Schizophrenia Research-Cognition最新文献

Objective

Social dysfunction is a major feature of clinical-high-risk states for psychosis (CHR-P). Prior research has identified a neuroanatomical pattern associated with impaired social function outcome in CHR-P. The aim of the current study was to test whether social dysfunction in CHR-P is neurobiologically distinct or in a continuum with the lower end of the normal distribution of individual differences in social functioning.

Methods

We used a machine learning classifier to test for the presence of a previously validated brain structural pattern associated with impaired social outcome in CHR-P (CHR-outcome-neurosignature) in the neuroimaging profiles of individuals from two non-clinical samples (total n = 1763) and examined its association with social function, psychopathology and cognition.

Results

Although the CHR-outcome-neurosignature could be detected in a subset of the non-clinical samples, it was not associated was adverse social outcomes or higher psychopathology levels. However, participants whose neuroanatomical profiles were highly aligned with the CHR-outcome-neurosignature manifested subtle disadvantage in fluid (P_FDR = 0.004) and crystallized intelligence (P_FDR = 0.01), cognitive flexibility (P_FDR = 0.02), inhibitory control (P_FDR = 0.01), working memory (P_FDR = 0.0005), and processing speed (P_FDR = 0.04).

Conclusions

We provide evidence of divergence in brain structural underpinnings of social dysfunction derived from a psychosis-risk enriched population when applied to non-clinical samples. This approach appears promising in identifying brain mechanisms bound to psychosis through comparisons of patient populations to non-clinical samples with the same neuroanatomical profiles.

Studies of patients with schizophrenia and offenders with severe mental disorders decision-making performance have produced mixed findings. In addition, most earlier studies have assessed decision-making skills in offenders or people with mental disorders, separately, thus neglecting the possible additional contribution of a mental disorder on choice patterns in people who offend.

This study aimed to fill this gap by comparing risk-taking in patients with schizophrenia spectrum disorders (SSD), with and without a history of serious violent offending assessing whether, and to what extent, risk-taking represents a significant predictor of group membership, controlling for their executive skills, as well as for socio-demographic and clinical characteristics.

Overall, 115 patients with a primary diagnosis of SSD were recruited: 74 were forensic patients with a lifetime history of severe interpersonal violence and 41 were patients with SSD without such a history. No significant group differences were observed on psychopathological symptoms severity. Forensic generally displayed lower scores than non-forensic patients in all cognitive subtests of the Brief Assessment of Cognition in Schizophrenia (except for the “token motor” and the “digit sequencing” tasks) and on all the six dimensions of the Cambridge Gambling Task, except for “Deliberation time”, in which forensic scored higher than non-forensic patients. “Deliberation time” was also positively, although weakly correlated with “poor impulse control”.

Identifying those facets of impaired decision-making mostly predicting offenders' behaviour among individuals with mental disorder might inform risk assessment and be targeted in treatment and rehabilitation protocols.

Loneliness is common in psychosis and occurs along a continuum. Here we investigate inter-relationships between loneliness, three-dimensional schizotypy, and depressive symptoms before and during the COVID-19 pandemic.

The sample included 507 university students (48.3% participated before and 51.7% during the COVID-19 pandemic) who completed the Multidimensional Schizotypy Scale-Brief, the Counseling Center Assessment of Psychological Symptoms depression scale and the University of California, Los Angeles Loneliness Scale. Schizotypy and depression scores were regressed onto loneliness individually and in multiple regressions.

The cohorts did not differ in any of the schizotypy domains (all p > .29). Depressive symptoms (p = .05) and loneliness (p = .006) were higher during the pandemic than before. Across cohorts, loneliness was significantly associated with positive (β = 0.23, p < .001), negative (β = 0.44, p < .001), and disorganised schizotypy (β = 0.44, p < .001), and with depression (β = 0.72, p < .001). Schizotypy together explained a significant amount of variance in loneliness (R² = 0.26), with significant associations with positive (β = −0.09, p = .047), negative (β = 0.31, p < .001) and disorganised schizotypy (β = 0.34, p < .001). When depression was included (β = 0.69, p < .001), only positive (β = −0.09, p = .008) and negative schizotypy (β = 0.22, p < .001) significantly predicted loneliness.

When all schizotypy dimensions and depression were considered together, only negative schizotypy and depression significantly predicted loneliness. Loneliness and depressive symptoms were higher during the pandemic, but this did not relate to cohort differences in schizotypy.

Background

Psychiatric disorders, especially schizophrenia, are characterised by cognitive impairment. The rapid detection of cognitive dysfunction - also in the course of the disease - is of great importance. The Screen for Cognitive Impairment in Psychiatry (SCIP) was developed to provide screening of psychiatric patients in clinical practice and is available in several languages. Prior psychometric investigations into the dimensionality of the SCIP have produced two different models: a one-factor model assumes that the five subscales of the SCIP load together, whereas an alternative model suggests that the subscales load on two factors, namely verbal memory and processing speed. We carried out a confirmatory factor analysis of the German version of the SCIP (SCIP-G).

Methods

323 patients with psychotic, bipolar affective, and depressive disorders were studied.

Results

The one-factor approach did not yield an acceptable model fit (chi-squared test: χ² = 109.5, df = 5, p < 0.001, χ²/df = 21.9). A two-factor solution, with the subtests Verbal Learning Test-Immediate Recall, Delayed Recall Test of the VLT, and Working Memory Test loading on the first factor, whereas the subtests Verbal Fluency Test and Psychomotor Speed Test loading on the second factor, obtained a good model fit (χ² = 6.7, df = 3, p = 0.08, χ²/df = 2.2).

Conclusions

These data show that a good model fit can be achieved with a two-factor solution for the SCIP. This study is the first to conduct a confirmatory factor analysis using the German SCIP version and to test its dimensional structure using a hypothesis-testing approach.

With an unmet clinical need for effective interventions for cognitive and negative symptoms in patients with schizophrenia, measures of functional status (often a co-primary endpoint) remain key clinical trial outcomes. This review aims to give an overview of the different types of functional assessments commonly used in clinical trials and research involving patients with schizophrenia and highlight pertinent challenges surrounding the use of these as reliable, sensitive, and specific assessments in intervention trials. We provide examples of commonly used functional measures and highlight emerging real-time digital assessment tools. Informant- and clinician-rated functional outcome measures and functional capacity assessments are valid, commonly used measures of functional status that try to overcome the need for often overly ambitious and insensitive ‘real world’ milestones. The wide range of scientific and practical challenges associated with these different tools leave room for the development of improved functional outcome measures for use in clinical trials. In particular, many existing measures fail to capture small, but meaningful, functional changes that may occur over the course of typically short intervention trials. Adding passive digital data collection and short active real-time digital assessments whilst patients go about their day offers the opportunity to build a more fine-grained picture of functional improvements that, if thoughtfully developed and carefully applied, could provide the sensitivity needed to accurately evaluate functional status in intervention studies, aiding the development of desperately needed treatments.

Cognitive Remediation Therapy (CRT) represents the gold standard treatment for cognitive impairment in schizophrenia, but the permanence of its effects over time have been poorly investigated. Our study aims to evaluate long lasting cognitive and functional effects of CRT together with standard rehabilitation interventions (SRT) in a group of patients diagnosed with schizophrenia, 10 years after the end of the treatment. Forty patients, previously included in a 5-year follow-up study evaluating the effects of CRT combined with SRT, were revalued 10 years after the complete of the intervention. Results revealed that cognitive and functional improvements of combined CRT/SRT interventions are still preserved 10 years after the end of the treatments, with the only exception of psychomotor speed and coordination cognitive subdomain. Moreover, investigating persistence of the influence of SRT, patients that underwent a shorter SRT following CRT (six months vs one year) showed worsened processing speed abilities.

This is the first study confirming that cognitive and functional improvements of joint CRT/SRT interventions are still conserved 10 years after the end of the treatments. Preliminary datas suggest that a longer SRT following CRT may lead to significant benefits, in terms of cognitive gains, in patients affected by schizophrenia.

Background

Emotion recognition deficits are linked with social dysfunction in psychosis, as is inaccurate self-assessment of emotion recognition abilities. However, little is known about the link between ER and real-time social appraisals and behavior.

Methods

In 136 people with psychotic disorders or affective disorder with psychosis we administered a novel ecological momentary cognitive test of emotion recognition which both assesses emotion recognition ability and self-assessed performance in conjunction with ecological momentary assessment of social appraisals, motivation, and time spent alone. Hybrid mixed effects models evaluated emotion recognition's associations with social experiences.

Results

Better recognition ability was associated with greater pleasure and more positive appraisals of others during interactions, whereas accuracy of self-assessment of emotion recognition ability was associated with more positive appraisals of interactions and social motivation. Overestimation of emotion recognition was linked with concurrent higher social motivation yet greater desire to avoid others. Time alone was unrelated to emotion recognition ability or self-assessment of ability.

Discussion

Mobile emotion recognition performance was associated with appraisals of recent interactions but not behavior. Self-assessment of social cognitive performance was associated with more positive appraisals and social motivation, and may be a novel target for interventions aimed at social dysfunction.

Background

Paranoid ideation is a core feature of psychosis and is associated with impaired social functioning. Severity of paranoia can fluctuate across time as symptoms wax and wane; however, no study has systematically investigated how this intra-individual variability in paranoia may relate to social impairments and social functioning.

Methods

Fifty-five patients with DSM-5 diagnoses and recent paranoia were followed for up to one year and completed the suspiciousness/persecution section (P6) of the Positive and Negative Symptom Scale (PANSS) on a monthly basis to monitor fluctuations in paranoia. Categorical changes between paranoid and non-paranoid status were monitored and tallied. Participants self-reported current paranoia and anxiety levels as well as social functioning when demonstrating paranoia changes.

Results

Most patients showed changes between paranoid categories (60%). Individuals with no paranoia change showed higher current paranoia and lower independence-competence subscores of the Birchwood Social Functioning Scale (SFS) compared with those with one change. Current paranoia and state anxiety explained significant variance in the prosocial activities subscore of SFS, and importantly, paranoia changes accounted for variance above and beyond these effects. Individuals with higher current paranoia participated less in prosocial activities, however those with higher paranoia variability were more involved in social activities. Similarly, individuals with more paranoia variability demonstrated better overall social functioning as measured by the averaged SFS total score.

Conclusion

Paranoia fluctuation is prevalent across time, and both paranoia severity and variability impact social functioning, in that lower levels of paranoia severity and higher levels of paranoia variability are associated with better interpersonal functioning.

We have previously shown that schizophrenia (SCZ) participants with high community functioning demonstrate better verbal working memory (vWM) performance relative to those with low community functioning. In the present study, we investigated whether neuroanatomical differences in regions supporting vWM also exist between schizophrenia groups that vary on community functioning. Utilizing magnetic resonance imaging, shape features of deep-brain nuclei known to be involved in vWM were calculated in samples of high functioning (HF-SCZ, n = 23) and low functioning schizophrenia participants (LF-SCZ, n = 18), as well as in a group of healthy control participants (CON, n = 45). Large deformation diffeomorphic metric mapping was employed to characterize surface anatomy of the caudate nucleus, globus pallidus, hippocampus, and thalamus. Statistical analyses involved linear mixed-effects models and vertex-wise contrast mapping to assess between-group differences in structural shape features, and Pearson correlations to evaluate relationships between shape metrics and vWM performance. We found significant between-group main effects in deep-brain surface anatomy across all structures. Post-hoc comparisons revealed HF-SCZ and LF-SCZ groups significantly differed on both caudate and hippocampal shape, however, significant correlations with vWM were only observed in hippocampal shape for both SCZ groups. Specifically, more abnormal hippocampal deformation was associated with lower vWM suggesting hippocampal shape is both a neural substrate for vWM deficits and a potential biomarker to predict or monitor the efficacy of cognitive rehabilitation. These findings add to a growing body of literature related to functional outcomes in schizophrenia by demonstrating unique shape patterns across the spectrum of community functioning in SCZ.

Cognitive impairment in schizophrenia represents one of the main obstacles to clinical and functional recovery. This expert group paper brings together experts in schizophrenia treatment to discuss scientific progress in the domain of cognitive impairment to address cognitive impairments and their consequences in the most effective way. We report on the onset and course of cognitive deficits, linking them to the alterations in brain function and structure in schizophrenia and discussing their role in predicting the transition to psychosis in people at risk. We then address the assessment tools with reference to functioning and social cognition, examining the role of subjective measures and addressing new methods for measuring functional outcomes including technology based approaches. Finally, we briefly review treatment options for cognitive deficits, focusing on cognitive remediation programs, highlighting their effects on brain activity and conclude with the potential benefit of individualized integrated interventions combing cognitive remediation with other approaches.