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Item 50 Years Ago in The Journal of Pediatrics: The Role of Marihuana in Patterns of Drug Abuse by Adolescents(Elsevier, 2019-02) Ferrin, Stephanie N.; Ott, Mary A.; Pediatrics, School of MedicineItem Addressing Formal Thought Disorder in Psychosis through Novel Assessment and Targeted Intervention(2020-08) Marggraf, Matthew P.; Minor, Kyle; Salyers, Michelle; Lysaker, Paul; Stewart, JesseFormal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD.Item Characterization of white matter abnormalities in early-stage schizophrenia(Wiley, 2016) Hummer, Tom A.; Francis, Michael M.; Vohs, Jenifer L.; Liffick, Emily; Mehdiyoun, Nicole F.; Breier, Alan; Department of Psychiatry, IU School of MedicineAim White matter abnormalities have been reported in schizophrenia and may indicate altered cortical network integrity and structural connectivity, which have been hypothesized as key pathophysiological components of this illness. In this study, we aimed to further characterize the nature and progression of white matter alterations during the early stages of the disorder. Methods We employed diffusion tensor imaging (DTI) approaches to investigate fractional anisotropy (FA), radial diffusivity (RD) and axial diffusivity (AD) in 40 patients with schizophrenia and related psychotic disorders (aged 18–30 years) who were within 5 years of illness, along with an age-, sex- and race-matched sample of 21 healthy controls. Relationships with illness duration, lifetime antipsychotic medication exposure and symptom levels were examined. Results Patients had lower FA and higher RD than controls in numerous white matter tracts, including the corpus callosum (CC) and the superior longitudinal fasciculus. Illness duration was associated with lower FA and higher RD, most prominently in the CC. No group differences or relationships to illness duration were detected with AD, and no relationships between any DTI measurements and lifetime antipsychotic medication use were found. Conclusions This investigation provides evidence of widespread disruptions to structural connectivity in the early stages of schizophrenia. The relationship to illness duration, coupled with an absence of relationships to AD or antipsychotic drug exposure, provides evidence of a progressive disease process, although prospective assessments with repeated DTI measurements are needed to fully characterize the trajectory of white matter abnormalities in this illness.Item Contrasting metacognitive profiles and their association with negative symptoms in groups with schizophrenia, early psychosis and depression in a Russian sample(Elsevier, 2020-09) Lysaker, Paul H.; Chernov, Nikita; Moiseeva, Tatyana; Sozinova, Marta; Dmitryeva, Nadezhda; Alyoshin, Vitaliy; Faith, Laura A.; Karpenko, Olga; Kostyuk, Georgiy; Psychiatry, School of MedicineResearch has suggested that negative symptoms in psychotic disorders may be in part fueled by deficits in metacognition or the ability to form integrated ideas about oneself and others. One limitation of this work is that it has largely come from North America and Western Europe. To further the literature, we assessed symptoms using the Positive and Negative Syndrome Scale and Metacognition using the Metacognitive Assessment Scale - Abbreviated in a sample of outpatients with prolonged schizophrenia (n = 41), early episode psychosis (n = 37) and major depression (n = 30) gathered in Moscow, Russia. Verbal memory was assessed for use as a potential covariate. ANOVA revealed the two groups with psychosis had significantly poorer metacognitive function in terms of self-reflectivity and awareness of the other, than the group with depression. In both psychosis groups negative symptoms were more robustly related to metacognition than other forms of symptoms after controlling for neurocognition. Results support the possibility that metacognitive deficits are a psychological factor which cross culturally contributes to negative symptoms and point to metacognition as a potentially important target for intervention.Item Essential Components of Early Intervention Programs for Psychosis: Available Intervention Services in the United States(Elsevier, 2015-10) White, Dominique A.; Luther, Lauren; Bonfils, Kelsey A.; Salyers, Michelle P.; Department of Psychology, School of SciencePrograms providing interventions for early psychosis are becoming commonplace in the United States (U.S.); however, the characteristics of existing services remain undocumented. We examined program characteristics, clinical services, and program eligibility criteria for outpatient early intervention programs across the U.S. using a semi-structured telephone interview. Content analysis was used to identify the presence or absence of program components, based in part on a recent list of essential evidence-based components recommended for early intervention programs (Addington, MacKenzie, Norman, Wang and Bond, 2013) as well as program characteristics, including eligibility criteria. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the examined components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The populations served by US programs were most frequently defined by restrictions on the duration of psychosis and age. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for future improvement.Item Interpretation, emotional reactions and daily life implications of hallucination-like experiences in clinical and nonclinical populations(2015) Langer, Álvaro I.; Stanghellini, Giovanni; Cangas, Adolfo J.; Lysaker, Paul H.; Nieto-Muñoz, Luz; Moriana, Juan A.; Barrigón, María L.; Ambrosini, Alessandra; Department of Psychiatry, IU School of MedicineBackground: Research on Hallucination-Like Experiences (HLEs) has not yet explored whether people without psychosis who have HLEs attribute the same level of significance to them. This significance includes whether or not the HLEs elicit similar emotional reactions in people with and without psychosis, or if the HLEs occur in same context between the two groups. The objective of this study was to compare the characteristics of these experiences in a non-clinical group and a clinical group of patients with schizophrenia and schizophrenia spectrum disorders. Method: Both groups were evaluated to determine the prevalence of HLEs. After the evaluation, they were interviewed about the characteristics of these experiences. Results: Both groups sought to actively eliminate the HLEs, could identify the presence of a trigger factor, and experienced little perceived control. However, HLEs elicited more anxiety, discomfort and interference in daily life in the clinical group than in the non-clinical group. Furthermore, the clinical group members defined their hallucinations more negatively and were reported to have experienced them under stressful events. Conclusions: These findings suggest that the two experiences are not entirely equivalent, especially when taking into account the emotional reaction produced by these experiences and the meaning people attach to them.Item A meta-analytic review of self-reported, clinician-rated, and performance-based motivation measures in schizophrenia: Are we measuring the same “stuff”?(Elsevier, 2018) Luther, Lauren; Firmin, Ruth L.; Lysaker, Paul H.; Minor, Kyle S.; Salyers, Michelle P.; Psychiatry, School of MedicineAn array of self-reported, clinician-rated, and performance-based measures has been used to assess motivation in schizophrenia; however, the convergent validity evidence for these motivation assessment methods is mixed. The current study is a series of meta-analyses that summarized the relationship between methods of motivation measurement in 45 studies of people with schizophrenia. The overall mean effect size between self-reported and clinician-rated motivation measures (r = 0.27, k = 33) was significant, positive, and approaching medium in magnitude, and the overall effect size between performance-based and clinician-rated motivation measures (r = 0.21, k = 11) was positive, significant, and small in magnitude. The overall mean effect size between self-reported and performance-based motivation measures was negligible and non-significant (r = −0.001, k = 2), but this meta-analysis was underpowered. Findings suggest modest convergent validity between clinician-rated and both self-reported and performance-based motivation measures, but additional work is needed to clarify the convergent validity between self-reported and performance-based measures. Further, there is likely more variability than similarity in the underlying construct that is being assessed across the three methods, particularly between the performance-based and other motivation measurement types. These motivation assessment methods should not be used interchangeably, and measures should be more precisely described as the specific motivational construct or domain they are capturing.Item Metacognitive mastery in persons with first-episode psychosis and their caregivers: Implications for timely help-seeking and caregiver experiences. Brief report(Elsevier, 2017-05) Jansen, Jens Einar; Lysaker, Paul H.; Trauelsen, Anne Marie; Luther, Lauren; Haahr, Ulrik Helt; Lyse, Hanne-Grethe; Pederson, Marlene Buch; Simonsen, Erik; Department of Psychiatry, IU School of MedicineWhile metacognitive mastery seems to be closely linked to general functioning in persons with psychosis, little is known of metacognitive capacity of family members, who often play an important role in recovery and often report high levels of distress. We gathered assessments of metacognitive mastery from persons with first-episode psychosis and their mothers. We found that relatively higher overall mean mastery levels among the dyads, was related to less negative caregiver experiences, and less caregiver criticism. Greater levels of mastery were related to decreased duration of untreated psychosis. Clinical implications in terms of family intervention programmes repertoire are discussed.