A Brief Cognitive Assessment Tool for Schizophrenia: Construction of a Tool for Clinicians

Cognitive impairment in schizophrenia is often severe, enduring, and contributes significantly to chronic disability. But clinicians have difficulty in assessing cognition due to a lack of brief instruments. We evaluated whether a brief battery of cognitive tests derived from larger batteries could generate a summary score representing global cognitive function. Using data from 3 previously published trials, we calculated the corrected item-total correlations (CITCs) or the correlation of each test with the battery total score. We computed the proportion of variance that each test shares with the global score excluding that test (R_t²=CITC²) and the variance explained per minute of administration time for each test (R_t²/min). The 3 tests with the highest R_t²/min were selected for the brief battery. The composite score from the trail making test B, category fluency, and digit symbol correlated .86 with the global score of the larger battery in 2 of the studies and correlated between .73 and .82 with the total battery scores excluding these 3 tests. A Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) using the above 3 tests can be administered in 10–11 min. The full batteries of the larger studies have administration times ranging from 90 to 210 min. Given prior research suggesting that a single factor of global cognition best explains the pattern of cognitive deficit in schizophrenia, an instrument like B-CATS can provide clinicians with meaningful data regarding their patients’ cognitive function. It can also serve researchers who want an estimate of global cognitive function without requiring a full neuropsychological battery.     

A Theoretical and Neurophysiological Consideration on the Pathogenesis of Positive Symptoms of Schizophrenia: Implications of Dopaminergic Function in the Emotional Circuit

Abstract: The implications of the emotional circuit and the gating mechanism by dopamine (DA) proposed by Maeda^72,73 in the pathogenesis of positive symptoms of schizophrenia were reconsidered based upon recent advances and findings in the fields of neurophysiology and neuropharmacology and in biological studies of schizophrenia. The gating mechanism by DA was partly supported by new evidence that glutamatergic or GABAergic neurotransmission, which mediates the hippocampo-lateral septal or the piriform cortico-amygdaloid neuronal connections, is likely to be modulated by DA. The compensation-facilitating or gating functions of DA was considered again to play an important role in producing positive symptoms in schizophrenics, who have been suggested to have morphological abnormalities in the limbic system or in the prefrontal cortex prior to the appearance of positive symptoms.     

α7-烟碱型乙酰胆碱受体激动剂对精神分裂症认知缺陷和阴性症状治疗:随机双盲对照研究的meta分析

背景:现有α7-烟碱型乙酰胆碱受体激动剂(α7-nAChR受体激动剂)对精神分裂症的认知障碍和阴性症状治疗的临床研究结果不尽一致.目的:评估α7-烟碱型乙酰胆碱受体激动剂在治疗精神分裂症认知缺损和阴性症状的临床疗效和安全性.方法:PubMed、Embase、ClinicalTrials.gov、CochraneLibrary和中国知网、万方、VIP数据库进行文献检索,检索时间截止于2017年5月26日.M eta分析双盲随机对照试验中α7-nAChR受体激动剂的作用,评估α7-nAChR受体激动剂对精神分裂症的总体认知功能和阴性症状的临床疗效.通过计算药物和安慰剂之间的平均差(SMDs),评估α7-nAChR受体激动剂能否作为有效的抗精神病药物.结果:8个低偏倚研究纳入了meta分析.我们没有发现α7乙酰受体激动剂对精神分裂症患者的认知障碍(SMD=-0.10(-0.46,0.25),=88％)和阴性症状(SMD=0.13(-0.04,0.30),I2=64％)有明显疗效.敏感性分析也印证了此结果.药物总体安全且耐受性良好,在不良事件(RR=1.02,[0.85,1.23])和脱落率(RR=1.04,[0.61,1.78])与安慰剂对照无显著差异.根据GRADE评级,该meta分析结果的证据强度为“中”.结论:α7-nAChR受体激动剂可能不是有效地改善精神分裂症患者总体认知障碍和的阴性症状的药物.     

The Biological Background of Refractory Schizophrenia: A Study on Clinical States, Serum Drug Concentration, Cognitive Function and Brain CT Findings

Abstract: Inpatients who had been in the hospital for more than three years (refractory group, n=53) were compared with outpatients who had not been admitted to the hospital in the last three years (remission group, n=42). There were differences between the two groups in "blunted affect-thought disturbance" symptoms, "hallucination-delusion" symptoms, the score of behavior rating scale (BRS), the dosage and serum concentration of antipsychotics, the score of Hasegawa's Dementia Scale (HDS) and brain CT findings. "Blunted affect-thought disturbance" symptoms were strongly related to the BRS score, the dosage of antipsychotics and the HDS score. Sylvian fissures enlargement was related to "blunted affect-thought disturbance" symptoms. Sylvian fissures enlargement was thought to be a biological background of refractory schizophrenia.     

The Medium is the Message: Effects of Mediums of Communication on Perceptions and Emotions in Social Anxiety Disorder

We examined the use of voice/text and visual mediums and their effects on perceptions and emotions in social anxiety disorder (SAD). Our sample included 88 individuals: 44 individuals with SAD and 44 non-socially-anxious (NSA) individuals. We used an experience sampling methodology (ESM) in which participants received daily links to online measures at random times during the day, for 21 days and reported on social interactions, emotions and perceptions. Results indicated that individuals with SAD used voice/text mediums to a greater extent and used visual mediums to a lesser extent compared to NSA individuals. However, despite preferring voice/text mediums, use of visual mediums resulted in immediate increases in positive perceptions and emotions for individuals with SAD. These findings were above and beyond the effect of depressive symptoms and remained when social anxiety was represented as a continuum of severity. This has important implications for exposure interventions in the treatment of SAD.     

The Impact of Cannabis Use on Cognitive Functioning in Patients With Schizophrenia: A Meta-analysis of Existing Findings and New Data in a First-Episode Sample

Cannabis use is highly prevalent among people with schizophrenia, and coupled with impaired cognition, is thought to heighten the risk of illness onset. However, while heavy cannabis use has been associated with cognitive deficits in long-term users, studies among patients with schizophrenia have been contradictory. This article consists of 2 studies. In Study I, a meta-analysis of 10 studies comprising 572 patients with established schizophrenia (with and without comorbid cannabis use) was conducted. Patients with a history of cannabis use were found to have superior neuropsychological functioning. This finding was largely driven by studies that included patients with a lifetime history of cannabis use rather than current or recent use. In Study II, we examined the neuropsychological performance of 85 patients with first-episode psychosis (FEP) and 43 healthy nonusing controls. Relative to controls, FEP patients with a history of cannabis use (FEP + CANN; n = 59) displayed only selective neuropsychological impairments while those without a history (FEP − CANN; n = 26) displayed generalized deficits. When directly compared, FEP + CANN patients performed better on tests of visual memory, working memory, and executive functioning. Patients with early onset cannabis use had less neuropsychological impairment than patients with later onset use. Together, these findings suggest that patients with schizophrenia or FEP with a history of cannabis use have superior neuropsychological functioning compared with nonusing patients. This association between better cognitive performance and cannabis use in schizophrenia may be driven by a subgroup of “neurocognitively less impaired” patients, who only developed psychosis after a relatively early initiation into cannabis use.     

Striatal Dopamine Transporter Availability in Drug-Naive Patients With Schizophrenia: A Case-Control SPECT Study With [99mTc]-TRODAT-1 and a Meta-Analysis

Central dopaminergic hyperactivity has been one of the main hypotheses of the pathophysiology of schizophrenia since the 1970s. Excess dopamine (DA) neurotransmission in the striatum is hypothesized to alter the processing of information and result in psychotic symptoms in schizophrenia. Single photon emission computerized tomography (SPECT) provides in vivo indices of DA neurotransmission. Our study aimed to compare dopamine transporter (DAT) availability between drug-naive patients with schizophrenia and controls using SPECT. DAT availability through [^99mTc]-TRODAT-1 SPECT was compared between 47 drug-naive patients with recent-onset schizophrenia and 112 healthy controls. We also conducted a random-effects meta-analysis of the available literature synthesizing the results of 6 comparable published articles as well as our current data. The mean specific striatal binding showed a statistical trend for a reduction among the patients compared with controls (estimated difference = 0.071; 95% CI −0.01, 0.15; P = .08). There was an effect of gender, whereby females had a higher ratio of specific striatal binding than males. Age was negatively correlated with the ratio of specific striatal binding, both in patients and controls. The meta-analysis provided a pooled standardized effect size (Cohen’s d) of −0.07 (95% CI −0.31, 0.18; P = .60) for the patient vs control comparison in TRODAT binding, with no evidence of heterogeneity between studies or publication bias. Our findings suggest that striatal DAT levels are not altered in the early stages of schizophrenia before medication is introduced. We identified gender differences and aging effects that could have significance for future studies.     

Affective Instability Prior to and after Thoughts about Self-Injury in Individuals With and At-Risk of Psychosis: A Mobile Phone Based Study

It has been proposed that affective instability may be associated with thoughts about self-injury. The aim of this study was to test the hypotheses that instability in feelings of depression, but not anxiety, guilt, or hostility, would predict greater concurrent and subsequent thoughts about self-injury. Thirty-six individuals with psychosis completed questions on touch-screen mobile phones at semi-random times each day for one week. The instability of depression predicted greater concurrent and subsequent levels of thoughts about self-injury, even when controlling for depression level. Conversely, self-injurious thoughts predicted more stable depression. The instability of guilt, anxiety, and hostility did not significantly predict levels of thoughts about self-injury. Results indicate that a variable depressive state may trigger the onset of thoughts about self-injury, which increases the risk of its subsequent recurrence. The onset of self-injurious thoughts may, however, have a stabilizing effect on subsequent depression.     

Associations of Clozapine Use With Psychosocial Functioning and Quality of Life in Patients With Schizophrenia: A Community-Based Cross-Sectional Study

ObjectiveMore attempts have been made recently to improve psychosocial functioning and quality of life in patients with schizophrenia, due to their crucial role in long-term outcomes. Previous studies on the effects of clozapine on psychosocial functioning have been limited in terms of generalizability and application to clinical practice. This study examined the relationship of clozapine use with psychosocial functioning and quality of life in patients with schizophrenia in a real-world setting. MethodsData were obtained from a survey targeting community-dwelling patients with schizophrenia. The Behavior and Symptom Identification Scale (BASIS) and Satisfaction with Life Scale (SWLS) were administered to evaluate psychosocial functioning and quality of life, and patients were classified into Clozapine and Non-clozapine groups. Group differences were assessed using ANCOVA, with additional sensitivity analyses for participants on atypical antipsychotic medications only. ResultsOf 292 patients, the Clozapine group (n=34) had significantly better psychosocial functioning and quality of life than the Nonclozapine group (n=258), as demonstrated by their low BASIS score (F=4.651, df=1, 290, p=0.032) and high SWLS score (F=14.637, df=1, 290, p<0.001). Similar findings for psychosocial outcomes were observed in the analyses of the atypical antipsychotic subgroup (n=195). ConclusionFor optimal recovery in schizophrenia, restoration of impaired social functioning and enhanced satisfaction with life are essential. In this study, clozapine use was related to high levels of psychosocial functioning and quality of life in real-world settings. Further research on the causal relationship between clozapine use and psychosocial functioning is needed.     

A Comparative Study of Benzodiazepine Hypnotics and Zopiclone in Schizophrenia: Effects on Polysomnograms and BPRS Scores

Abstract: Sleep variables and psychiatric symptoms during benzodiazepine (BZD) hypnotic therapy and during zopiclone (ZPC) treatment were investigated in 6 male chronic schizophrenics. The amount of stage 1 was smaller and that of stage 2 was larger during treatment with ZPC than BZDs. However, no significant difference was shown in the amount of slow-wave sleep (SWS) between the treatments. Both the total and negative-symptom scores in the Brief Psychiatric Rating Scale (BPRS) were lower, and the soundness of sleep in the subjective sleep assessments was better evaluated during treatment with ZPC than BZDs. These results suggest that ZPC may be more beneficial in treating schizophrenic insomnia than BZDs.     

A light in a sea of darkness: the moderating role of emotional complexity in the PTSD symptoms-successful aging association

Objectives: This study aimed to assess the underexplored effects of posttraumatic stress disorder (PTSD) symptoms on objective and subjective successful aging and to inquire whether emotional complexity moderates these effects.

Methods: Community-dwelling older adults (N = 127, mean age = 67.86, SD = 11.07) rated their PTSD symptoms and completed measures of objective and subjective successful aging. They further reported their emotions on a daily basis over 14 days.

Results: After controlling for background characteristics, self-rated health and cumulative lifetime adversity, results showed that higher PTSD symptoms were related to less successful aging, both objective and subjective. However, this relationship existed only amongst older adults with low emotional complexity, but not amongst those with high emotional complexity.

Conclusion: The findings suggest that high emotional complexity buffers against the negative effects of PTSD symptoms on successful aging. Interventions that empower emotional complexity amongst traumatized older adults may attenuate these negative effects.     

The Role of Expressed Emotion in Relationships Between Psychiatric Staff and People With a Diagnosis of Psychosis: A Review of the Literature

The concept of expressed emotion (EE) has been extended to the study of staff-patient relationships in schizophrenia. A comprehensive review of the literature identified a total of 27 studies investigating EE in this group published between 1990 and 2008. The article aims to assess whether the concept of EE is a useful and valid measure of the quality of professional caregiver and patient relationships, given that staff may be less emotionally invested in relationships than relatives. In doing so, it summarizes methods of measuring EE, the nature of professional EE compared with familial EE, associations between high EE and patient outcomes, associations between EE and both patient and staff variables, and intervention studies to reduce staff high EE. The available evidence suggests that the Camberwell Family Interview is an acceptable measure of EE in staff-patient relationships, although the Five Minute Speech Sample may provide a less resource intensive alternative. However, in contrast to familial research, neither the EE status on the Camberwell Family Interview nor the Five Minute Speech Sample show a robust relationship with outcomes. The presence or absence of a positive staff-patient relationship may have more predictive validity in this group. There is relatively consistent evidence of associations between staff criticism and poorer patient social functioning. Consistent with findings in familial research, staff attributions may play a key role in driving critical responses, and it may be possible to reduce staff high EE by modifying negative appraisals.     

Oxytocin,Dopamine, and the Amygdala: A Neurofunctional Model of Social Cognitive Deficits in Schizophrenia

Until recently, the social cognitive impairment in schizophrenia has been underappreciated and remains essentially untreated. Deficits in emotional processing, social perception and knowledge, theory of mind, and attributional bias may contribute to functional social cognitive impairments in schizophrenia. The amygdala has been implicated as a key component of social cognitive circuitry in both animal and human studies. In addition, structural and functional studies of schizophrenia reproducibly demonstrate abnormalities in the amygdala and dopaminergic signaling. Finally, the neurohormone oxytocin plays an important role in multiple social behaviors in several mammals, including humans. We propose a model of social cognitive dysfunction in schizophrenia and discuss its therapeutic implications. The model comprises abnormalities in oxytocinergic and dopaminergic signaling in the amygdala that result in impaired emotional salience processing with consequent social cognitive deficits.     

Cognitive behaviour therapy with coping training for persistent auditory hallucinations in schizophrenia: a naturalistic follow-up study of the durability of effects

OBJECTIVE: To investigate the durability of positive effects of cognitive behaviour therapy (CBT) with coping training on psychotic symptoms and social functioning. Method: Forty patients with schizophrenia or related psychotic disorders and refractory auditory hallucinations were given CBT and coping training in an integrated single family treatment programme. In a naturalistic study patients were followed after 2 and 4 years since the start of treatment. RESULTS: The treatment improved overall burden of 'hearing voices', with a generalization into daily functioning. Improvement with regard to fear, loss of control, disturbance of thought and interference with thinking was sustained by 60% of the patients while one-third improved further. Complete disappearance of hallucinations occurred in 18% of the patients. CONCLUSION: CBT with coping training can improve both overall symptomatology and quality of life, even over longer periods of time, but a status of persistent disablement indicates a continuing need for mental health care.