Effects of cognitive remediation therapy on neurocognition and negative symptoms in schizophrenia: an Italian naturalistic study

Introduction: Cognitive remediation therapy (CRT) has been reported to positively affect neurocognitive processes among patients with schizophrenia; however, the degree to which changes in cognition is linked to improved clinical symptoms, remains poorly understood. The current study aimed to investigate whether cognitive gains were associated to improvements in negative symptoms’ severity in patients with schizophrenia living in two Italian psychiatric facilities.

Methods: Patients with a diagnosis of schizophrenia were consecutively assigned to CRT (n?=?33) and compared with an historical control group (n?=?28). Assessments were performed at baseline and post-treatment using a neuropsychological battery (Trail Making Test A and B, Self-Ordered Pointing Task, California Verbal Learning Test), along with clinical and functioning measures.

Results: Visual attention (TMT-A score change) was found as the only significant predictor of improvement in negative symptoms subscale of the Positive and Negative Syndrome Scale. Furthermore, a mediation path analysis confirmed that better performance in visual attention acts as mediator of the positive association between CRT intervention and lower post-treatment negative symptoms score.

Conclusions: CRT can have a positive impact on a measure of visual attention in patients with schizophrenia and on negative symptoms reduction that is mediated by this significant intervention effect.     

Effort discounting and its association with negative symptoms in schizophrenia

Introduction. Deficits in the initiation and persistence of goal-directed behaviour are key aspects of schizophrenia. In this study, the association between these motivational deficits and discounting of reward value in function of increasing physical effort costs was investigated.

Methods. Effort-based decision-making was investigated in 40 patients with a DSM-IV diagnosis of schizophrenia and 30 age- and sex-matched healthy control subjects by means of an effort discounting task. To assess negative symptom severity, we made use of the Scale for the Assessment of Negative Symptoms as well as objective measurements of hedonic response to stimuli and motor activity levels.

Results. Patients as well as control subjects discounted the subjective value of rewards significantly with increasing physical effort costs. However, we failed to find a difference in the discounting curves between patients and controls. Furthermore, effort discounting was not associated with any of the negative symptoms measures.

Conclusions. Physical effort discounting was not found to be associated with motivational symptoms in schizophrenia if other decision costs are constant. However, recent findings show that more cognitive effort and/or an interaction between effort and other decision costs (e.g. temporal delay or uncertainty) are associated with negative symptoms in schizophrenia. This should be investigated further in future research.     

Category fluency in schizophrenia: opposing effects of negative and positive symptoms?

Introduction: Category fluency is associated with speed-, executive- and semantic impairments in schizphrenia. It has traditionally been linked to negative symptoms, whereas the relation to positive symptoms is mixed. Associations to the consensus negative, positive and disorganisation factors have not been analysed before.

Methods: Animal fluency was administered to 81 patients with schizophrenia. Measures of overall performance and applied strategies were analysed in relation to the Wallwork five-factor PANSS-model.

Results: Negative and disorganisation symptoms were negatively related to overall fluency performance. Positive symptoms were positively related to overall performance when controlling for disorganisation symptoms. Negative symptoms were related to fewer switches, less repetitions, less single animals intrusions, and both less rare and common animals. Positive symptoms were related to more effective retrieval of sub-category exemplars following a sub-category title, whereas there were no relation between symptoms and exemplars when the title was not retrieved. The Beta values of negative and positive symptoms were opposite.

Conclusion: This is the first study showing that positive symptoms are related to increased fluency performance when disorganisation is controlled for. Like previous studies, negative symptoms were found to depress fluency. Strategy measures indicated that negative symptoms predispose for rigidity, whereas positive symptoms facilitate more efficient associative pathways.     

Neurocognitive insight and executive functioning in schizophrenia

Introduction. This study explored whether integrity of executive functioning is required for good neurocognitive insight (NI) in subjects with schizophrenia.

Methods. NI was measured by subtracting executive difficulties (errors in the Modified Card Sorting Task) from executive cognitive complaints (Subjective Scale to Investigate Cognition in Schizophrenia) in 40 outpatients with schizophrenia and 42 normal controls. The schizophrenia sample was a priori divided into two subgroups on the basis of executive level. Multivariate analyses were conducted to compare groups and to control for potential confounding factors.

Results. Only the schizophrenia dysexecutive subgroup had a poorer NI compared to normal controls. Group differences remained significant after adjustment for potential confounding factors (education, depression, anxiety and self-esteem).

Conclusion. These results provide support for the hypothesis that executive dysfunctioning is a limiting factor for NI, independently from depressive and anxiety symptoms.     

Discriminating between first- and second-order cognition in first-episode paranoid schizophrenia*

Introduction: An impairment of visually perceiving backward masked stimuli is commonly observed in patients with schizophrenia, yet it is unclear whether this impairment is the result of a deficiency in first or higher order processing and for which subtypes of schizophrenia it is present.

Methods: Here, we compare identification (first order) and metacognitive (higher order) performance in a visual masking paradigm between a highly homogenous group of young first-episode patients diagnosed with paranoid schizophrenia (N?=?11) to that of carefully matched healthy controls (N?=?13).

Results: We find no difference across groups in first-order performance, but find a difference in metacognitive performance, particularly for stimuli with relatively high visibility.

Conclusions: These results indicate that the masking deficit is present in first-episode patients with paranoid schizophrenia, but that it is primarily an impairment of metacognition.     

Impaired facial and vocal emotion decoding in schizophrenia is underpinned by basic perceptivo-motor deficits*

Introduction: Emotional decoding impairments have been largely demonstrated in schizophrenia for facial and prosodic stimuli, when presented separately. Nevertheless, the exploration of crossmodal integration has been far less considered, despite its omnipresence in daily social interactions. Moreover, the role played by basic visuo-motor impairments in unimodal and crossmodal decoding remains unexplored.

Methods: Thirty-two patients were compared with 32 matched controls in an emotional decoding task including unimodal (visual and auditory) and crossmodal (congruent and incongruent) conditions. A control perceptive task was also conducted to take potential low-level perceptual deficits into account.

Results: Schizoprenic patients presented lower performance and higher reaction times for both unimodal tasks (visual and auditory) and crossmodal conditions. Moreover, reaction times for the visuo-perceptive task were also significantly longer for patients compared to controls.

Conclusions: The consistency of the results across unimodal and crossmodal tasks suggests a globalised emotional impairment in schizophrenia, independent of the sensorial modality and crossmodal nature of the stimuli. Centrally, given the results in the visuo-perceptive task, the impairments observed for emotional recognition appears at least partly explained by primary cognitive deficits, namely reduced processing speed.     

Assessing early processing of eye gaze in schizophrenia: measuring the cone of direct gaze and reflexive orienting of attention

Introduction: The accurate discrimination of another person’s eye-gaze direction is vital as it provides a cue to the gazer’s focus of attention, which in turn supports joint attention. Patients with schizophrenia have shown a “direct gaze bias” when judging gaze direction. However, current tasks do not dissociate an early perceptual bias from high-level top-down effects. We investigated early stages of gaze processing in schizophrenia by measuring perceptual sensitivity to fine deviations in gaze direction (i.e., the cone of direct gaze: CoDG) and ability to reflexively orient to locations cued by the same deviations.

Methods: Twenty-four patients and 26 controls completed a CoDG discrimination task that used realistic direct-face images with six fine degrees of deviation (i.e., 3, 6 or 9 pixels to the left and right) and direct gaze, and a gaze cueing task that assessed reflexive orienting to the same fine-grained deviations.

Results: Our data showed patients exhibited no impairment in gaze discrimination, nor did we observe a reduced orienting response.

Conclusions: These results suggest that while patients may suffer deficits associated with interpreting another person’s gaze, the earliest processes concerned with detecting averted gaze and reflexively orienting to the gazed-at location are intact.     

Correlation of Proteinuria with Podocyte Foot Process Effacement in IgA Nephropathy: An Ultrastructural Study

Background: Proteinuria is an uncommon clinical manifestation of IgA nephropathy and is usually seen in cases with severe lesions like endocapillary proliferation. However, it is occasionally seen even with cases with mild glomerular manifestations and may even be of nephrotic range.

Predictor: Podocyte foot process effacement.

Outcome: Severity of proteinuria.

Measurements: Podocyte foot process effacement was measured. Morphometric analysis was performed on transmission electron microscope images using a computerized digital photomicrograph system (BioWizard 4.2 Image analysis software, New Delhi, India). Proteinuria was measured quantitatively assigned into five grades.

Results: It was found that as the extent of proteinuria increased, the effacement ratio also increased, and this was most significant between “no” proteinuria and the rest of the categories.

Conclusion: Nephrotic presentation in IgA nephropathy is a known phenomenon and in certain cases may show near normal glomerular morphology with severe foot process effacement on EM being the only significant finding to explain the proteinuria. Proteinuria in these cases shows a significant correlation with degree of foot process effacement. Renal biopsy is important in these cases because they are known to have a better prognosis and are usually steroid responsive.     

Confabulations in schizophrenia

Introduction. Current theories of confabulation are based primarily on the observation of neurological patients. The present paper evaluates these theories based on evidence from schizophrenia. Schizophrenia is unique in that it presents with a pathophysiology which differs from that of other neuropsychiatric conditions, and yet the candidate's deficits that various theories of confabulation implicate are often simultaneously present in schizophrenia.

Methods. A selective review of literature on schizophrenic and neurological confabulations was undertaken.

Results. Schizophrenic confabulation differs from neurological confabulation in terms of its characteristic features and association with symptoms, cognition and linguistic functions. Current evidence also suggests that confabulation may be conceptualized as a special class of delusions pertaining to memory phenomena.

Conclusions. Schizophrenia presents with confabulations that cannot be fully accounted for by the existing theories. It also presents with confabulations with unique features, which have different cognitive correlates and relation to other symptoms of the condition.     

Colour influences perception of facial emotions but this effect is impaired in healthy ageing and schizophrenia

Introduction. Social cognition is commonly assessed by identification of emotions in facial expressions. Presence of colour, a salient feature of stimuli, might influence emotional face perception.

Methods. We administered 2 tests of facial emotion recognition, the Emotion Recognition Test (ER40) using colour pictures and the Penn Emotional Acuity Test using monochromatic pictures, to 37 young healthy, 39 old healthy and 37 schizophrenic men.

Results. Among young healthy individuals recognition of emotions was more accurate and faster in colour than in monochromatic pictures. Compared to the younger group, older healthy individuals revealed impairment in identification of sad expressions in colour but not monochromatic pictures. Schizophrenia patients showed greater impairment in colour than monochromatic pictures of neutral and sad expressions and overall total score compared to both healthy groups. Patients showed significant correlations between cognitive impairment and perception of emotion in colour but not monochromatic pictures.

Conclusions. Colour enhances perception of general emotional clues and this contextual effect is impaired in healthy ageing and schizophrenia. The effects of colour need to be considered in interpreting and comparing studies of emotion perception. Coloured face stimuli may be more sensitive to emotion processing impairments but less selective for emotion-specific information than monochromatic stimuli. This may impact on their utility in early detection of impairments and investigations of underlying mechanisms.     

Secular trends in cranial morphological traits: a socioeconomic perspective of change and sexual dimorphism in North Americans 1849–1960

Background: The human body has undergone significant changes in stature and other areas, which reflect secular trends associated with socioeconomics.

Aim: To analyse cranial morphological traits for deciphering if they are subject to secular trends.

Subjects and methods: Two documented skeletal collections were sampled for a total of 525 individuals from 1849–1960. Cranial morphological traits were scored and input into time series statistics (logistic regression).

Results: In females, nuchal crests have enlarged, while glabella has decreased. In males, supraorbital margins have dulled, while glabella decreased. Sexual dimorphism increased in supraorbital margins.

Conclusion: The patterns in the data here reflect those found in other areas of the skeleton, namely height, as regards to secular trends. These findings can be extended to stature and cranial changes that parallel socioeconomic trends during the Industrial Revolution, antebellum period and after.     

Inhibitory deterioration may contribute to hallucinations in Alzheimer's disease

Introduction. Although delusions and hallucinations are relatively common symptoms in individuals with Alzheimer's disease (AD), very little is known regarding underlying mechanisms. We examined whether these manifestations could be underpinned by psychological distress and executive impairments.

Methods. Thirty-one participants with probable mild AD and 33 healthy older adults were administered a neuropsychological and clinical battery assessing delusions, hallucinations, anxiety, depression, episodic memory and executive functions (shifting, updating and inhibition).

Results. Prevalence of delusions and hallucinations were significantly higher in AD participants compared to control participants. Further, hallucinations in AD participants were significantly correlated with poor inhibition, with the latter uniquely predicting the former, as compared to other variables. In addition, hallucinations in AD participants were associated with depression, a relationship that was further mediated by inhibition.

Conclusion. Hallucinations in individuals with AD seem to be related to difficulties suppressing irrelevant thoughts, resulting in these irrelevant thoughts becoming confused with ongoing reality.     

Trends in thin body stature among Japanese male adolescents, 2003–2012

Background: The desire for thin body stature and unhealthy eating behaviours have spread among Japanese boys. The prevalence of thinness in boys is expected to increase; however, recent trends have not been reported.

Aim: To describe changes in the distribution of body mass index (BMI) of Japanese boys, from 2003 to 2012.

Subjects and methods: BMI distribution changes were studied in 2599 relatively affluent Japanese children and adolescents, aged 12.5–17.5 years, during 2003–2012. The 2003 and 2004 data were combined and compared to the combined 2011 and 2012 data. Tukey mean-difference plots were used to study the direction and magnitude of shifts in BMI distributions.

Results: Prevalence of thinness has progressively increased from 2.8–4.7% in 2003–2004 to 5.1–7.6% in 2011–2012 in Japanese boys. Tukey plots showed that the increases in the prevalence of thinness are related to shifts in the entire distribution of BMI in the sample.

Conclusion: Thin body stature was documented in increasing proportion of Japanese male adolescents. BMI z-scores decreased across the entire BMI centile spectrums, indicating that the whole school population may be at risk of thinness.     

Isometric torso muscle endurance profiles in adolescents aged 15–18: normative values for age and gender differences

Objective: The aim of this study was to establish normative values for torso muscle endurance in adolescents aged 15–18 years. It was hypothesized that torso endurance profiles of adolescents differs between males and females and between adolescents and adults.

Background: Decreased torso muscle endurance has been identified as a potential personal risk factor for low back pain development in both adolescents and later years together with being detrimental for athletic performance.

Design: Measurement of torso muscle endurance, established through four tests performed in random order in a healthy adolescent population.

Setting: High school in Novi Sad, Province of Vojvodina, Republic of Serbia.

Methods: Two hundred and ninety-four adolescents from one high school (178 males and 116 females) were grouped into four age strata. Selected isometric torso muscle endurance tests were: Biering-Sørensen test for extensor endurance; Flexor endurance test; right and left Side Bridge tests. The mean, ratio, standard deviation and 25th, 50th and 75th percentile scores were determined for each gender/age strata.

Results and conclusion: Males had higher lateral torso endurance than females. Adolescents in general demonstrate their peak lifetime endurance as they appear more endurable than children and comparable adult groups. These data of endurance times, their ratios and percentiles in healthy normal subjects form a database bridging existing data for children and adults that may be useful for guiding training and rehabilitation.     

Preserved priming effect in individuals with schizophrenia: cues towards rehabilitation

Introduction. Individuals with schizophrenia and affective disorders show relatively intact implicit memory as compared to declarative memory. Implicit memory is usually assessed with skill learning and priming tasks. Whereas priming is thought to involve storage changes in the posterior neocortex, skill learning is thought to rely more on the corticostriatal pathway. Since frontostriatal and frontotemporal dysfunctions are, respectively, found in schizophrenia and affective disorders, we hypothesised that individuals with schizophrenia and first-episode psychosis would exhibit disturbances in skill learning, but not priming.

Methods. Thirty-five patients (11 first-episode psychosis; 11 schizophrenia; 13 affective disorders) and 10 controls completed a procedural learning and priming task. Participants had to identify fragmented images throughout five training sessions. The improvement of the threshold at which the images could be identified between the first and last session was used as an index of procedural learning. In a final session, the identification thresholds for old and new images were compared to assess the priming effect.

Results. Whereas individuals with schizophrenia and first-episode psychosis showed impaired skill learning, the priming effect was similar in all groups.

Conclusion. Even though some aspects of learning and memory are affected in schizophrenia, our results suggest that the posterior cortical pathway remains efficient at modulating the priming effect. This intact ability could be used to guide the elaboration of new rehabilitation programmes.     

Cognition and social cognition in non-psychotic siblings of patients with schizophrenia

Introduction. Deficits in Social Cognition are common in people with schizophrenia. However, it is not clear if these deficits are a vulnerability marker and whether they are independent to cognitive difficulties. This study investigates these two issues in individuals with a genetic liability to psychosis.

Methods. Twenty-one healthy siblings of patients with schizophrenia were compared with 21 healthy individuals on a range of cognitive and social cognitive measures. Significant differences in cognitive domains were controlled for when comparing the two groups on measures of social cognition.

Results. Siblings of people with schizophrenia performed significantly worst on tests of theory of mind and social perception but not on affect recognition. Scores on tests of executive function, processing speed and general IQ were also lower in the sibling group. When controlled for differences in cognitive tests, the two groups still retained significant differences in theory of mind and social perception. However, executive function significantly contributed to theory of mind and processing speed to social perception differences.

Conclusions. These results further suggest that difficulties in some domains of social cognition are associated with a genetic vulnerability for schizophrenia. In these areas, cognitive difficulties account only partially for social cognition problems suggesting that these two domains may represent relatively independent liability factors.     

Is this my voice or yours? The role of emotion and acoustic quality in self-other voice discrimination in schizophrenia

Introduction: Impairments in self-other voice discrimination have been consistently reported in schizophrenia, and associated with the severity of auditory verbal hallucinations (AVHs). This study probed the interactions between voice identity, voice acoustic quality, and semantic valence in a self-other voice discrimination task in schizophrenia patients compared with healthy subjects. The relationship between voice identity discrimination and AVH severity was also explored.

Methods: Seventeen chronic schizophrenia patients and 19 healthy controls were asked to read aloud a list of adjectives characterised by emotional or neutral content. Participants’ voice was recorded in the first session. In the behavioural task, 840 spoken words differing in identity (self/non-self), acoustic quality (undistorted/distorted), and semantic valence (negative/positive/neutral) were presented. Participants indicated if the words were spoken in their own voice, another person’s voice, or were unsure.

Results: Patients were less accurate than controls in the recognition of self-generated speech with negative content only. Impaired recognition of negative self-generated speech was associated with AVH severity (“voices conversing”).

Conclusions: These results suggest that abnormalities in higher order processes (evaluation of the salience of a speech stimulus) modulate impaired self-other voice discrimination in schizophrenia. Abnormal processing of negative self-generated speech may play a role in the experience of AVH.     

Body image,body dissatisfaction and weight status in children from Emilia-Romagna (Italy): comparison between immigrant and native-born

Background: Cross-sectional study among immigrant and native children from Emilia-Romagna (Italy).

Aim: The purpose of the present study was to examine the relative contribution of weight status, ethnicity and sex on body dissatisfaction in a sample of children from Emilia-Romagna (Italy).

Subjects and methods: Primary school children (226 immigrants and 1206 Italians) aged 6–11 years were measured: immigrant children were divided into Asians, Africans, Latin Americans and East Europeans. Height and weight were measured and Body Mass Index (BMI) was calculated. Body image perception was assessed using Body Silhouette Charts. A body dissatisfaction score (BDS) was derived by subtracting the "ideal self" from the "self" score.

Results: Weight status disorders were higher in immigrants than in native-born males; Italian females had higher prevalence of underweight and overweight and lower prevalence of obesity than immigrants peers. BDS rose with the increase of weight status categories.

Conclusions: Awareness of body image size and increasing body dissatisfaction with higher weight status is established in childhood, regardless of ethnicity and gender.