Reduced willingness to invest effort in schizophrenia with high negative symptoms regardless of reward stimulus presentation and reward value

BackgroundNegative symptoms in schizophrenia, which are related to poor functioning, are thought to be grounded on aberrant functioning in the reward system. We aimed to disentangle how negative symptoms and two cognitive aspects of goal-directed behavior, mental representation of reward and reward value, affect willingness to invest effort to attain a reward in schizophrenia.Aims and proceduresTo this purpose, 43 schizophrenia patients and 35 healthy controls were assessed for negative symptoms and general functioning, and completed an effort-based reward task. Patients were split in high and low negative symptoms scorers. A series of ANOVA tests were conducted in order to test the effects of group controlling for representation of reward (Task 1) and balance between reward value and effort (Task 2) on will to invest effort to attain a reward.Main findingsSchizophrenia patients with high negative symptoms chose to invest lower amounts of effort for a reward compared both to low negative symptoms patients and to controls in both tasks. Neither mental representation of reward (Task 1) nor reward value (Task 2) did differentially affect will to invest effort between-groups.ConclusionsThese findings suggest that the lower willingness to invest effort observed in schizophrenia patients with high negative symptoms may not be related to cognitive aspects of goal-oriented behavior.     

Relational Memory in the Early Stage of Psychosis: A 2-Year Follow-up Study

BackgroundRelational memory, the ability to bind information into complex memories, is moderately impaired in early psychosis and severely impaired in chronic schizophrenia, suggesting relational memory may worsen throughout the course of illness. MethodsWe examined relational memory in 66 early psychosis patients and 64 healthy control subjects, with 59 patients and 52 control subjects assessed longitudinally at baseline and 2-year follow-up. Relational memory was assessed with 2 complementary tasks, to test how individuals learn relationships between items (face-scene binding task) and make inferences about trained relationships (associative inference task).ResultsThe early psychosis group showed impaired relational memory in both tasks relative to the healthy control group. The ability to learn relationships between items remained impaired in early psychosis patients, while the ability to make inferences about trained relationships improved, although never reaching the level of healthy control performance. Early psychosis patients who did not progress to schizophrenia at follow-up had better relational memory than patients who did.ConclusionsRelational memory impairments, some of which improve and are less severe in patients who do not progress to schizophrenia, are a target for intervention in early psychosis.     

The relationship between care providers' relational behaviors and residents mood and behavior in long-term care settings

Background: Care providers’ interactions with residents are an important element in long-term care settings. This study aimed at examining the association between care providers’ relational behaviors and affect and mood of residents with dementia over different caregiving situations and with different residents.

Methods: This study utilized a repeated-measures design. Thirty-eight residents with a diagnosis of dementia and 35 care providers from three nursing homes in Ontario, Canada, participated in the study. Care providers’ relational behaviors and residents’ mood and affect were assessed using direct observation methods and self-rating scales.

Results: The care providers’ relational behavior varied according to the caregiving situation, with the most effective relational behaviors observed during interpersonal interactions and the least effective during mealtimes. Less effective relational behaviors were observed between care providers and residents that were perceived as more resistive to care. In addition, effective relational behaviors were associated with positive mood and affect of the residents.

Conclusion: These findings emphasize the importance of acknowledging and enhancing care providers’ relational behaviors when caring for persons with dementia living in long-term care settings.     

Regards croisés sur le polyhandicap : de la création du terme aux représentations actuelles

Introduction“Polyhandicap” is a French term used since the 1960s originally in the context of medico-social institutions. Its closest english translation is “Profound Intellectual and Multiple Disabilities” but these terms may reflect a slightly different approach. Recent recommendations were issued by the French “Haute Autorité de santé”. The objective of this study is to explore the representations of different french stakeholders associated with “polyhandicap”, in order to better define the concept and facilitate international publications.MethodsThis study is based on 33 semi-structured interviews conducted from January to April 2021 with medical doctors, rehabilitation workers, caregivers, and administrative staff involved with such patients. The interview explored the respondents’ opinion regarding the definition, assessment and management of “polyhandicap”.ResultsForty-five percent of the respondents include profound intellectual disability in the core-definition of “polyhandicap”. Other respondents highlight the variability of the importance of mental retardation and some associate this item to the difficulties encountered in communication. Coexisting disabilities are more or less extensively listed. Fifty-eight percent of the respondents state that the term of “polyhandicap” should not be restricted to injuries taking place during early brain development. Fifty-five percent consider that the needs of such patients are not adequately met.DiscussionThese multiple representations, source of confusion, can be detrimental to people with “polyhandicap”. This French concept, comprising three levels of analysis (medical, functional and social), and imperfectly covering other terms used abroad, is difficult to transpose internationally.     

Assessment of explicit and implicit linguistic impairments in patients with aphasia after resection of tumour of the left cerebral hemisphere. Preliminary results

Background and purposeClassical definitions of aphasia describe deficits of different language levels (syntactic, semantic, phonologic) hindering the ability to communicate. Recent studies indicate, however, that impairment of particular aspects of linguistic competencies in aphasia differs in severity. Contemporary approach to the aphasic symptoms presents them as disturbed access of linguistic representations to the awareness system. Accordingly, such an approach requires different types of tasks: direct, involving explicit language processes, and indirect, based on implicit language representations. The aim of our study was to examine explicit and implicit language processes in patients with aphasia after resection of the tumour of left cerebral hemisphere along with characterization of relationships between explicit and implicit language processes.Material and methodsOur cohort included 28 right-handed patients who were divided into four equal groups: two clinical (brain tumours) and two control (lumbar disc disease). Four tasks that assess and compare language processes: lexical decisions (at explicit and implicit levels), sorting of picture captions and word monitoring were implemented.ResultsIn direct tasks, patients with aphasia provided less correct lexical decisions at word level, but did not show deficits in sentence comprehension. In both groups, no priming effect was observed in tasks requiring implicit lexical decisions. The longest time was found in non-primed words, the shortest in pseudowords. The differences between groups regarding word monitoring were also observed. Patients with aphasia obtained longer reaction times in all types of sentences (of different grade of language correctness), with respect to low- and high- frequency words.ConclusionsPatients with aphasia after brain tumour resection show more pronounced impairments of explicit than implicit linguistic behavior; the same effect was found in studies on forgetting in amnestic syndrome.     

The association between discrepancy in illness representations on distress in stroke patients and carers

BackgroundTo investigate the association between the illness representations of recently diagnosed stroke patients and their carers and distress in the months after stroke.MethodForty-two stroke survivors and their carers were assessed at 3 months and 32 couples returned data at 6 months after stroke. Patients and carers completed the Illness Perceptions Questionnaire-Revised, Barthel Index, Significant Others Scale and General Health Questionnaire. Analyses were conducted using the Actor–Partner Interdependence Model.ResultsCarers were more pessimistic than patients about the symptoms, timeline and consequences of the stroke. Patient distress was associated with both patient and carer illness representations at Time 1, and their own illness representations and discrepancy in the illness representations of patients and carers at Time 2. Carer distress was associated with their own illness representations at Time 1, but not the patient's illness representations. Discrepant illness representations were associated with higher carer distress at Time 1 but not Time 2.ConclusionIllness representations of stroke patients and carers have implications for adjustment for both partners. It is important to understand couples' views of stroke, as discrepancy was as strongly associated with patient and carer distress as was physical disability.     

The Urban Teaching Cohort: pre-service training to support mental health in urban schools

Abstract

Supporting students’ mental health needs is critical in high-poverty urban school districts where many students are at risk for mental health problems. Although teacher–student relationships are at the core of student mental health promotion in the classroom, many teacher preparation programmes do not adequately prepare pre-service teachers entering into urban teaching for the realities of urban teaching. Miami University’s Urban Teaching Cohort (UTC) is an innovative, community-based approach to preparing pre-service teachers for work in the field of urban teacher preparation. In this paper, we review research on the challenges impacting the mental health of urban youth, describe how these challenges connect to the work of urban teachers and discuss how urban teacher preparation can help teachers better support students’ mental health. We discuss the elements of the UTC programme and how this preparation approach can help teachers build relationships with urban students and their families, as well as understand their communities from an asset perspective, to create a positive classroom community that supports the mental health of all students. Preliminary qualitative data indicate student and community support for the programme and support the impact of the programme on relationships and teaching practices.     

Mnemonic anosognosia in Alzheimer’s disease is caused by a failure to transfer online evaluations of performance: Evidence from memory training programs

Introduction. There is a debate about the ability of patients with Alzheimer’s disease to build an up-to-date representation of their memory function, which has been termed mnemonic anosognosia. This form of anosognosia is typified by accurate online evaluations of performance, but dysfunctional or outmoded representations of function more generally. Method. We tested whether people with Alzheimer’s disease could adapt or change their representations of memory performance across three different six-week memory training programs using global judgements of learning. Results. We showed that whereas online assessments of performance were accurate, patients continued to make inaccurate overestimations of their memory performance. This was despite the fact that the magnitude of predictions shifted according to the memory training. That is, on some level patients showed an ability to change and retain a representation of performance over time, but it was a dysfunctional one. For the first time in the literature we were able to use an analysis using correlations to support this claim, based on a large heterogeneous sample of 51 patients with Alzheimer’s disease. Conclusion. The results point not to a failure to retain online metamemory information, but rather that this information is never used or incorporated into longer term representations, supporting but refining the mnemonic anosognosia hypothesis.     

Sleep quantity and quality as predictors of behavior and mental health issues for children and adolescents with autism

BackgroundResearch has supported a relationship between sleep problems and day-time behavior and mental health for young children with autism. Fewer studies have investigated these relationships across young children to adolescents.MethodThis study analyzed data retrieved from a sleep and behavior data base constructed from information obtained from patient charts and psychological assessments at a developmental pediatric clinic. The study evaluated the relationships among sleep quality and quantity (measured by the Behavioral Evaluation of Disorders of Sleep), age, and mental health and behavior problems (measured by the Child Behavior Checklist) for children and adolescents with autism (N = 446) from 16 months to 18 years old.ResultsResults indicated that despite age, children and adolescents with autism who experienced sleep quantity and quality problems were more likely to experience internalizing (e.g., anxiety/depression), and externalizing (aggression, destructiveness, delinquency) behavior problems. Internalizing and externalizing behavior problems were associated with sleep behavior, such as sensitivity to environmental stimuli, waking during the night, disoriented waking, and fewer hours of sleep (last 24 h for externalizing and total).ConclusionsThe results of this study replicate and extend previous research on daytime behavior, mental health, and sleep quality and quantity relationships. Indications of sensitivity to the environment to these daytime issues indicates the need for subsequent research delineating the influence of variables within the biopsychosocial model (e.g., sensory hyperarousal) of the inter-relatedness of sleep, daytime behaviors, and mental health for individuals with autism across the lifespan.     

Dreams and Decision

Abstract

Studies connecting childhood experience and adult psychopathology often focus on consequences of abuse and neglect. Copy process theory (Benjamin, 2003) states that constructive as well as destructive experiences shape adult behavior with surprising interpersonal specificity. Childhood perceptions and social learning are encoded in memory and then “copied” in 3 basic ways in subsequent relationships: Identification (behaving as he or she behaved), Recapitulation (behaving as one behaved when with him or her), and Introjection (treating oneself as he or she was treated). The first step in evaluating copy process theory is to verify that the predicted correspondence between adult relational patterns and internal representation of early experience can be observed in different adult samples. Remembered interpersonal patterns from childhood and perceptions of adult relational patterns were measured using the Structural Analysis of Social Behavior (SASB). Strong evidence was found for each copy process in a sample of psychiatric inpatients (N = 161) and a college sample (N = 133). Positive and negative behaviors were copied in both. Evidence suggests that gender, patient status, and rated state may influence whether, and in which forms, copying occurs.     

What do “interpersonally sensitive” supervisors do and how do supervisees experience a relational approach to supervision?

Objective: In two investigations, we identified explicitly relational supervision strategies and examined whether use of these strategies was associated with perceptions of the supervisory alliance and evaluations of the supervisor. Method: First, ratings by nine supervision researchers identified five clearly relational in-session strategies (focus on countertransference, exploration of feelings, attend to parallel process, focus on the therapeutic process, focus on the supervisory alliance) in the Critical Events model of supervision. Based on these expert ratings, we created and assessed the Relational Behavior Scale (RBS). Results: Analyses with two samples of supervisees at all levels of training supported the measure's reliability and factorial validity. The RBS's validity was further indicated by its unique association with the “interpersonally sensitive” style of supervision. In both studies, supervisees perceived more frequent use of relational behavior on the part of psychoanalytic/psychodynamic/humanistic supervisors than cognitive-behavioral supervisors. Moreover, as hypothesized, supervisors’ use of relational behavior in a specific session mediated the association between trainees’ alliance perceptions and evaluations of their supervisors in that session. Conclusion: The identification of specific in-session supervision behaviors that explain one way in which a strong alliance contributes to trainees’ positive experiences of their supervisors has implications for supervision theory, research, and practice.     

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

Purpose

Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels.

Methods

A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically.

Results

The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention.

Conclusions

Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.

     

The relational reframe and parents’ problem constructions in attachment-based family therapy

Abstract

The authors studied the impact of relational reframes on parents’ problem constructions and the reciprocal impact of parents’ problem constructions on therapists’ use of the relational reframe in five early sessions of attachment-based family therapy for depressed adolescents. Across all five sessions, relational reframes led parents to construct problems in interpersonal terms in at least two of their six subsequent speech turns. There was partial support for the hypothesis that reframes led to shifts in parents’ constructions, from intrapersonal to interpersonal. In good, but not poor alliance sessions, parents’ interpersonal problem constructions led therapists to use relational reframes. Future research should examine not only how interpersonal problem constructions are generated but their quality as well.     

Peer-relationship-problems account for quality of life impairments in pediatric psoriasis

ObjectiveMost research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample.MethodsThe impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n = 6518) of children and adolescents aged 11–17.ResultsTotal HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale ‘quality of relationships with friends/peers’. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%.ConclusionOur findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis.     

Developing and testing a principle-based fidelity index for peer support in mental health services

Purpose

Evidence suggests that the distinctive relational qualities of peer support—compared to clinical-patient relationships—can be eroded in regulated healthcare environments. Measurement of fidelity in trials of peer support is lacking. This paper reports the development and testing of a fidelity index for one-to-one peer support in mental health services, designed to assess fidelity to principles that characterise the distinctiveness of peer support.

Methods

A draft index was developed using expert panels of service user researchers and people doing peer support, informed by an evidence-based, peer support principles framework. Two rounds of testing took place in 24 mental health services providing peer support in a range of settings. Fidelity was assessed through interviews with peer workers, their supervisors and people receiving peer support. Responses were tested for spread and internal consistency, independently double rated for inter-rater reliability, with feedback from interviewees and service user researchers used to refine the index.

Results

A fidelity index for one-to-one peer support in mental health services was produced with good psychometric properties. Fidelity is assessed in four principle-based domains; building trusting relationships based on shared lived experience; reciprocity and mutuality; leadership, choice and control; building strengths and making connections to community.

Conclusions

The index offers potential to improve the evidence base for peer support in mental health services, enabling future trials to assess fidelity of interventions to peer support principles, and service providers a means of ensuring that peer support retains its distinctive qualities as it is introduced into mental health services.

     

The interaction of social risk factors and HPA axis dysregulation in predicting emotional symptoms of five- and six-year-old children

ObjectiveWe examined the links of social relational (family environment and peer victimization) and neuroendocrinological (HPA axis dysregulation) risk factors to children’s emotional symptoms. We placed special emphasis on the joint effects of these risk factors with respect to the emergence and course of the emotional symptoms.MethodsOne hundred and sixty-six children were interviewed (Berkeley Puppet Interview) at age 5 and 6. Teachers and parents completed the Strengths and Difficulties Questionnaire. Parents completed the Family Environment Scales. Peer victimization was assessed by teacher and child reports. Children’s saliva cortisol was measured before and after a highly structured story completion task which targeted their cognitive emotional representations of family conflicts.ResultsIn the cross-sectional analyses, negative family environment, peer victimization, and cortisol increase during the story completion task independently contributed to the variance of emotional symptoms. There was a significant interaction effect between family environment and cortisol increase: those six-year-olds who had experienced an unfavorable family environment only showed high levels of emotional symptoms if they exhibited a cortisol increase during the story completion task. In the longitudinal analysis, peer victimization at age 5 predicted an increase of emotional symptoms at age 6, but only for those children who exhibited a blunted cortisol response a year earlier.ConclusionsNegative family environment and peer victimization proved to be independently associated with emotional symptoms. HPA axis reactivity differentially moderated these associations. Therapeutic strategies should take the interaction between negative relational experiences and biological susceptibility to stress into account.     

Long-term stability of personality traits in a clinical psychiatric sample

Abstract

Background: The aim of this study was to describe personality traits in psychiatric patients and to investigate whether these traits are stable over 13 years.

Methods: A total of 95 individuals who were patients at a psychiatric outpatients’ clinic in 2003 completed the Swedish universities Scales of Personality (SSP). Scores from 2003 were compared with SSP scores from 2016. Based on the current score on the comprehensive psychopathological rating scale – self rating for affective disorders (CPRS-S-A), the participants were divided into two groups representing ‘good’ and ‘poor’ current mental states, to investigate the effect of current mental state on reports of personality traits.

Results: Out of 13 personality traits, 11 showed a significant change in mean T-score over the study interval. The group with lower CPRS-S-A scores showed a significant change in T-score for 10 traits, whereas in the group with higher CPRS-S-A scores only 3 traits showed a significant change.

Conclusions: The findings support the theory that personality is changeable over the course of life, also in psychiatric patients. We do not know if persisting psychiatric symptoms halter change or if deviant personality traits cause psychiatric symptoms to continue.     

Illness perceptions,mood and health-related quality of life in patients with amyotrophic lateral sclerosis

ObjectivesTo divide amyotrophic lateral sclerosis (ALS) patients in two clusters according to their illness representation, and to identify, between the two clusters, the differences in functional state, mood, and quality of life.MethodsSeventy-four patients with ALS were recruited at our ALS Centre from different Italian regions, having been for multidisciplinary consultations. The patients' functional impairment was evaluated by the ALS Functional Rating Scale as well as the Bulbar Score and Forced Vital Capacity. Psychological Characteristics and quality of life of ALS patients were evaluated by Profile of Mood State, Illness Perception Questionnaire, and 36-item Short Form Health Survey.ResultsOnly few of the ALS patients studied showed critical mood ratings. On the whole, the perceived quality of life, mood state, and the dimensions relating to their illness representation seem to be correlated to the functional state and respiratory capacity. The clustering of patients according to their illness representations allowed to highlight that ALS patients can be divided into two groups: adaptors and nonadaptors. The patients of the two groups, adaptors and nonadaptors, differed in respiratory capacity as well as in their mood and health-related quality of life.ConclusionsThis study supports the Common Sense Model (CSM) of illness representation when considering ALS patients. Their psychological reactions to illness and quality of life depend not only on the severity of the illness but also on the way the illness is represented. Therefore, CSM could become the theoretical framework for psychological interventions in ALS patients.