Verbal creativity and schizotypal personality in relation to prefrontal hemispheric laterality: a behavioral and near-infrared optical imaging study

Although anecdotal and correlational results have suggested a reliable relationship between creativity and psychosis, few studies have examined this relationship using empirical methods. In addition, little is known about the neural substrates of creative thinking. We investigated the creative thinking process in relation to schizotypal personality, schizophrenia and prefrontal hemispheric laterality using behavioral and near-infrared optical spectroscopy (NIRS) methods. Schizophrenic, psychometrically ascertained schizotypal, and healthy control subjects (all right-handed) participated in a novel “alternate uses” task designed to assess divergent thinking (DT) ability. The DT task required subjects to generate “uses” for conventional and ambiguous objects. Prefrontal activity was measured using NIRS while subjects were engaged in DT vs. a cognitive control task in a subset of the subjects. Behavioral data indicated that schizotypes had enhanced DT ability compared with schizophrenic and control subjects, who showed similar performance overall. NIRS data showed that DT was associated with bilateral prefrontal cortex (PFC) activation, but the right PFC particularly contributed to the enhanced creative thinking in psychometric schizotypes compared with the other two groups. Thus, creative thinking seems to robustly recruit bilateral PFC, but it is the right PFC that is preferentially activated in schizotypes in relation to their enhanced DT.     

Cognitive dimensions in first-episode schizophrenia spectrum disorders

BACKGROUND: The severity and pattern of cognitive deficits in epidemiological cohorts of patients with first-episode schizophrenia spectrum disorders still remains unclear. We aimed to characterize the basic cognitive functioning of a representative sample of patients with a first-episode schizophrenia spectrum disorders. METHOD: One hundred thirty-one patients experiencing first-episode psychosis and 28 healthy volunteers were administered a comprehensive neuropsychological evaluation. To reduce the number of cognitive test measures into meaningful cognitive dimensions, before analyzing differences between patient and healthy volunteer samples, exploratory factor analysis was carried out on data collected in patients group. The method of extraction was Principal Components Analysis with oblique rotation. RESULTS: An eight-factor model including verbal learning/memory, verbal comprehensive abilities, speed of processing/executive functioning, motor dexterity, motor speed, sustained attention, and impulsivity emerged. A significant below average performance in all cognitive dimensions, except impulsivity, was found. Patient's performance in speed of processing/executive functioning, motor dexterity and sustained attention dimensions exceeded one standard deviation below healthy comparison subjects. CONCLUSIONS: At early stages of the illness, patients display a marked impairment in several functionally relevant cognitive domains.     

Neurobiological correlates of theory of mind in psychosis proneness

Theory of mind (ToM) refers to the capacity to infer one's own and other persons’ mental states. ToM abilities are compromised in schizophrenia, in association with dysfunctional activity in predominantly prefrontal brain regions. Prior behavioral studies have also suggested ToM deficits in healthy individuals with psychosis proneness (PP), although no study to date had investigated the associated neural mechanisms in such a sample. Here we used functional magnetic resonance imaging (fMRI) to compare brain activation of subjects with high versus low scores on positive-dimension PP and a ToM task. The ToM task involved first and second order attribution of cognitive and affective mental states to a cartoon character based on verbal and eye-gaze cues. No between-group differences were found on behavioral performance. fMRI analyses revealed a group interaction in anterior prefrontal cortex (BA 10), with the high PP group showing significantly more activity thereof, relative to the low PP, during second order mentalizing than during first order mentalizing. Further between-group differences were observed in dorsomedial and lateral prefrontal regions (BA 46/9), with the high PP group also showing greater activation during second order mentalizing. These results suggest that subjects with positive-dimension PP require more activation of prefrontal areas to adequately mentalize. Differences in the neural mechanisms underlying ToM might be associated with vulnerability to psychosis.     

Autism in community pre-schoolers: Developmental profiles

Autism is often a complex developmental disorder. The aim of the present study was to describe the developmental characteristics of 129 1–4-year-old children (102 boys, 27 girls) referred for clinical assessment (mean age 2.9 years) due to suspicion of autism spectrum disorder (ASD) after community screening at Child Health Care centers. All children were clinically assessed at the Child Neuropsychiatry Clinic (CNC) in Gothenburg by a research team (neurodevelopmental examination, structured interviews and general cognitive and language examinations). Of the 129 children, 100 met diagnostic criteria for ASD (69 with autistic disorder, and 31 with atypical autism/pervasive developmental disorder-not otherwise specified). The remaining 29 children had a variety of developmental disorders, most often attention-deficit/hyperactivity disorder (ADHD), language disorder, borderline intellectual functioning, and intellectual developmental disorder (IDD) with (n = 25) or without (n = 4) autistic traits (AT). IDD was found in 36% of the 100 children with ASD, and in 4% of the 25 children with AT. Of the children with ASD, 56% had language disorder with no or just a few words at the initial assessment at the CNC, many of whom in combination with IDD. Hyperactivity was found in 37% of those with ASD and in 40% of those with AT. Epilepsy was found in 6% of the total group and in 7% of those with a diagnosis of ASD. Of the latter group 11% had a history of regression, while none of the AT cases had a similar background. When results were compared with a non-screened preschool ASD group of 208 children, referred for ASD intervention at a mean age of 3.4 years, very similar developmental profiles were seen. In conclusion, early community ASD screening appears to systematically identify those children who are in need of intervention and follow-up.     

Cognitive control in autism spectrum disorders

Cognitive control refers to the ability to flexibly allocate mental resources to guide thoughts and actions in light of internal goals. Given the behavioral inflexibility exhibited by individuals with autism spectrum disorders (ASDs), it would appear they experience cognitive control deficits. Cognitive correlates of this behavioral inflexibility have been elusive in previous investigations. Study goals were to investigate deficits in cognitive control in ASDs; to explore its developmental trajectory; and to test whether control deficits are related to symptoms of inflexible thoughts and/or behaviors, and attention symptoms. Thirty-one children and adolescents aged 8-17 with ASDs and 32 age, IQ, and gender matched control subjects completed cognitive, diagnostic, and behavorial assessments, as well as a measure of cognitive control involving overcoming a prepotent response tendency. Compared with typically developing control subjects, individuals with ASDs exhibited deficits in cognitive control. Younger children with ASDs did not demonstrate age-related improvements in cognitive control. Modest relationships between cognitive control, IQ, and attention problems were found for the sample. Only the relationship between cognitive control and full-scale IQ survived correction for multiple comparisons.     

Schizotypy and the shift from dextrality: a study of handedness in a large non-clinical sample

Numerous previous studies have reported associations between schizophrenia/schizotypy and atypical handedness. While there is broad agreement that schizophrenia/schizotypy is associated with a shift away from typical (strong right) handedness, it is not entirely clear what aspect of atypical handedness is implicated: ‘ambiguous’ handedness (the absence of hand preference for given actions) or ‘mixed handedness’ (different hand preferences for different actions). The present study used several indices of handedness (derived from the Annett scale) to address these questions in 3000+ (mostly) University student subjects recruited by electronic mail. It was found that positive schizotypy (indexed by a scale of ‘unusual experiences’) was associated with both aspects of atypical handedness. These findings are discussed in the light of various possible explanations of the association between handedness and schizophrenia/schizotypy.     

Computer-aided neurocognitive remediation in schizophrenia: Durability of rehabilitation outcomes in a follow-up study

Cognitive deficits in patients with schizophrenia constitute a limiting factor to the chances of rehabilitation of daily living abilities, like personal and relational autonomy and working ability. Cognitive Remediation Therapy (CRT) is a rehabilitative technique that aims at the recovery of single cognitive functions through the execution of massive exercises of impaired cognitive domains. This study aims to establish if the results achieved through an intensive deficit-specific neurocognitive treatment of three months duration, were maintained over time. The sample consists in 100 patients diagnosed with schizophrenia according to the criteria of DSM IV. Patients were assessed on cognitive and daily functioning at baseline, after 3 months of either CRT or placebo training added to their standard rehabilitation treatment, at 6 month and 12-month follow-up. Results showed significant changes that were maintained at follow-up for executive function, attention and psychomotor coordination. Moreover the significant improvement in daily functioning was maintained at 6 and 12-month follow-up. In conclusion improvements in cognitive functions and daily functioning achieved through the association of CRT and standard rehabilitation treatment persist over time after the conclusion of the training period.     

规范化认知行为治疗对社区残留型精神分裂症患者生活质量和社会功能的影响

目的 探讨规范化的认知行为治疗（CBT）对社区慢性残留型精神分裂症患者的生活质量及其社会功能的改善作用.方法 于2011年6月～2012年1月将北京市原崇文区的社区慢性残留型精神分裂症患者32例按随机数字表分为CBT组和对照组,CBT组给予常规治疗联合规范化的认知行为治疗,对照组仅给予常规治疗,均干预3个月,比较两组患者的生活质量和社会功能变化.结果 12周时CBT组的心理因子、社会功能评分显著高于对照组（t分别为2.229,3.024; P＜0.05）;38周时CBT组的生活质量总分、心理因子和社会功能评分显著高于对照组（t分别为2.072,2.706,2.818;P＜0.05）;64周时CBT组的生活质量总分、生理因子、心理因子及社会功能评分均显著高于对照组（t分别为2.208,2.055,2.647,4.109; P＜0.05）.结论 规范化的认知行为治疗可能显著改善社区慢性残留型精神分裂症患者的生活质量和社会功能,但由于样本量小等因素尚需在社区中进一步研究与推广应用.     

Cognitive deficits in early-onset schizophrenia spectrum patients and their non-psychotic siblings: a comparison with ADHD

BACKGROUND: Previous research has shown cognitive deficits in patients with schizophrenia spectrum disorders in the areas of executive function, verbal memory and attention. Subtle deficits have been shown in healthy first-degree relatives of patients, suggesting that they may be trait markers. The specificity of these markers for schizophrenia compared with another neurodevelopmental disorder, Attention Deficit Hyperactivity Disorder (ADHD) has not been reliably established. METHODS: The Rey Auditory Verbal Learning Test (RAVLT), Hayling Sentence Completion Test (HSCT), FAS Test of orthographic verbal fluency (FAS) and Continuous Performance Test-Identical Pairs (CPT-IP) were administered to adolescent schizophrenia spectrum patients (SZ; n=30), adolescent siblings of schizophrenia spectrum patients (SZ-SIB; n=36), healthy control participants (HC; n=72); a neurodevelopmental comparison group of adolescents with ADHD (n=27). RESULTS: The SZ group were impaired on all measures. The SZ-SIB group were impaired on IQ, immediate recall (RAVLT), target sensitivity (CPT-IP), response initiation (HSCT); error rates for the FAS and HSCT. There were no significant differences between the SZ-SIB and ADHD groups on individual measures of cognitive function. Principal Components Analysis revealed four factors on which further analyses were conducted. The SZ-SIB and ADHD groups showed different profiles of impairment on components related to response initiation and sustained attention/vigilance when each was compared with the HC group. CONCLUSIONS: Deficits in intellectual function, verbal memory and response initiation/inhibition were found in the SZ-SIB group indicating that these are markers of risk for schizophrenia. Subtle differences in profiles of impairment in the SZ-SIB and ADHD groups on composite measures of attention and response initiation require further investigation.     

Cognitive functions and psychological symptoms in migraine: a study on patients with and without aura

Aim: Migraine is neurological disorder with a complex pathophysiology. We described the neuropsychological profile of 100 migraineurs (50 with visual aura and 50 without aura), in interictal phase, compared to 50 matched healthy controls.

Materials and methods: A battery of standardized neuropsychological tests was used to assess attention, memory and executive functions. Beck Depression Inventory and Hamilton Rating Scale for Anxiety were used to evaluate anxiety and depressive symptoms. Severity of disability during daily activities was assessed by Migraine Disability Assessment.

Results: Migraine without aura showed a significant difference in comparison to healthy controls in semantic verbal fluency (p?=?0.02), delayed memory (p?<?0.001) and set-shifting (p?<?0.001). Migraine with aura showed a significant difference in delayed memory (p?=?0.001) and set-shifting (p?=?0.005) if compared to healthy controls. No significant correlation between cognitive functions and mood was found (HAM-A p?=?0.67) (BDI-II p?=?0.42).

Conclusions: Our data showed isolate and specific cognitive deficit during interictal phase in migraine patients. Future studies are need to identify if specific migraine characteristics may affect cognitive functions.     

精神分裂症患者未患病一级亲属的认知功能研究

目的 探讨精神分裂症未患病的一级亲属认知功能的特点。方法 对110例精神分裂症患者未患病一级亲属（亲属组）及50例正常对照（对照组）进行认知功能测验,包括持续注意力测试（CPT）、威斯康星卡片分类测试（WCST）、修订版韦氏记忆量表（WMS-RC）的逻辑记忆和词语流畅性测试。结果 精神分裂症患者一级亲属在WMS-RC逻辑记忆中的即刻逻辑记忆、延迟逻辑记忆,词语流畅性测试中的词语总数、词语正确数,CPT中的视觉漏报、视觉平均反映时间1和2、听觉漏报数、听觉平均反应时间1和2的成绩均差于对照组（P〈0.05）。结论 精神分裂症未患病的一级亲属存在一定程度的认知功能损害,提示认知损害可能是精神分裂症的内表型指标之一。     

Cognitive insight and psychotic disorder: the impact of active delusions

While several studies have determined the Beck Cognitive Insight Scale (BCIS; [Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., Warman, D.M., 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr. Res. 68, 319–329] is a useful measure of cognitive insight, a number of questions have remained unanswered. While individuals with psychotic disorders have been shown to have impaired cognitive insight compared to a psychiatric comparison group, it has remained unclear how the cognitive insight of individuals with psychotic disorders compares to healthy individuals. Further, as previous studies have classified participants based on diagnostic classification, it has remained unknown if individuals with delusions and individuals with psychotic disorders without active delusions score differently on this measure. To examine these questions, we assessed the cognitive insight of healthy individuals and individuals with psychotic disorders, both with and without active delusions. Results indicated that individuals with psychotic disorders had impaired cognitive insight relative to healthy controls (p = .005), though individuals with active delusions and individuals with psychotic disorders without delusions had impairments in different domains. Individuals with delusions were overly confident in their own judgment relative to healthy controls and those without delusions (p = .011), though their self-reflectiveness was the same as normal controls. Individuals without delusions reported low self-reflectiveness relative to healthy controls and individuals with delusions (p = .004), though they were not overconfident in their judgment. These results are discussed in terms of existing research on cognitive insight, decision making, and psychosis.     

Executive processes in Asperger syndrome: patterns of performance in a multiple case series

Mixed evidence exists for executive dysfunction in autism spectrum disorders (ASD). This may be because of the nature of the tasks used, the heterogeneity of participants, and difficulties with recruiting appropriate control groups. A comprehensive battery of ‘executive’ tests was administered to 22 individuals with Asperger syndrome and 22 well-matched controls. Performance was analysed both between groups and on an individual basis to identify outliers in both the ASD and control groups. There were no differences between the groups on all ‘classical’ tests of executive function. However, differences were found on newer tests of executive function. Specifically, deficits in planning, abstract problem solving and especially multitasking. On the tests that discriminated the groups, all of the ASD individuals except one were identified as significantly impaired (i.e. below the 5th percentile of the control mean) on at least one executive measure. This study provides evidence for significant executive dysfunction in Asperger syndrome. Greatest dysfunction appeared in response initiation and intentionality at the highest level—the ability to engage and disengage actions in the service of overarching goals. These deficits are best observed through using more recent, ecologically valid tests of executive dysfunction. Moreover, performance on these measures correlated with autistic symptomatology.     

Cognitive functioning, symptoms, and work in supported employment: a review and heuristic model

Objective: Supported employment has been shown to improve the employment outcomes of clients with severe mental illness (SMI), but many clients who receive this service still fail to achieve their vocational goals. There is a need to better understand how illness-related impairments interfere with work, and how supported employment services deal with those impairments in order to improve the employment outcomes of clients with SMI. Method: We conducted a review of research on the relationship between cognitive functioning, symptoms, and competitive employment in clients with SMI. Based on this review, we developed a heuristic model of supported employment that proposes specific interactions between cognitive factors, symptoms, vocational services, and employment outcomes. Results: The review indicated that cognitive functioning and symptoms were strongly related to work in studies of general psychiatric samples. In studies of clients participating in vocational rehabilitation programs, associations between cognitive functioning, symptoms, and work were also present, but were attenuated, suggesting that vocational rehabilitation compensates for the effects of some cognitive impairments and symptoms on work. We describe a heuristic model of supported employment that posits specific and testable effects of cognitive domains and symptoms on vocational services and employment outcomes. Conclusions: Supported employment appears to work by compensating for the effects of cognitive impairment and symptoms on work. The model may serve as a guide for research aimed at understanding how supported employment works, and for developing supplementary strategies designed to improve the effectiveness and cost-effectiveness of supported employment services.     

Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial

Background and Objectives

Insomnia is a putative causal factor for persecutory thinking. Recent epidemiological studies show a strong association of insomnia and paranoia. The clinical implication is that reducing insomnia will reduce paranoid delusions. This study, evaluating for the first time the treatment of insomnia in individuals with persecutory delusions, provides a test of this hypothesis. It was predicted that a brief cognitive behavioural intervention for insomnia (CBT-I) for individuals with persistent persecutory delusions and sleep difficulties would not only reduce the insomnia but that it would also reduce the paranoia.

Methods

Fifteen patients with persistent persecutory delusions and insomnia in the context of a psychotic disorder were each individually given a standard-format, four-session CBT-I intervention. Outcome assessments were conducted at pre-treatment, post-treatment and one-month follow-up.

Results

There were no missing data. Following the intervention, significant reductions were found in levels of insomnia and the persecutory delusions. The effect sizes were large, and the changes were maintained at the follow-up. At least two-thirds of participants made substantial improvements in insomnia and approximately half showed substantial reductions in the persecutory delusions. There were also reductions in levels of anomalies of experience, anxiety and depression.

Limitations

The main limitations are the absence of a control group and unblinded assessments. A more methodologically rigorous evaluation of this intervention is now warranted.

Conclusions

These preliminary findings suggest that CBT-I can be used to treat insomnia in individuals with persecutory delusions and that, consistent with the hypothesised causal role, it also lessens the delusions.     

Cognitive fatigue of executive processes: interaction between interference resolution tasks

A resource depletion framework motivated a novel strategy for investigating whether the central executive is unitary or separable into relatively independent subprocesses. The idea that tasks with overlapping neural representations may involve similar executive components was also critical to our approach. Of particular interest were tasks requiring resolution of interference among competing representations. Within a single experimental session intensive training reduced the ability to resolve interference on a transfer task if the training task placed high demands on interference resolution. Negative transfer was absent when interference resolution was minimally required by the task, or when the training and transfer tasks did not rely on overlapping neural representations. These results suggest a nonunitary central executive composed of separable subcomponents, at least one of which mediates interference resolution. Our results are consistent with an executive control process specialized for the selection of task-relevant representations from competitors. The results also agree with the view that higher cognitive processes are resource limited and can be temporarily depleted.     

Comparative Analysis of Cognitive Function in Schizophrenia with and without Obsessive Compulsive Disorder

Objective

We investigated the neurocognitive deficits in schizophrenic patients with and without obsessive-compulsive disorder (OCD).

Methods

We grouped 27 patients as either obsessive-compulsive or non-obsessive-compulsive based on the presence of OCD. The two groups completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Positive and Negative Symptom Scale (PANSS), and Hamilton Depression Scale. The intelligence quotient (IQ) was tested using the Korean Wechsler Adult Intelligence Scale. The memory quotient (MQ) was tested using the Korean-Auditory Verbal Learning and Korean-Complex Figure Test. The executive intelligence quotient (EIQ) was determined using the Kims executive intelligence test (EXIT).

Results

Ten of the 27 patients had OCD. The compulsion score of Y-BOCS was positively correlated with positive symptoms, negative symptoms, and the total scores of PANSS. The OCD-schizophrenia patients had higher IQs. No difference was found in MQ. Although the EIQ did not differ between the two groups, the OCD-schizophrenia patients performed better at the Stroop-interference and verbal fluency tests, which was highly dependent on executive function.

Conclusion

Our findings suggest that OCD may have a protective effect on some cognitive function, at least in relatively early stage of illness. Moreover, based on clinical, neurocognitive features, schizophrenia with OCD could be considered as a distinct subtype of schizophrenia.     

综合康复治疗对社区慢性精神分裂症患者认知功能影响的3年随访

目的 探讨社区治疗及家庭心理治疗的综合康复治疗模式对社区慢性精神分裂症患者认知功能的影响.方法 采用随机抽样法,将98例上海市普陀区社区慢性精神分裂症患者随机分为干预组(48例)和对照组(50例),在维持原有抗精神病药物治疗的同时,由专职精神科医师和经过专业培训的社区工作者对干预组组织社区治疗并进行定期综合心理教育式家庭干预,对照组仅为上门随访.于入组前及第3年末分别对两组患者进行阳性症状与阴性症状量表(PANSS) 评定精神症状、Morning Side康复状态量表(MRSS)评定康复状态、韦氏成人智力测验(WAIS-RC)、简易精神状态检查表(MMSE)、威斯康星卡片分类试验(WCST)测定患者认知功能水平.随访3年.结果 观察前后干预组在PANSS总分[(47.43±12.62)与( 42.38±11.40),t=8.89,P=0.001]、MRSS总分[(48.60±2.99)与( 40.46±3.47), t=7.696,P=0.002]、 MMSE[(19.54±2.99) 与( 23.68±1.42), t=3.684,P=0.005]、WCST总测验数[(87.76±20.54) 与( 80.08±21.33 ), t=3.431,P=0.003]等存在统计学差异(P＜0.05).结论 社区治疗及家庭心理治疗的综合康复治疗模式对社区慢性精神分裂症患者的阴性症状,认知功能尤其是执行功能具有明显改善.     

利培酮治疗对精神分裂症患者认知功能影响的Meta分析

目的进一步分析利培酮治疗对精神分裂症患者认知功能的影响。方法收集关于利培酮对精神分裂症患者认知功能影响的研究文献,进行Meta分析。结果利培酮治疗后记忆商(MQ)评分增加非常显著[y合并=-8.27,95%CI为(-11.49,-5.05),χ2=25.31,P0.001],但威斯康星卡片分类测验(WCST)的持续错误数[d=0.50,95%CI为(-0.01,1.01)]和非持续错误数[y合并=3.17,95%CI为(-0.14,6.48),χ2=3.52,P0.05]无明显减少;在剔除慢性组后分层分析,WCST持续错误数[d=0.59,95%CI为(0.12,1.06)]和非持续错误数[y合并=3.93,95%CI为(0.16,7.70),χ2=4.16,P0.05]均明显减少。结论利培酮治疗后精神分裂症患者的执行和记忆两方面认知功能确有明显改善。