Why do people seek reassurance and check repeatedly? An investigation of factors involved in compulsive behavior in OCD and depression

Excessive reassurance-seeking (ERS) is a common problem among both obsessive-compulsive and depressed populations. However, the content and cognitive processes involved in ERS may differ in these populations according to the unique cognitive and behavioral characteristics demonstrated by each group. To assess factors involved in the onset, maintenance and termination of ERS and repeated checking, the current investigation employed a semi-structured interview with non-depressed obsessive-compulsive disorder (OCD) respondents (n = 15), clinically depressed individuals without OCD (n = 15), and healthy control participants (n = 20). Results showed that whereas individuals with OCD reported seeking reassurance primarily about perceived general threats (e.g., fire, theft), the depressed group reported seeking reassurance primarily about perceived social threats (e.g., abandonment, loss of support). Clinical participants reported greater anxiety, sadness and perceived threat in association with ERS and repeated checking than healthy control participants. These findings are discussed in terms of cognitive-behavioral models of OCD and depression.     

Additional support for the cognitive model of schizophrenia: evidence of elevated defeatist beliefs in schizotypy

ObjectivesThe cognitive model of poor functioning in schizophrenia posits that defeatist performance beliefs—overgeneralized negative beliefs about one's ability to perform tasks—develop prior to the onset of psychosis and contribute to the development and maintenance of negative symptoms and poor functioning. Although several studies with schizophrenia samples have provided support for the model, there is a paucity of research investigating these beliefs in individuals with schizotypy—those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had two aims: to examine whether defeatist performance beliefs (1) are elevated in schizotypy compared to controls and (2) are associated with decreased quality of life and working memory and increased negative but not positive schizotypy traits in the schizotypy group.MethodsSchizotypy (n = 48) and control (n = 53) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory.ResultsAnalyses revealed that the schizotypy group reported significantly more defeatist performance beliefs than the control group. Within the schizotypy group, increased defeatist performance beliefs were significantly associated with greater negative schizotypy traits and lower quality of life. No significant associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory.ConclusionsResults generally support the theoretical validity of the cognitive model of poor functioning in schizophrenia and suggest that elevated defeatist performance beliefs may contribute to the manifestation of subclinical negative symptom traits and reduced quality of life among those with a latent vulnerability for schizophrenia.     

Effects of smoking cues on caffeine urges in heavy smokers and caffeine consumers with and without schizophrenia

Cigarette smoking and caffeine use are established and problematic drug-use behaviors in people with schizophrenia. Associative links between drugs of abuse may occur but the relationship between caffeine use and cigarette smoking has received little attention in schizophrenia. In this cross-cue reactivity laboratory study, we examined the effects of neutral and smoking cues on craving for caffeinated beverages in participants with schizophrenia or schizoaffective disorder (SS; n = 15) and non-psychiatric controls (CS; n = 18) all of whom were heavy smokers and daily caffeine users. Participants were tested under non-abstinent and 5-hour abstinent conditions. SS tended to report greater daily levels of caffeine use than CS. Although this difference was not significant, that may be due to the small sample sizes as the size of this effect was large. Daily caffeine intake was significantly correlated with daily smoking rate in SS but not CS. A significant interaction between group and cue type after controlling for caffeine intake indicated that exposure to smoking cues increased urge for caffeinated beverages in SS but not CS. These results indicate support for associative connections between cigarette smoking cues and craving for caffeine in smokers with schizophrenia.     

Comparing cognitive functioning in schizophrenia and autism using WAIS-III

The main goal of this study was to investigate differences and similarities in general cognitive functioning between adults with schizophrenia and autism, because this has not been systematically investigated. We used a cross-sectional design to compare adults with schizophrenia (n = 27), with autism (n = 114) and a healthy control group (n = 30). Schizophrenia diagnoses were based on the Structured Clinical Interview for the DSM-IV Axis I (SCID-I) and behavioral symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Autism was diagnosed with a DSM-IV questionnaire for autism spectrum disorders and the Autistic Diagnostic Interview, revised version. The Wechsler Adult Intelligence Scale, third version (WAIS-III) was used to assess cognitive functions. All participants were between 18 and 65 years of age and had a minimum full scale intelligence of 80. Results showed that patients with schizophrenia scored significantly lower on processing speed than patients with autism and the healthy control group. Differences on other index scales were not found. In participants with schizophrenia a correlation was found between processing speed impairment and negative symptoms. Diagnosis could be predicted correctly with WAIS-III profile in 70.4% of the cases with schizophrenia compared to 56.7% of the healthy control group and 22.8% of the autism group.     

Neurological soft signs in schizophrenia and obsessive compulsive disorder spectrum

Obsessive compulsive symptoms are more frequent in patients with schizophrenia compared to normal population. Patients with obsessive compulsive disorder may also exhibit psychosis-like symptoms. Based on these findings, it has been suggested that there is a spectrum of disorders between OCD and schizophrenia. We compared two OCD groups (with good and poor insight) and two schizophrenia groups (with and without OCD) in this recommended spectrum especially in terms of neurological soft signs (NSSs) associated with sensory integration. The schizophrenia with OCD (schizo-obsessive) group exhibited worse performance than the schizophrenia group (p = 0.002) in only graphesthesia tasks. Moreover, schizo-obsessive patients exhibited worse performance compared to OCD patients in terms of graphesthesia (p = 0.001) and audiovisual integration (p = 0.001). Interestingly, OCD patients with poor insight tended to exhibit graphesthesia deficit in a similar manner to schizo-obsessive patients rather than OCD patients. According to our results, graphesthesia disorder is strongly associated both with OCD and schizophrenia. This suggests that neurodevelopmental disorders that lead to graphesthesia disorder overlap in comorbid OCD and schizophrenia patients.     

The influence of job stress,social support and health status on intermittent and chronic sleep disturbance: an 8-year longitudinal analysis

ObjectiveTo determine the role of health status and social support in the relationship between job stress and sleep disturbance, for both intermittent and chronic sleep disturbance.MethodsA total of 1946 mid-life adults completed three questionnaires spanning an 8-year time frame. Sleep disturbance was assessed at each time point, and participants were classified as experiencing intermittent, chronic or no sleep disturbance across this 8-year period. Independent variables included a range of job stress measures, social support, physical and mental health, and demographic characteristics.ResultsAfter controlling for physical and mental health, perceived lack of job marketability increased risk of intermittent sleep disturbance (odds ratio (OR) = 1.33, p = 0.012). No other job stress measures were associated with either intermittent or chronic sleep disturbance after adjusting for years of education, social support, and employment status. Poorer mental and physical health status, although significantly increasing odds for intermittent sleep disturbance, represented a significantly greater increase in the odds for chronic sleep disturbance over and above intermittent disturbance (OR = 0.96, p < 0.001 for both SF-12 mental and physical health).ConclusionThis population-based cohort study found little evidence that job stress had an independent effect on chronic or intermittent sleep disturbance independent of health, social support, and education. Risk profiles for intermittent and chronic sleep disturbance did not differ with regard to job stress; however, various demographic and social support factors were distinguishing factors. Health status, both physical and mental, also showed a significantly greater impact on chronic sleep disturbance than intermittent sleep disturbance. Karasek’s model of job strain had little value in predicting sleep disturbance outcomes.     

Verbal fluency as a possible predictor for psychosis

BackgroundNeurocognitive abnormalities are prevalent in both first episode schizophrenia patients and in ultra high risk (UHR) patients.AimTo compare verbal fluency performance at baseline in UHR in patients that did and did not make the transition to psychosis.MethodBaseline verbal fluency performance in UHR-patients (n = 47) was compared to match first episode patients (n = 69) and normal controls (n = 42).ResultsVerbal fluency (semantic category) scores in UHR-patients did not differ significantly from the score in first episode schizophrenia patients. Both the UHR group (p < 0.003) and the patient group (p < 0.0001) performed significantly worse than controls. Compared to the non-transition group, the transition group performed worse on verbal fluency, semantic category (p < 0.006) at baseline.ConclusionsVerbal fluency (semantic category) is disturbed in UHR-patients that make the transition to psychosis and could contribute to an improved prediction of transition to psychosis in UHR-patients.     

Arrêt et réduction du tabac chez le patient souffrant de schizophrénie

ObjectivesThis systematic review of the literature looked at data on pharmacological and non-pharmacological strategies of smoking cessation and reduction of consumption in patients with schizophrenia.MethodThe research was conducted on Medline for the period 1980–2018. We included randomized controlled trials, including preliminary studies of stable schizophrenic patients with no other severe psychiatric disorder and no other substance use than tobacco, treated with antipsychotic medications. Individual or group smoking cessation programs with or without pharmacological treatment, including a validation of abstinence, were included.ResultsPharmacotherapies for nicotine dependence—nicotine replacement therapy (n = 3), bupropion (n = 6), varenicline (n = 8), association of medications (n = 4)—were used in 23 studies combined with behavioral support. Compared to the placebo, bupropion and varenicline at the end of treatment were found to be the most effective pharmacotherapies to stop or reduce smoking and control craving. All the medications were well tolerated and did not lead to aggravation of psychosis or changes in symptoms. Non-pharmacological interventions: behavioral and cognitive therapies (n = 5) combined with pharmacological treatment facilitated the management of smoking risk situations and improved adherence to antipsychotics; other psychosocial interventions (n = 7) allowed the development of social skills; contigency management strategies with financial reinforcement can be used (n = 4); the practice of physical activity and the use of an electronic cigarette allowed reduction of tobacco consumption. The results of transcranial electromagnetic stimulation studies (n = 6) were discordant. Atypical antipsychotics appear to be associated with a better success of attempts to stop smoking.ConclusionSmoking cessation strategies for patients with schizophrenia appear to be effective and should combine (1) smoking cessation medications with sufficient duration, (2) diversified psychosocial approaches and (3) physical activity practice.     

Auditory P300 latency prolongation with age in schizophrenia: Gender and subcomponent effects

Previous studies showing prolongation of auditory P300b latency with increasing age provided support for post-onset progressive change in schizophrenia. We sought to extend the findings by evaluating the effects of gender and the subcomponents (P3b versus P3a) in schizophrenia (N = 108) and controls (N = 70). P3b latency significantly correlated with age in schizophrenia (Spearman's rho = 0.214, P = 0.026) and in male patients with schizophrenia (rho = 0.260, P = 0.049) whereas, it did not reach significance in female patients with schizophrenia (rho = 0.174, P = 0.23). P3a latency showed no correlation. Our findings may provide evidence for progressive change in the brain function in schizophrenia, and this change may be slower in female than male patients. P3b may serve as a more sensitive index for cognitive decline than P3a.     

Association between altered physical activity and neurocognitive function among people with schizophrenia: A minimum 6-months' follow-up study

BackgroundThe long-term benefits of physical activity on neurocognitive function among patients with schizophrenia, specifically among inpatients, remain unclear. This preliminary study, with a minimum of 6-months' follow-up, examined alterations in physical activity and neurocognitive function in both inpatients and outpatients with schizophrenia.MethodsSymptoms and neurocognitive function were assessed at 2 intervals using the Positive and Negative Symptom Scale and Cognitrax, respectively. After each testing period, participants wore an accelerometer for 1 week to measure their levels and duration of physical activity. After the 6-months' follow-up (average duration, 235.9 ± 36.2 days), participants were divided into 2 groups based on either increased or decreased activity, as compared with baseline: increased-activity and decreased-activity groups.ResultsOf the 29 initially enrolled participants, 25 (mean age, 56.8 ± 11.8 years) completed the follow-up. Reaction times in the increased-activity group in daily activity (n = 10) improved as compared with the decreased-activity group (n = 15). Moreover, cognitive flexibility and executive function improved in the increased-activity group in steps (n = 7) compared with the decreased-activity group (n = 18). Finally, there was no association between the duration of moderate or vigorous exercise and neurocognitive function.ConclusionsTogether, our results suggest that increased daily activity and walking, but not high intensity activity, are associated with improved neurocognitive function in patients with schizophrenia.     

Comparing how co-morbid depression affects individual domains of functioning and life satisfaction in schizophrenia

ObjectiveDepression in schizophrenia is often associated with reduced life satisfaction. Yet, it is not clear how depression influences different functioning domains. The relative impact across objective and subjective quality of life (QOL) has also not been clearly compared. This study sought to examine the differences in individual QOL indicators between schizophrenia patients with and without co-morbid depression. This was completed separately for objective and subjective QOL.Method57 patients with schizophrenia/schizoaffective disorder were classified into groups with (DP: N = 31, M = 45.81, SD = 10.29) and without depression (NDP: N = 26, M = 40.54, SD = 11.00) using MADRS scores. Objective and subjective QOL was assessed using Lehman's (1988) QOL Interview using five domains: daily activities and functioning, family relations, social relations, safety and health. z-scores were created for these domains (objective and subjective) based on responses from 44 healthy controls (M = 39.80, SD = 13.94).ResultsObjectively, DP patients had significantly reduced social interaction frequency compared to HCs. Subjectively, DP patients had significantly poorer scores than HCs on all five domains, and additionally reported poorer satisfaction with daily activities and health compared with the NDP group.ConclusionsPresence of depression in schizophrenia results in reduced self-reported life satisfaction across a broad spectrum of QOL domains. Objectively, depression resulted in decreased interactions with friends and peers, i.e. greater social isolation. The findings support the need to continue developing and implementing peer support groups in schizophrenia, a challenging task especially in the face of depression. More broadly, the assessment of depression in other illnesses is recommended.     

Health-related quality of life and alternative forms of exercise in Parkinson disease

Parkinson disease (PD) reduces health-related quality of life (HRQoL), but exercise may improve HRQoL. This pilot study compared the effects of Tango, Waltz/Foxtrot, Tai Chi and No Intervention on HRQoL in individuals with PD. Seventy-five persons with PD (Hoehn and Yahr I-III) were assigned to 20 lessons of Tango, Waltz/Foxtrot, Tai Chi, or an untreated No Intervention group. Participants completed the PDQ-39 before and after participation in 20 classes or within 13 weeks in the case of the No Intervention group. Two-way repeated measures ANOVAs determined differences between interventions. Tango significantly improved on mobility (p = 0.03), social support (p = 0.05) and the PDQ-39 SI (p < 0.01) at post-testing. No significant changes in HRQoL were noted in the Waltz/Foxtrot, Tai Chi or No Intervention. Tango may be helpful for improving HRQoL in PD because it addresses balance and gait deficits in the context of a social interaction that requires working closely with a partner.     

Motor imagery for walking: A comparison between cerebral palsy adolescents with hemiplegia and diplegia

The goal of the study was to investigate whether motor imagery (MI) could be observed in cerebral palsy (CP) participants presenting a bilateral affected body side (diplegia) as it has been previously revealed in participants presenting a unilateral body affected sided (hemiplegia). MI capacity for walking was investigated in CP adolescents diagnosed with hemiplegia (n = 10) or diplegia (n = 10) and in adolescents with typical motor development (n = 10). Participants were explicitly asked to imagine walking before and after actually walking toward a target located at 4 m and 8 m. Movement durations for executed and imagined trials were recorded. ANOVA and Pearson's correlation analyses revealed the existence of time invariance between executed and imagined movement durations for the control group and both groups of CP participants. However, results revealed that MI capacity in CP participants was observed for the short distance (4 m) but not for the long distance (8 m). Moreover, even for short distance, CP participants performed worse than typical adolescents. These results are discussed inline of recent researches suggesting that MI in CP participants may not depend on the side of the lesion.     

Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial

Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.     

Psychosocial job characteristics and insomnia: A prospective cohort study using the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) job stress models

ObjectiveTo examine the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) models on insomnia.MethodsA prospective cohort study with a two-year observation was performed. The subjects were 1022 middle-aged (?39 years) Japanese workers. The following associations were analyzed: high job strain, low social support, effort–reward imbalance, and overcommitment to work at the baseline with self-reported persistence and future onset of insomnia.ResultsAmong those who were insomniacs at the baseline (N = 292), low social support [adjusted odds ratio (95% CI): 2.00 (1.18, 3.40)] and effort–reward imbalance [2.40 (1.13, 5.10)] at the baseline had a significant relationship to insomnia at the follow-up. Among those who were not insomniacs at the baseline (N = 730), overcommitment to work [1.75 (1.16, 2.66)] and high job strain [1.72 (1.06, 2.79)] at the baseline were associated with insomnia at follow-up.ConclusionsProspective effects of psychosocial job characteristics on insomnia differed between its persistence and future onset. Proportionate reward for work effort and sufficient support at work assist recovery from insomnia, while overcommitment to work and high job strain cause future onset of insomnia.     

The meaning of beauty: Implicit and explicit self-esteem and attractiveness beliefs in body dysmorphic disorder

Body dysmorphic disorder (BDD) is characterized by imagined or slight defects in one's appearance. We evaluated implicit and explicit biases among individuals diagnosed with BDD (n = 21), individuals with subclinical BDD symptoms (n = 21), and healthy control participants (n = 21). Specifically, we used the Implicit Association Test [IAT; Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: the implicit association test. Journal of Personality and Social Psychology, 74, 1464–1480] to examine automatic associations related to self-esteem, associations between attractive and important, and a physical attractiveness stereotype (associations between attractive and competent). BDD participants had significantly lower implicit self-esteem, relative to control participants, and the subclinical BDD participants were intermediate between these groups. Although no group differences were observed on the implicit Attractive Important IAT; as predicted, BDD participants had significantly stronger implicit associations between attractive and competent than the other groups, in line with a common stereotype about physical attractiveness. Both the Attractive Competent IAT and Self-Esteem IAT were significant predictors of BDD symptom severity, and distress and avoidance during a mirror exposure task. Findings are discussed in light of cognitive-behavioral models of BDD.     

The impact of negative treatment experiences on persistent refusal of antipsychotics

AimsWe investigate reasons for persistent medication refusal in schizophrenia spectrum disorders and test whether factors that speak for a rational decision, such as negative experiences with medication or low symptom distress predict medication refusal, even after taking differences in insight into account.MethodWe included 45 participants with schizophrenia spectrum disorders, of which 20 had refused antipsychotic medication for at least three months and assessed reasons for taking or not taking medication, labeling condition as mental disorder (“insight"), experiences with the previous treatments, symptoms and symptom distress, positive and negative consequences and experiences of psychosis, causal beliefs, therapeutic relationships with previous clinicians and attitudes towards medication.ResultsGroups did not differ in symptom severity but medication refusers reported significantly less insight, less satisfaction with their most-recent psychiatrist and with previous medication, and more negative beliefs about harmful effects of medication. They also felt less informed about medication. After controlling for insight, the perceived helpfulness of the previous treating psychiatrist (OR = 0.30, z = 5.58, p = 0.018) and of previous medication (OR = 0.27, z = 6.87, p = 0.009) and feeling insufficiently informed about medication (OR = 0.53, z = 3. 85, p = 0.050) significantly predicted medication discontinuation.ConclusionsBuilding rapport with patients with a different view of the nature of their condition and encouraging informed decisions on medication are likely to improve medication adherence. However, the findings also suggest that refusing medication after a phase of initial adherence is also the consequence of negative experiences with medication and could result from weighing the pros against the cons.     

Job satisfaction is associated with elevated natural killer cell immunity among healthy white-collar employees

Although the association of job satisfaction with health has been well documented, little is known about the biological mechanisms underlying this relationship. This study investigates the association of job satisfaction with cell-mediated immunity among Japanese white-collar daytime workers. A total of 306 healthy full-time employees (141 women and 165 men), aged 22–69 (mean 36) years, provided a blood sample for the measurement of circulating immune (natural killer (NK), B, and total T) cells and NK cell cytotoxicity (NKCC) and completed a questionnaire survey during April to June 2002. Job satisfaction was measured by a 4-item scale from the Japanese version of the generic job stress questionnaire with higher scores indicating greater satisfaction. Analyses were done separately for women and men using a hierarchical multiple linear regression model controlling for multiple confounders. The results revealed that greater job satisfaction was positively correlated with NKCC (β = .207; p = .029) and the number of NK (CD3^?CD56⁺) cells (β = .261; p = .008) in women. In men, job satisfaction was marginally correlated with NKCC (β = .165; p = .050) but was not correlated with the number of NK (CD3^?CD56⁺) cells (β = .142; p = .107). Job satisfaction did not correlate with numbers of T (CD3⁺CD56^?) and B (CD19⁺) cells in both women and men. Our findings suggest an independent association between job satisfaction and NK cells but the association seems to be stronger in women than in men. Although the results provide a support for the biological plausibility of the job satisfaction-health relationship, additional research is required to determine whether greater job satisfaction contributes to recovery/maintenance of NK cell immunity and host defense over time.     

An ERP study of the processing of response conflict in a dynamic localization task: The role of individual differences in task-appropriate behavior

ObjectiveThe study aimed at finding specific conflict-sensitive ERP components in a novel dynamic localization task. It was investigated whether these ERP components are sensitive to individual differences in task-appropriate behavior.MethodsForty-four participants performed a localization task employing three differentially conflict-inducing experimental conditions: a frequent standard condition (O = target, X = distractor), a rare conflict condition (S = target, O = distractor), and a rare control condition (S = target, X = distractor).ResultsBehavioral data revealed increases of RT and error percent in the conflict condition. Early frequency-sensitive components P3a and fronto-central N2, and late conflict-sensitive components left-central N2, P3b, and CRN were observed. Two groups of participants were selected, those responding fast and accurately, and those responding slowly and inaccurately. Interestingly, the left-central N2 correlate of conflict was observed in the first group, whereas the CRN correlate was observed in the latter group.ConclusionsFindings suggest that pre-response conflict monitoring is required to successfully complete the task, whereas post-response conflict monitoring did not seem to improve performance.SignificanceThe present study used a novel dynamic localization task to identify ERP components that were sensitive to response conflict, but differentially predictive of good vs. poor task performance.     

Cortisol awakening response in patients with psychosis: Systematic review and meta-analysis

The cortisol awakening response (CAR), defined as the increase in cortisol release in response to waking up, shows associations with social and environmental risk factors of schizophrenia and has been studied as a potential biomarker in schizophrenia. We report a systematic review and meta-analysis of 11 studies and 879 participants focusing on the CAR of patients with schizophrenia, first-episode psychosis, and at-risk mental states. Random-effects meta-analysis showed that CAR is attenuated in patients with psychosis compared to healthy controls (g = ⿿0.426, 95% CI ⿿0.585 to ⿿0.267, p < 0.001, 11 between-group comparisons, n = 879). Subgroup analysis showed flattened CAR in patients with schizophrenia (g = ⿿0.556, 95% CI ⿿1.069 to ⿿0.044, p < 0.05, 2 between-group comparisons, n = 114) and first-episode psychosis (g = ⿿0.544, 95% CI ⿿0.731 to ⿿0.358, p < 0.001, 6 between-group comparisons, n = 505), but not in individuals with at-risk mental states. These distinctive alterations of hypothalamic-pituitary-adrenal axis function may have important implications for CAR as a marker for transition risk. However, the lack of objective verification of sampling adherence in these studies may limit the interpretation of the results.