neural adaptation for visual objects in schizophrenia and bipolar disorder: An ERP study

People with schizophrenia (SZ) or bipolar disorder (BD) experience dysfunction in visual processing. Dysfunctional neural tuning, in which neurons and neuronal populations are selectively activated by specific features of visual stimuli, may contribute to these deficits. Few studies have examined this possibility and there are inconsistent findings of tuning deficits in the literature. We utilized an event-related potential (ERP) paradigm to examine neural adaptation for visual objects, a measure of neural tuning whereby neurons respond less strongly to the repeated presentation of the same stimulus. Seventy-seven SZ, 53 BD, and 49 healthy comparison participants (HC) were examined. In three separate conditions, pictures of objects were presented repeatedly: the same object (SS), different objects from the same category (e.g., two different vases; SD), or different objects from different categories (e.g., a barrel and a clock, DD). Mass-univariate cluster-based permutation analyses identified electrodes and time-windows in which there were significant differences between the SS vs. DD and the SD vs. DD conditions. Mean ERP amplitudes were extracted from these clusters and analyzed for group differences. Results revealed a significant condition difference over parieto-occipital electrodes for the SS-DD comparison between 109–164 ms and for the SD-DD comparison between 78–203 ms, with larger amplitudes in the DD compared to either SS or SD condition. However, there were no significant differences in the pattern of results between groups. Thus, while we found neural adaptation effects using this ERP paradigm, we did not find evidence of group differences. Our results suggest that people with SZ or BD may not exhibit deficits in neural tuning for processing of visual objects using this EEG task with rapidly presented stimuli. However, the results are inconsistent with other studies using different methodologies (e.g., fMRI, behavioral tasks) that have found tuning deficits in people with schizophrenia.

Parsing components of auditory predictive coding in schizophrenia using a roving standard mismatch negativity paradigm

BACKGROUND

Mismatch negativity (MMN) is an event-related potential (ERP) component reflecting auditory predictive coding. Repeated standard tones evoke increasing positivity ('repetition positivity'; RP), reflecting strengthening of the standard's memory trace and the prediction it will recur. Likewise, deviant tones preceded by more standard repetitions evoke greater negativity ('deviant negativity'; DN), reflecting stronger prediction error signaling. These memory trace effects are also evident in MMN difference wave. Here, we assess group differences and test-retest reliability of these indices in schizophrenia patients (SZ) and healthy controls (HC).

METHODS

Electroencephalography was recorded twice, 2 weeks apart, from 43 SZ and 30 HC, during a roving standard paradigm. We examined ERPs to the third, eighth, and 33rd standards (RP), immediately subsequent deviants (DN), and the corresponding MMN. Memory trace effects were assessed by comparing amplitudes associated with the three standard repetition trains.

RESULTS

Compared with controls, SZ showed reduced MMNs and DNs, but normal RPs. Both groups showed memory trace effects for RP, MMN, and DN, with a trend for attenuated DNs in SZ. Intraclass correlations obtained via this paradigm indicated good-to-moderate reliabilities for overall MMN, DN and RP, but moderate to poor reliabilities for components associated with short, intermediate, and long standard trains, and poor reliability of their memory trace effects.

CONCLUSION

MMN deficits in SZ reflected attenuated prediction error signaling (DN), with relatively intact predictive code formation (RP) and memory trace effects. This roving standard MMN paradigm requires additional development/validation to obtain suitable levels of reliability for use in clinical trials.

Motivational and cognitive correlates of community integration in homeless veterans entering a permanent supported housing program

Homelessness is a major public health problem, and serious mental illness (SMI) is highly prevalent in the homeless population. Although supported housing services-which provide permanent housing in the community along with case management-improve housing outcomes, community integration typically remains poor, and little is known about the underlying determinants of poor community integration postresidential placement. The general SMI literature has indicated that motivational and cognitive ability factors are key determinants of successful community integration, which provides a foundation for examining this issue. This study evaluated whether interview- and performance-based assessments of motivation, nonsocial and social-cognitive ability, and psychiatric symptoms were associated with community integration indices in 2 samples of homeless veterans either with (N = 96) or without (N = 80) a psychotic disorder who had recently been admitted to a supported housing program but who had not yet attained housing. Motivation indices, including experiential negative symptoms and defeatist performance attitudes, stood out as the most robust correlates (rs = -.30 to -.69) of community integration across both samples, particularly for social role participation. Demographics, general psychiatric symptoms, and nonsocial cognition showed generally weak relations with community integration, though social cognition showed a few relations. The consistent findings across samples point to the importance of motivational factors for understanding the determinants of poor community integration in this complex population. Further, interventions that target motivational challenges may have widespread usefulness for enhancing community integration outcomes beyond obtaining housing. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Reduced Neural Sensitivity to Social vs Nonsocial Reward in Schizophrenia

BACKGROUND

Human beings find social stimuli rewarding, which is thought to facilitate efficient social functioning. Although reward processing has been extensively studied in schizophrenia, a few studies have examined neural processes specifically involved in social reward processing. This study examined neural sensitivity to social and nonsocial rewards in schizophrenia.

METHODS

Twenty-seven patients with schizophrenia and 25 community controls completed a One-Armed Bandit Task, an implicit reinforcement learning task, in the scanner. There were 2 conditions with an identical trial structure, one with social rewards and the other with nonsocial rewards. The data were analyzed using a region of interest (ROI) approach, focusing on the ventral striatum, ventromedial prefrontal cortex, and anterior cingulate cortex.

RESULTS

Across all 3 ROIs, patients showed reduced activation for social rewards compared to controls. However, the 2 groups showed comparable levels of activation for nonsocial rewards. Within the patient group, levels of neural activation in these ROIs during the social reward condition were associated with better performance.

CONCLUSIONS

This study found reduced neural sensitivity in patients with schizophrenia in key reward-processing regions for social but not for nonsocial rewards. These findings suggest a relatively specific social reward-processing deficit in schizophrenia during an implicit reinforcement learning task.

A randomized controlled trial comparing a "bottom-up" and "top-down" approach to cognitive training in schizophrenia

The development of effective cognitive training (CT) interventions is critical for improving the daily lives of people with schizophrenia. At this point, it is unclear whether a so-called "bottom-up" or "top-down" CT approach is more beneficial for inducing cognitive gains and generalization in this population. The aims of this randomized controlled trial were to: 1) Compare the effects of these two types of training approaches on performance-based (MATRICS Consensus Cognitive Battery, MCCB) and neurophysiological (mismatch negativity, MMN) measures of cognition, and 2) Evaluate MMN as a potential predictor of treatment response. Ninety-nine patients with persistent schizophrenia (mean age of 51 and illness duration of 30 years) were randomly assigned in a 2:2:1 ratio to a "bottom-up" intervention that selectively targets basic auditory processing and verbal learning (Brain Fitness), a "top-down" intervention that targets a broad range of higher-order cognitive functions (COGPACK), or a control condition consisting of commercial computer games (Sporcle). Participants completed on average 30 h of training over 12 weeks. Despite demonstrated improvement on training tasks, we found no significant treatment effects on measures of neurocognition (MCCB), MMN, or functional capacity from either intervention. Interestingly, there was an association between an enhanced MMN response at 6 weeks and improved reasoning/problem solving at 12 weeks in the COGPACK group. Although this study had several methodological strengths, the results were mainly negative. It suggests that CT trials in schizophrenia should try to better understand mediators and moderators of treatment response to develop more personalized interventions.

fMRI evidence of aberrant neural adaptation for objects in schizophrenia and bipolar disorder

Functional magnetic resonance imaging (fMRI) adaptation (also known as fMRI repetition suppression) has been widely used to characterize stimulus selectivity in vivo, a fundamental feature of neuronal processing in the brain. We investigated whether SZ patients and BD patients show aberrant fMRI adaptation for object perception. About 52 SZ patients, 55 BD patients, and 53 community controls completed an object discrimination task with three conditions: the same object presented twice, two exemplars from the same category, and two exemplars from different categories. We also administered two functional localizer tasks. A region of interest analysis was employed to evaluate a priori hypotheses about the lateral occipital complex (LOC) and early visual cortex (EVC). An exploratory whole brain analysis was also conducted. In the LOC and EVC, controls showed the expected reduced fMRI responses to repeated presentation of the same objects compared with different objects (i.e., fMRI adaptation for objects, p < .001). SZ patients showed an adaptation effect that was significantly smaller compared with controls. BD patients showed a lack of fMRI adaptation. The whole brain analyses showed enhanced fMRI responses to repeated presentation of the same objects only in BD patients in several brain regions including anterior cingulate cortex. This study was the first to employ fMRI adaptation for objects in SZ and BD. The current findings provide empirical evidence of aberrant fMRI adaptation in the visual cortex in SZ and BD, but in distinctly different ways.

Understanding the Association Between Negative Symptoms and Performance on Effort-Based Decision-Making Tasks: The Importance of Defeatist Performance Beliefs

Effort-based decision-making paradigms are increasingly utilized to gain insight into the nature of motivation deficits. Research has shown associations between effort-based decision making and experiential negative symptoms; however, the associations are not consistent. The current study had two primary goals. First, we aimed to replicate previous findings of a deficit in effort-based decision making among individuals with schizophrenia on a test of cognitive effort. Second, in a large sample combined from the current and a previous study, we sought to examine the association between negative symptoms and effort by including the related construct of defeatist beliefs. The results replicated previous findings of impaired cognitive effort-based decision making in schizophrenia. Defeatist beliefs significantly moderated the association between negative symptoms and effort-based decision making such that there was a strong association between high negative symptoms and deficits in effort-based decision making, but only among participants with high levels of defeatist beliefs. Thus, our findings suggest the relationship between negative symptoms and effort performance may be understood by taking into account the role of defeatist beliefs, and finding that might explain discrepancies in previous studies.

ERP indices of performance monitoring and feedback processing in psychosis: A meta-analysis

BACKGROUND

Although individuals with, or at risk for, psychotic disorders often show difficulties with performance monitoring and feedback processing, findings from studies using event-related potentials (ERPs) to index these processes are not consistent. This meta-analytic review focused on studies of two different indexes of performance monitoring, the early error-related negativity (ERN; n = 25) and the later error positivity (Pe; n = 17), and one index of feedback processing, the feedback negativity (FN; n = 6).

METHODS

We evaluated whether individuals (1) with psychotic disorders, or (2) at heightened risk for these disorders differ from healthy controls in available studies of the ERN, Pe, and FN.

RESULTS

There was a significant, large ERN reduction in those with psychosis (g = -0.96) compared to controls, and a significant, moderate ERN reduction in those at-risk (g = -0.48). In contrast, there were uniformly non-significant, small between-group differences for Pe and FN (gs ≤ |0.16|).

CONCLUSIONS

The results reveal a differential pattern of impairment in psychosis. Early performance monitoring (ERN) impairments are substantial among those with psychotic disorders in general and may be a useful vulnerability indicator for these disorders. However, later performance monitoring (Pe) and basic feedback processing (FN) appear to be relatively spared in psychosis.

Pupillary responses to a cognitive effort task in schizophrenia

Effort-based decision making paradigms are increasingly utilized to gain insight into the nature of motivation deficits. Although these tasks are being used to assess effort and motivation in schizophrenia, little work has been done to confirm that effort-based decision making tasks validly manipulate effort. In the current study, we adapted the effort component a cognitive effort-based decision making task (the Deck Choice Effort Task) for use with pupillometric assessment. We sought to confirm with psychophysiology that cognitive effort is manipulated. We also examined correlations between physiological indicators of effort exertion and cognition and negative symptoms. The results confirmed manipulation of cognitive effort: there was a significant difference in pupillary responses between easy and difficult task conditions. Pupillary responses were also correlated with cognitive ability, and with negative symptoms when controlling for cognition. Thus, our findings offer physiological validation of an effort manipulation included in a cognitive effort-based decision making task for schizophrenia.

Aberrant patterns of neural activity when perceiving emotion from biological motion in schizophrenia

Social perceptual deficits in schizophrenia are well established. Recent work suggests that the ability to extract social information from bodily cues is reduced in patients. However, little is known about the neurobiological mechanisms underlying this deficit. In the current study, 20 schizophrenia patients and 16 controls completed two tasks using point-light animations during fMRI: a basic biological motion task and an emotion in biological motion task. The basic biological motion task was used to localize activity in posterior superior temporal sulcus (pSTS), a critical region for biological motion perception. During the emotion in biological motion task, participants viewed brief videos depicting happiness, fear, anger, or neutral emotions and were asked to decide which emotion was portrayed. Activity in pSTS and amygdala was interrogated during this task. Results indicated that patients showed overall reduced activation compared to controls in pSTS and at a trend level in amygdala across emotions, despite similar task performance. Further, a functional connectivity analysis revealed that controls, but not patients, showed significant positive connectivity between pSTS and left frontal regions as well as bilateral angular gyrus during the emotion in biological motion task. These findings indicate that schizophrenia patients show aberrant neural activity and functional connectivity when extracting complex social information from simple motion stimuli, which may contribute to social perception deficits in this disorder.

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Perception of social information from bodily cues is impaired in schizophrenia.

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We examined neural correlates of perception of emotion from biological motion.

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Activity in amygdala and posterior superior temporal sulcus was reduced in patients.

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pSTS functional connectivity with frontal and parietal regions was reduced in patients.

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Aberrant neural responses may contribute to social perceptual deficits in schizophrenia.

Single transcranial direct current stimulation in schizophrenia: Randomized, cross-over study of neurocognition, social cognition, ERPs, and side effects

Over the last decades, the treatment of schizophrenia has shifted fundamentally from a focus on symptom reduction to a focus on recovery and improving aspects of functioning. In this study, we examined the effect of transcranial direct current stimulation (tDCS) on social cognitive and nonsocial neurocognitive functions, as well as on electroencephalogram (EEG) measures, in individuals with schizophrenia. Thirty-seven individuals with schizophrenia were administered one of three different tDCS conditions (cathodal, anodal, and sham) per visit over the course of three visits, with approximately one week between each visit. Order of conditions was randomized and counterbalanced across subjects. For the active conditions, the electrode was placed over the left dorsolateral prefrontal cortex with the reference electrode over right supraorbital cortex. Current intensity was 2 mA and was maintained for two 20-minute sessions, with a one hour break between the sessions. Assessments were conducted immediately following each session, in a counterbalanced order of administration. No systematic effects were found across the social and nonsocial cognitive domains, and no significant effects were detected on event-related potentials (ERPs). The very small effect sizes, further validated by post-hoc power analyses (large Critical Ns), demonstrated that these findings were not due to lack of statistical power. Except for mild local discomfort, no significant side effects were reported. Findings demonstrate the safety and ease of administration of this procedure, but suggest that a single dose of tDCS over these areas does not yield a therapeutic effect on cognition in schizophrenia.

Trial registration: ClinicalTrials.gov NCT02539797.

Cortical Thickness of Functionally Defined Visual Areas in Schizophrenia and Bipolar Disorder

Patients with schizophrenia show specific abnormalities in visual perception, and patients with bipolar disorder may have related perceptual deficits. During tasks that highlight perceptual dysfunction, patients with schizophrenia show abnormal activity in visual brain areas, including the lateral occipital complex (LOC) and early retinotopic cortex. It is unclear whether the anatomical structure of those visual areas is atypical in schizophrenia and bipolar disorder. In members of those two patient groups and healthy controls, we localized LOC and early retinotopic cortex individually for each participant using functional magnetic resonance imaging (MRI), then measured the thickness of those regions of interest using structural MRI scans. In both regions, patients with schizophrenia had the thinnest cortex, controls had the thickest cortex, and bipolar patients had intermediate cortical thickness. A control region, motor cortex, did not show this pattern of group differences. The thickness of each visual region of interest was significantly correlated with performance on a visual object masking task, but only in schizophrenia patients. These findings suggest an anatomical substrate for visual processing abnormalities that have been found with both neural and behavioral measures in schizophrenia and other severe mental illnesses.

Hallucinations, neuroplasticity, and prediction errors in schizophrenia

Auditory hallucinations, a hallmark symptom of psychosis, are experienced by most people with a diagnosis of schizophrenia at some point in their illness. Auditory hallucinations can be understood as a failure in predictive coding, whereby abnormalities in sensory/perceptual processing combine with biased cognitive processes to result in a dampening of normal prediction error signaling. In this paper, we used a roving mismatch negativity (MMN) paradigm to optimize evaluation of prediction error signaling and short-term neuroplasticity in 30 people with schizophrenia (n = 16 with and n = 14 without recent auditory hallucinations) and 20 healthy comparison participants. The recent hallucinations group exhibited an abnormal roving MMN profile [F(2,27) = 3.98, p = 0.03], significantly reduced prediction error signaling [t(28) = -2.25, p = 0.03], and a trend for diminished short-term neuroplasticity [t(28) = 1.80, p = 0.08]. There were no statistically significant differences between the healthy comparison group and the combined schizophrenia group on any of the roving MMN indices. These findings are consistent with a predictive coding account of hallucinations in schizophrenia, which posits reduced prediction error signaling in those who are prone to hallucinations. These results also suggest that plasticity-mediated formation and online updating of predictive coding models may also be disrupted in individuals with recent hallucinations.

Social Disconnection in Schizophrenia and the General Community

Social disability is a defining characteristic of schizophrenia and a substantial public health problem. It has several components that are difficult to disentangle. One component, social disconnection, occurs extensively in the general community among nonhelp-seeking individuals. Social disconnection is an objective, long-standing lack of social/family relationships and minimal participation in social activities. It is associated with negative health effects, including early mortality, and is distinct from subjective loneliness. These 2 topics, social disability in schizophrenia and social disconnection in the general community, have generated entirely distinct research literatures that differ in their respective knowledge gaps and emphases. Specifically, the consequences of social disability in schizophrenia are unknown but its determinants (ie, nonsocial cognition, social cognition, and social motivation) have been well-examined. Conversely, the health consequences of social disconnection in the general community are well-established, but the determinants are largely unknown. Social disconnection is a condition that presents substantial public health concerns, exists within and outside of current psychiatric diagnostic boundaries, and may be related to the schizophrenia spectrum. A comparison of these 2 literatures is mutually informative and it generates intriguing research questions that can be critically evaluated.

The neural correlates of self-referential memory encoding and retrieval in schizophrenia

BACKGROUND

Enhanced memory for self-oriented information is known as the self-referential memory (SRM) effect. fMRI studies of the SRM effect have focused almost exclusively on encoding, revealing selective engagement of the medial prefrontal cortex (mPFC) during "self" relative to other processing conditions. Other critical areas for self-processing include ventrolateral prefrontal cortex (vlPFC), temporo-parietal junction (TPJ) and posterior cingulate/precuneus (PCC/PC). Previous behavioral studies show that individuals with schizophrenia fail to benefit from this memory boost. However, the neural correlates of this deficit, at either encoding or retrieval, are unknown.

METHODS

Twenty individuals with schizophrenia and 16 healthy controls completed an event-related fMRI SRM paradigm. During encoding, trait adjectives were judged in terms of structural features ("case" condition), social desirability ("other" condition), or as self-referential ("self" condition). Participants then completed an unexpected recognition test (retrieval phase). We examined BOLD activation during both encoding and retrieval within mPFC, vlPFC, TPJ, and PCC/PC regions-of-interest (ROIs).

RESULTS

During encoding, fMRI data indicated both groups had greater activation during the "self" relative to the "other" condition across ROIs. Controls showed this primarily in mPFC whereas patients showed this in PCC/PC. During retrieval, fMRI data indicated controls showed differentiation across ROIs between "self" and "other" conditions, but patients did not.

CONCLUSIONS

Results suggest regional differences in the neural processing of self-referential information in individuals with schizophrenia, perhaps because representation of the self is not as well established in patients relative to controls. The current study presents novel findings that add to the literature implicating impaired self-oriented processing in schizophrenia.