Browsing by Subject "Psychotic disorders"
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Item Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia- Spectrum Disorders: Relationship to Metacognitive Deficits(Oxford University Press, 2021-07-20) Mervis, Joshua E.; Bonfils, Kelsey A.; Cooper, Samuel E.; Wiesepape, Courtney; Lysaker, Paul H.; Psychiatry, School of MedicinePeople diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.Item Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure(Oxford University Press, 2023) Abel, Danielle B.; Rand, Kevin L.; Salyers, Michelle P.; Myers, Evan J.; Mickens, Jessica L.; Minor, Kyle S.; Psychology, School of ScienceBackground: The "emotion paradox" of schizophrenia suggests people with schizophrenia demonstrate deficits when reporting anticipated and retrospective pleasure; yet, in-the-moment, consummatory pleasure is largely intact. It is uncertain how these findings extend to social situations. This meta-analysis aimed to (1) determine the mean difference in consummatory social pleasure between people with schizophrenia and healthy controls, and (2) examine moderators of this effect, including study design and clinical characteristics of participants. Design: A literature search using PsycINFO, Web of Science, Pubmed, and EMBASE databases was conducted. Studies measuring consummatory social pleasure using experience sampling methods and laboratory social simulations were included. Random effects meta-analyses were conducted using Hedge's g. Results: Meta-analysis of 26 studies suggests people with schizophrenia exhibited a small, significant deficit in consummatory social pleasure (g = -0.38, 90% CI [-0.53, -0.22]). There was significant heterogeneity in effect sizes; magnitude was moderated by study design and type of measure used to assess social pleasure. Conclusions: Overall, people with schizophrenia seem to exhibit less consummatory social pleasure than controls. However, this deficit is smaller than in studies of anticipated and retrospective pleasure. Thus, consummatory social pleasure may not be quite as impaired in people with schizophrenia as traditional anhedonia research suggests. Moreover, pleasure deficits observed in people with schizophrenia may result from differences in the quality of their daily social experiences rather than differences in their capacity for social pleasure. Results have important implications for clinical interventions that address barriers to social engagement, low-pleasure beliefs, and cognitive remediation to treat schizophrenia.Item Genome-wide association identifies the first risk loci for psychosis in Alzheimer disease(Springer Nature, 2021) DeMichele-Sweet, Mary Ann A.; Klei, Lambertus; Creese, Byron; Harwood, Janet C.; Weamer, Elise A.; McClain, Lora; Sims, Rebecca; Hernandez, Isabel; Moreno-Grau, Sonia; Tárraga, Lluís; Boada, Mercè; Alarcón-Martín, Emilio; Valero, Sergi; NIA-LOAD Family Based Study Consortium; Alzheimer’s Disease Genetics Consortium (ADGC); Liu, Yushi; Hooli, Basavaraj; Aarsland, Dag; Selbaek, Geir; Bergh, Sverre; Rongve, Arvid; Saltvedt, Ingvild; Skjellegrind, Håvard K.; Engdahl, Bo; Stordal, Eystein; Andreassen, Ole A.; Djurovic, Srdjan; Athanasiu, Lavinia; Seripa, Davide; Borroni, Barbara; Albani, Diego; Forloni, Gianluigi; Mecocci, Patrizia; Serretti, Alessandro; De Ronchi, Diana; Politis, Antonis; Williams, Julie; Mayeux, Richard; Foroud, Tatiana; Ruiz, Agustín; Ballard, Clive; Holmans, Peter; Lopez, Oscar L.; Kamboh, M. Ilyas; Devlin, Bernie; Sweet, Robert A.; Medical and Molecular Genetics, School of MedicinePsychotic symptoms, defined as the occurrence of delusions or hallucinations, are frequent in Alzheimer disease (AD with psychosis, AD + P). AD + P affects ~50% of individuals with AD, identifies a subgroup with poor outcomes, and is associated with a greater degree of cognitive impairment and depressive symptoms, compared to subjects without psychosis (AD - P). Although the estimated heritability of AD + P is 61%, genetic sources of risk are unknown. We report a genome-wide meta-analysis of 12,317 AD subjects, 5445 AD + P. Results showed common genetic variation accounted for a significant portion of heritability. Two loci, one in ENPP6 (rs9994623, O.R. (95%CI) 1.16 (1.10, 1.22), p = 1.26 × 10-8) and one spanning the 3'-UTR of an alternatively spliced transcript of SUMF1 (rs201109606, O.R. 0.65 (0.56-0.76), p = 3.24 × 10-8), had genome-wide significant associations with AD + P. Gene-based analysis identified a significant association with APOE, due to the APOE risk haplotype ε4. AD + P demonstrated negative genetic correlations with cognitive and educational attainment and positive genetic correlation with depressive symptoms. We previously observed a negative genetic correlation with schizophrenia; instead, we now found a stronger negative correlation with the related phenotype of bipolar disorder. Analysis of polygenic risk scores supported this genetic correlation and documented a positive genetic correlation with risk variation for AD, beyond the effect of ε4. We also document a small set of SNPs likely to affect risk for AD + P and AD or schizophrenia. These findings provide the first unbiased identification of the association of psychosis in AD with common genetic variation and provide insights into its genetic architecture.Item Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation(BMJ, 2022-05-30) Eliacin, Johanne; Carter, Jessica; Bass, Emily; Flanagan, Mindy; Salyers, Michelle P.; McGuire, Alan; Psychiatry, School of MedicineObjectives: To examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units. Design: VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient Scale (RAIN). Scores on the RAIN item for medication SDM were used to rank each site from lowest to highest. The top 7 and bottom 8 sites (n=15) were selected for additional analyses using a mixed-methods approach, involving qualitative interviews, observation notes and quantitative data. Setting: 34 VHA inpatient mental health units located in every geographical region of the USA. Participants: 55 treatment team members. Results: Our results identified an overarching theme of 'power-sharing' that describes participants' conceptualisation and practice of medication decision-making. Three levels of power sharing emerged from both interview and observational data: (1) No power sharing: patients are excluded from treatment decisions; (2) Limited power sharing: patients are informed of treatment decisions but have limited influence on the decision-making process; and (3) Shared-power: patients and providers work collaboratively and contribute to medication decisions. Comparing interview to observational data, only observational data indicating those themes differentiate top from bottom scoring sites on the RAIN SDM item scores. All but one top scoring sites indicated shared power medication decision processes, whereas bottom sites reflected mostly no power sharing. Additionally, our findings highlight three key factors that facilitate the implementation of SDM: inclusion of veteran in treatment teams, patient education and respect for patient autonomy. Conclusions: Implementation of SDM appears feasible in acute inpatient mental health units. Although most participants were well informed about SDM, that knowledge did not always translate into practice, which supports the need for ongoing implementation support for SDM. Additional contextual factors underscore the value of patients' self-determination as a guiding principle for SDM, highlighting the role of a supporting, empowering and autonomy-generating environment.Item Investigating Cerebellar Neural Function in Schizophrenia Using Delay Eyeblink Conditioning: A Pilot fMRI Study(Elsevier, 2020) Kent, Jerillyn S.; Kim, Dae-Jin; Newman, Sharlene D.; Bolbecker, Amanda R.; O’Donnell, Brian F.; Hetrick, William P.; Psychiatry, School of MedicineThere is accruing evidence of cerebellar abnormalities in individuals with schizophrenia as measured by performance on a variety of tasks believed to be dependent on cerebellar integrity, including delay eyeblink conditioning. There is also evidence of cerebellar dysfunction on a neural level in schizophrenia from both task-based and resting state neuroimaging studies, however few studies have examined cerebellar neural function while the cerebellum is directly recruited in individuals with schizophrenia. In the current pilot study, we examined neural activity during an explicitly cerebellar task in individuals with schizophrenia or schizoaffective disorder and non-psychiatric controls. Participants underwent delay eyeblink conditioning during fMRI. Results indicated eyeblink conditioning impairment in patients as evidenced by a group by time interaction for conditioned responses. A significant cluster of cerebellar activation was present in controls but not patients during the first half of conditioning; there were no significant differences in activation between groups. An ROI analysis focused on the cerebellum in patients revealed two significant clusters that were inversely associated with negative symptom severity. These results are broadly consistent with the theory of cognitive dysmetria, wherein cerebellar abnormalities are theorized to contribute to motor as well as cognitive and affective disturbances in schizophrenia.Item Metacognitive Beliefs and Metacognitive Capacity: Do They Assess Related Phenomena?(Wolters Kluwer, 2023) Ayala, Alexandra; Mickens, Jessica L.; Myers, Evan J.; Abel, Danielle B.; Hegwood, Ceouna M.; Davis, Beshaun J.; Lysaker, Paul H.; Minor, Kyle S.; Psychology, School of ScienceMetacognition has been defined several ways across different fields. In schizophrenia, two primary approaches to assessing metacognition focus on measuring metacognitive beliefs and metacognitive capacity. The degree of association between these two approaches is unclear. In this pilot study, schizophrenia (n = 39) and control groups (n = 46) were assessed using metacognitive beliefs (Metacognition Questionnaire-30) and metacognitive capacity (Metacognition Assessment Scale-Abbreviated) scales. We also examined how these two approaches predicted quality of life. Results showed anticipated differences for metacognitive beliefs, metacognitive capacity, and quality of life when comparing schizophrenia and healthy control groups. However, metacognitive beliefs and metacognitive capacity were not significantly related and only predicted quality of life in the healthy control group. Although preliminary, these findings suggest these two approaches have a limited relationship with one another. Future studies should test these findings in larger samples and focus on examining associations at different levels of metacognitive functioning in those with schizophrenia.Item PSYCHOSIS IN HINDSIGHT: A COLLECTIVE RECOLLECTION OF THE ONSET OF PSYCHOSIS(Office of the Vice Chancellor for Research, 2012-04-13) Francis, Michael M.; Liffick, Emily C.; Mehdiyoun, Nicole F.; Radnovich, Alexander; Breier, AlanPsychotic disorders cause marked cognitive, perceptual, and social impairments and may lead to significant disability. Those affected with these illnesses may have great difficulty in educational, occupational, and social functioning; especially troubling is the fact that these illness often strike when those afflicted should be entering into some of the most productive years of their lives. The primary purpose of this study is to ascertain the perspective of subjects with psychotic disorders on the mental health system and treatment, stigmatization, social functioning, and symptom experience. This information will be of use in improving treatment engagement, compliance, and education of providers. Fifty subjects with nonaffective psychoses in each of two arms (new onset psychosis and chronic psychosis) will be enrolled and asked to complete a self-administered questionnaire. After subjects complete the questionnaire, investigators will review medical records to confirm subject age and diagnosis, compare subject report with symptomatology, and look for trends or topics of interest in comparing patient survey reports with medical records which may provide for useful insight upon further investigation.Item Stuck Inside: How Social Functioning in Schizophrenia Changed During the COVID-19 Pandemic(Wolters Kluwer, 2022) Minor, Kyle S.; Myers, Evan J.; Abel, Danielle B.; Mickens, Jessica L.; Ayala, Alexandra; Warren, Kiara K.; Vohs, Jenifer L.; Psychology, School of ScienceSocial distancing policies enacted during the COVID-19 pandemic altered our social interactions. People with schizophrenia, who already exhibit social deficits, may have been disproportionally impacted. In this pilot study, we a) compared prepandemic social functioning to functioning during the pandemic in people with schizophrenia ( n = 21) who had data at both time points; and b) examined if patterns of decline in schizophrenia differed from healthy controls ( n = 21) across a series of repeated-measures analyses of variance. We observed larger declines in social functioning in schizophrenia (η 2 = 0.07, medium effect size) during the pandemic compared with the control group. Between-group declines did not extend to other domains, suggesting that declines are specific to social functioning. Our findings signal that treatments focusing on reconnecting people with schizophrenia to their social networks should be prioritized. Future studies should continue tracking social functioning after the pandemic to illustrate patterns of recovery.