Social cognition and interaction training for recent-onset schizophrenia: A preliminary randomized trial

Comprehensive social cognition training programs have been effective to improve social cognition in people with chronic schizophrenia, although there is insufficient quality evidence for recent-onset psychosis. The aim of this study was to assess the effects of Social Cognition and Interaction Training (SCIT) in a sample of recent-onset schizophrenia outpatients. Sixteen participants who had their first psychotic episode for less than 2 years were randomly allocated to the SCIT group during 20 weeks (weekly sessions) or to a psychoeducation group and completed baseline and post-training assessment for cognitive biases, social cognition, clinical symptoms and functioning. Permutation-based analysis revealed improvements in overall functioning (P = 0.036) and blame score (P = 0.070) in the SCIT group compared to the psychoeducation intervention, with large effect sizes (d = 1.438 and d = 1.204, respectively). There were also large effect sizes for hostility, emotion recognition, social perception, positive and total symptoms (d = 0.833-1.158). These results suggest that SCIT may be an effective tool to improve attributional biases and functional outcomes in recent-onset schizophrenia outpatients. Future controlled trials with larger sample size and follow-up assessments should be developed to further understand effective intervention outcomes for this population.

Depression as a predictor of hypoglycemia worry in parents of youth with recent-onset type 1 diabetes

BACKGROUND

During the recent-onset period of type 1 diabetes (T1D), parents may be at increased risk for depression, stress, and hypoglycemia fear; however, current studies have not examined the parental psychological experience and anxiety from hypoglycemia fear (ie, hypoglycemia worry) over time. This study examined the trajectory of parental hypoglycemia worry (Hypoglycemia Fear Survey-Worry [HFS-Worry]) in families of children with recent-onset T1D and the effects of baseline parental depression on parents' trajectory of HFS-Worry.

METHODS

We enrolled 128 families of children ages 5- to 9-years-old with recent onset T1D in this study. At baseline, 125 parents completed measures of depression and HFS-Worry, followed by 111 at 6-month follow-up, 113 at 12-month follow-up, and 107 at 18-month follow-up. We used multilevel modeling to examine the 18-month trajectories of HFS-Worry and to examine if parental depression modified these trajectories.

RESULTS

We found that parents HFS-Worry scores increased over time for parents with and without elevated depressive symptoms. Parents' baseline report of depression appeared to modify their trajectory of HFS-Worry over time such that parents with elevated depressive symptoms reported significantly higher levels of worry when compared to parents without depressive symptoms across the 18-month study period (P < .05).

CONCLUSIONS

Parents of children with recent-onset T1D, who reported elevated depressive symptoms, reported higher HFS-Worry across the study period. Our findings suggest clinics should consider screening for parent depression and hypoglycemia worry following a T1D diagnosis. Integrating psychological screening for parents could help clinics to provide relevant treatment resources and tailor diabetes education for parents. Trial Registration NCT03698708.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

White matter connectivity disruptions in early and chronic schizophrenia

BACKGROUND

White matter disruptions in schizophrenia have been widely reported, but it remains unclear whether these abnormalities differ between illness stages. We mapped the connectome in patients with recently diagnosed and chronic schizophrenia and investigated the extent and overlap of white matter connectivity disruptions between these illness stages.

METHODS

Diffusion-weighted magnetic resonance images were acquired in recent-onset (n = 19) and chronic patients (n = 45) with schizophrenia, as well as age-matched controls (n = 87). Whole-brain fiber tracking was performed to quantify the strength of white matter connections. Connections were tested for significant streamline count reductions in recent-onset and chronic groups, relative to separate age-matched controls. Permutation tests were used to assess whether disrupted connections significantly overlapped between chronic and recent-onset patients. Linear regression was performed to test whether connectivity was strongest in controls, weakest in chronic patients, and midway between these extremities in recent-onset patients (controls > recent-onset > chronic).

RESULTS

Compared with controls, chronic patients displayed a widespread network of connectivity disruptions (p < 0.01). In contrast, connectivity reductions were circumscribed to the anterior fibers of the corpus callosum in recent-onset patients (p < 0.01). A significant proportion of disrupted connections in recent-onset patients (86%) coincided with disrupted connections in chronic patients (p < 0.01). Linear regression revealed that chronic patients displayed reduced connectivity relative to controls, while recent-onset patients showed an intermediate reduction compared with chronic patients (p < 0.01).

CONCLUSIONS

Connectome pathology in recent-onset patients with schizophrenia is confined to select tracts within a more extensive network of white matter connectivity disruptions found in chronic illness. These findings may suggest a trajectory of progressive deterioration of connectivity in schizophrenia.

Cognitive deficits in recent-onset and chronic schizophrenia

Although cognitive dysfunction is a primary characteristic of schizophrenia, only recently have investigations begun to pinpoint when the dysfunction develops in the individual afflicted by the disorder. Research to date provides evidence for significant cognitive impairments prior to disorder onset. Less is known about the course of cognitive dysfunction from onset to the chronic phase of schizophrenia. Although longitudinal studies are optimal for assessing stability of cognitive deficits, practice effects often confound assessments, and large and representative subject samples have not been followed over long periods of time. We report results of a cross-sectional study of cognitive deficits early and late in the course of schizophrenia carried out at four different geographic locations to increase sample size and generalizability of findings. We examined a broad set of cognitive functions in 41 recent-onset schizophrenia patients and 106 chronic schizophrenia patients. The study included separate groups of 43 matched controls for the recent-onset sample and 105 matched controls for the chronic schizophrenia sample in order to evaluate the effects of cohort (i.e., age) and diagnosis (i.e., schizophrenia) on cognitive functions. All measures of cognitive function showed effects of diagnosis; however, select time-based measures of problem solving and fine motor dexterity exhibited interactions of diagnosis and cohort indicating that these deficits may progress beyond what is expected with normal aging. Also, worse recall of material in episodic memory was associated with greater length of illness. Nevertheless, findings indicate that nearly all cognitive deficits are comparably impaired across recent-onset and chronic schizophrenia.

Extra-medical stimulant dependence among recent initiates

New estimates for the risk of becoming stimulant dependent within 24 months after first extra-medical (EM) use of a stimulant drug compound are presented, with a focus on subgroup variations in this risk (e.g., alcohol dependence, male-female differences). The study estimates are derived from a representative sample of United States residents ages 12 and older (n=166,737) obtained from the 2003 to 2005 National Surveys on Drug Use and Health. A total of 1700 respondents were found to have used stimulants extra-medically for the first time within 24 months prior to assessment. Approximately 5% of these recent-onset EM users had become stimulant dependent since onset of EM use. As hypothesized, alcohol dependence cases were found to have experienced an excess risk of becoming stimulant dependent soon after onset of stimulant drug use; there was no robust male-female difference in risk. Independently, initiates who had used multiple types of stimulants extra-medically, and methamphetamine users, were more likely to have become stimulant dependent soon after onset of use; by comparison, EM users of methylphenidate (Ritalin) were less likely to have developed rapid-onset dependence. These epidemiologic findings help quantify a continuing public health burden associated with new onsets of extra-medical stimulant use in the 21st century.

Who is becoming hallucinogen dependent soon after hallucinogen use starts?

This study, based upon epidemiological survey data from the United States (U.S.) National Household Surveys on Drug Abuse (NHSDA) from 2000 to 2001, presents new estimates for the risk of developing a hallucinogen dependence syndrome within 24 months after first use of any hallucinogen (median elapsed time approximately 12 months). Subgroup variations in risk of becoming hallucinogen dependent also are explored. Estimates are derived from the NHSDA representative samples of non-institutionalized U.S. residents ages 12 and older (n=114,241). A total of 2035 respondents had used hallucinogens for the first time within 24 months prior to assessment. An estimated 2-3% of these recent-onset hallucinogen users had become dependent on hallucinogens, according to the NHSDA DSM-IV computerized diagnostic algorithm. Controlling for sociodemographic and other drug use covariates, very early first use of hallucinogens (age 10-11 years) is associated with increased risk of hallucinogen dependence (p<0.01). Excess risk of developing hallucinogen dependence was found in association with recent-onset use of mescaline; excess risk also was found for recent-onset users of ecstasy and of PCP. This study's evidence is consistent with prior evidence on a tangible but quite infrequent dependence syndrome soon after the start of hallucinogen use; it offers leads that can be confirmed or disconfirmed in future investigations.