Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis

Abstract Neurocognitive deficits are associated with impaired global functioning and psychotic symptoms. However, whether symptoms can mediate the relationship between neurocognition and global functioning in adolescent psychosis is unclear. Here, we investigated if symptoms assessed with the Positive And Negative Syndrome Scale (PANSS), mediated the relationship between neurocognitive performance and global functioning in adolescents with non-affective early-onset psychotic disorders (EOP). Sixty-one adolescent EOP patients (age 12–18 years) from 2 Norwegian clinical cohorts were included. Linear regression models were applied to investigate associations between neurocognitive domains from the MATRICS Consensus Cognitive Battery (MCCB) and global functioning. PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. Using the INDIRECT macro for SPSS, mediation effects were tested using bootstrapping with 95% bias corrected confidence intervals. Verbal learning was positively associated with global functioning (P < 0.001) and negatively associated with the disorganized symptom factor (P = 0.002), controlling for age, sex and cohort. Testing of indirect effects, controlling for age, sex and cohort, showed that the Negative (point estimate = 1.56, 95% CI 0.22, 3.47) and Disorganized (point estimate = 1.24, 95% CI 0.05, 3.69) symptom factors significantly mediated the relationship between verbal learning and global functioning. We found that verbal learning, negative and disorganized symptoms influenced global functioning in adolescents with EOP, while reality-distorted positive symptoms did not. These results suggest that assessing these domains in EOP is helpful for planning treatment and rehabilitation programs focusing on functional outcome.

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Can the ‘mediation’ approach help to understand the role of lack of insight in the relationship between symptoms and functioning in schizophrenia?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1634 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s832-s832

Author(s):

R. Rossi ◽

V. Santarelli ◽

C. Marucci ◽

G. Pizziconi ◽

F. Pacitti

Keyword(s):

Factor Model ◽

Five Factor Model ◽

Psychotic Symptoms ◽

Global Assessment Of Functioning ◽

Global Functioning ◽

Mediation Analyses ◽

Competing Interest ◽

The One ◽

The Relationship

IntroductionThe relationship between Lack of insight (LoI) and other symptoms in schizophrenia is complex. LoI could be associated with severity of symptoms at one side and global functioning at the other. For this nature LoI is a candidate ‘mediator’ for the relationship between psychotic symptoms and global functioning.ObjectivesThe aim of this study is to explore the possible role of LoI as a mediator between psychotic symptoms and global functioning in a sample of people with schizophrenia.MethodsSeventy-three patients with a diagnosis of schizophrenia were included. The five-factor model of the PANSS by Wall work was used to assess psychopathology and G12 item as an estimate of LoI. Global assessment of functioning (GAF) was used to measure global disability. Pearson's r correlations and linear regressions for Sobel test for mediation were performed. PANSS factors were modeled as predictors of global functioning and LoI as the mediator.ResultsCorrelations revealed the prerequisite relationships between LoI, positive, negative and disorganized PANSS factors and global functioning. Mediation analyses show that LoI partially mediates the relationship between positive and disorganized factor scores and global functioning. No mediation for negative factor score was observed.ConclusionsLack of insight mediates the relationships between positive and disorganized factors and global functioning. The partial mediation we report suggests that LoI on the one hand is an independent contributor to global function, but further shows an indirect effect of PANSS positive and disorganized factors to GAF total score.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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M176. INTESTINAL PERMEABILITY AND LOW-GRADE CHRONIC INFLAMMATION IN SCHIZOPHRENIA: DO THEY INFLUENCE COGNITION AND COGNITIVE RESERVE?

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.488 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S203-S204

Author(s):

Gerard Anmella ◽

Silvia Amoretti ◽

Miqueu Alfonso ◽

Oriol Cuñat ◽

Gemma Safont ◽

...

Keyword(s):

Chronic Inflammation ◽

Mediterranean Diet ◽

Intestinal Permeability ◽

Cognitive Reserve ◽

Psychotic Disorders ◽

Verbal Learning ◽

Psychotic Symptoms ◽

First Episode ◽

Low Grade ◽

Cross Sectional

Abstract Background Higher intestinal-permeability is known to cause low-grade chronic inflammation, which seems to participate in the development and worsening of psychotic disorders both in first-episode psychosis (FEP) and schizophrenia (SCZ) patients. Moreover, in psychotic disorders, inflammation has been linked to cognition and cognitive reserve (CR). The aim of this study is to assess the relation between intestinal-permeability, low-grade chronic inflammation, cognition and cognitive reserve in psychotic disorders. Methods Observational, cross-sectional and multisite study including four centers in Spain (Grant from Fondo de Investigación Sanitaria, PI17/00246). A total of 500 adult patients with DSM-5 SCZ-spectrum disorder at any stage of the disease were recruited. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Disease severity was assessed using the Clinical Global Impression (CGI) scale and functioning was assessed using the Global Assessment of Functioning (GAF) scale. The intestinal-permeability was estimated with the “Permeable-Intestine-syndrome questionnaire”. The diet was assessed with the “Mediterranean-diet-adherence questionnaire”. Exercise was measured with the “International Physical Activity Questionnaire (IPAQ)”. Cognition was measured with the SCIP-S scale. CR was assessed with the Cognitive Reserve Assessment Scale in Health (CRASH), which is a scale developed to measure CR specifically for patients with severe mental illness. Correlations between CRASH scores and the remainder variables were performed. Results For the present study we included only the subjects who had CRASH score, a total of 112 patients, 42.7% female, aged 40.61±12.4 (mean±SD). Substance use was present in 44.3%. The CRASH score was 33.30±15.72 (mean±SD) and was associated with negative (but not positive) psychotic symptoms assessed by PANSS (PANSS negative; rp=-3.98; p=0.001, PANSS general; rp=-2.13; p=0.038, GAF; rp=0.410; p<0.0001, CGI; rp=-0.30; p=0.002, IPAQ; rs=0.224; p=0.025 and the permeability-scale; rs=-0.266; p=0.008. All cognitive domains (assessed by SCIP-S) were associated to CRASH: verbal learning immediate (rp=0.584; p<0.0001) and differed (rp=0.515; p<0.0001), working memory (rp=0.539; p<0.0001), verbal fluency (rs=0.485; p<0.0001) and processing speed (rp=0.584; p<0.0001). No significant associations were found with Mediterranean-diet scale (rs=0.195; p=0.056), IMC (rs=-0.192; p=0.063), C-reactive protein (rs=-0.104; p=0.278) and the IPAQ-resting scale and permeability-scale (rs=0.119; p=0.244). Discussion

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Age at onset and outcome in schizophrenia are related to the degree of familial loading

The British Journal of Psychiatry ◽

10.1192/bjp.173.6.494 ◽

1998 ◽

Vol 173 (6) ◽

pp. 494-500 ◽

Cited By ~ 66

Author(s):

Jaana M. Suvisaari ◽

Jari Haukka ◽

Antti Tanskanen ◽

Jouko K. Lönnqvist

Keyword(s):

Mixed Models ◽

Early Onset ◽

Disability Pension ◽

Psychotic Disorders ◽

Age At Onset ◽

Cox Proportional Hazard Model ◽

Proportional Hazard ◽

Proportional Hazard Model ◽

Cox Proportional Hazard ◽

The Relationship

BackgroundRecent research suggests that high familial loading is associated with early onset of schizophrenia. Results concerning outcome have been controversial.MethodWe assessed the relationship between familial loading, age at onset and outcome in all Finnish patients with schizophrenia born between 1950 and 1969. Patients and their first-degree relatives were identified using nationwide registers. Familial loading scores were calculated for schizophrenia and for combined psychotic disorders, and patients were accordingly classified into three groups: high (n = 761), intermediate (n = 14 247), and low familial loading (n = 725). Linear mixed models and the Cox proportional hazard model were used in the analyses.ResultsOnset was earliest, hospitalisation longest and risk of retirement in receipt of a disability pension highest in the group with high familial loading, with opposite extremes found in the group with low familial loading.ConclusionsHigh familial loading for schizophrenia is associated with early onset and poor outcome of schizophrenia.

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Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders

Psychological Medicine ◽

10.1017/s0033291717000848 ◽

2017 ◽

Vol 47 (13) ◽

pp. 2323-2333 ◽

Cited By ~ 11

Author(s):

T. Østefjells ◽

J. U. Lystad ◽

A. O. Berg ◽

R. Hagen ◽

R. Loewy ◽

...

Keyword(s):

Emotional Abuse ◽

Psychotic Disorders ◽

Bipolar Disorders ◽

Ordinary Least Squares ◽

Psychotic Symptoms ◽

Positive Symptoms ◽

Moderate Amount ◽

Metacognitive Beliefs ◽

Early Trauma ◽

The Relationship

BackgroundEarly trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.MethodPatients (N= 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.ResultsMetacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R2= 0.21–0.29).ConclusionOur results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.

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Cognitive impairment as a risk factor for psychosis

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2005.7.1/areichenberg ◽

2005 ◽

Vol 7 (1) ◽

pp. 31-38 ◽

Cited By ~ 1

Keyword(s):

Risk Factor ◽

Cognitive Impairment ◽

Cognitive Functioning ◽

Brain Function ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Epidemiological Studies ◽

Psychotic Symptoms ◽

Future Research ◽

The Relationship

Since the time of Kraepelin and Bleuler, it has been recognized that schizophrenia is associated with a profound and persistent cognitive impairment. This paper reviews the major clinical and epidemiological studies of cognitive functioning in schizophrenia and other psychotic disorders, and presents several possible models to explain the association between cognitive impairment and psychosis. Cognitive impairment is present in the majority of patients with schizophrenia, and, in some, it is already evident in the premorbid stages of the disorder. This cognitive impairment is not secondary to psychotic symptoms, negative symptoms, or socioeconomic status. Cognitive impairment can also be observed in nonpsychotic family members of psychotic patients. On the basis of this evidence, it has been proposed that abnormal cognitive functioning can be considered as a possible causal risk factor for psychosis. Recent studies assessing the relationship between genetic background, cognition, brain function, and schizophrenia are presented here as an outline for future research.

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Meditation-induced psychosis: a narrative review and individual patient data analysis

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2019.47 ◽

2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Pawan Sharma ◽

Ananya Mahapatra ◽

Rishab Gupta

Keyword(s):

English Language ◽

Psychotic Disorders ◽

Case Reports ◽

Psychotic Symptoms ◽

Clinical Settings ◽

Equal Distribution ◽

Meditative Practice ◽

History Of ◽

Age Range ◽

The Relationship

Background: Meditation is associated with health benefits; however, there are reports that it may trigger or exacerbate psychotic states. In this review, we aim to collate case reports of psychotic disorders occurring in association with meditative practice and to discuss the relationship between psychosis and meditation. Methodology: We performed case-based analysis of all the existing studies published in English language using PubMed, PsycINFO, Cochrane, Scopus, EMBASE, CINAHL and Google Scholar with the search terms; ‘Psychosis’ OR ‘Psychotic Symptoms’ OR ‘Schizophrenia’ AND ‘Meditation.’ Results: A total of 19 studies and 28 cases were included in the review. The patients described had an age range of 18–57 years; there was equal distribution of males and females. The diagnoses included acute psychosis in 14 cases, schizophrenia in 7 cases, mania with psychotic symptoms in 3 cases, and schizoaffective disorder in 1 case. The types of meditation described were Transcendent, Mindfulness, Buddhist Meditation like Qigong, Zen, and Theraveda, and others like Bikram yoga, Pranic Healing, and Hindustan Type meditation. Of the 28 cases reported, 14 patients had certain precipitating factors like insomnia, lack of food intake, history of mental illness, stress, and psychoactive substance use. Conclusion: There are case reports of psychotic disorder arising in association with meditative practice; however, it is difficult to attribute a causal relationship between the two. At the same time, there is a body of research describing the beneficial effect of meditative practice in clinical settings for patients with psychotic disorders. Appropriately designed studies are needed to further investigate the relationship between meditative practice and psychosis.

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Neuropsychological evidence for abnormal neurodevelopment associated with early-onset psychoses

Psychological Medicine ◽

10.1017/s0033291712001535 ◽

2012 ◽

Vol 43 (4) ◽

pp. 757-768 ◽

Cited By ~ 37

Author(s):

I. Bombin ◽

M. Mayoral ◽

J. Castro-Fornieles ◽

A. Gonzalez-Pinto ◽

E. de la Serna ◽

...

Keyword(s):

Working Memory ◽

Cognitive Impairment ◽

Cognitive Development ◽

Psychotic Symptom ◽

Early Onset ◽

Healthy Subjects ◽

Psychotic Disorders ◽

Brain Maturation ◽

Psychotic Symptoms ◽

First Episode

BackgroundThe longitudinal neuropsychological study of first-episode early-onset psychosis (EOP) patients, whose brain maturation is still in progress at the time of illness onset, provides a unique opportunity to compare their cognitive development with that of healthy subjects, in search of specific patterns resulting from the interaction between neurodevelopmental processes and the presence of psychotic disorders.MethodSeventy-five first-episode EOP patients (schizophrenia n = 35; bipolar disorder n = 17; other forms of psychosis n = 23) with a mean age of 15.53 years were assessed with a neuropsychological battery that included measures of attention, working memory, memory and executive functions within 6 months following the onset of the first psychotic symptom (baseline) and 2 years later. Psychotic symptoms were assessed at both times with the Positive and Negative Symptom Scale (PANSS). Seventy-nine healthy subjects matched for age and education served as controls.ResultsEOP patients showed significant cognitive impairment at both baseline and the 2-year follow-up, with no significant differences between diagnostic groups at either time. Both healthy controls and EOP patients improved in all cognitive measures, except for patient working memory. Improvement in patient attention lost significance after controlling for psychotic symptom reduction. No significant time/diagnosis interaction was found among patients (p > 0.405).ConclusionsCognitive impairment in EOP is already present at the first episode, and cognitive development seems to be arrested early in EOP patients compared to their healthy peers, at least for some cognitive functions. These and previous similar results support the neurodevelopmental hypothesis of psychosis.

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Duration of untreated psychosis: a critical examination of the concept and its importance

Psychological Medicine ◽

10.1017/s0033291701003488 ◽

2001 ◽

Vol 31 (3) ◽

pp. 381-400 ◽

Cited By ~ 282

Author(s):

ROSS M. G. NORMAN ◽

ASHOK K. MALLA

Keyword(s):

Treatment Outcome ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

First Episode ◽

Critical Examination ◽

Duration Of Untreated Psychosis ◽

Relationship Of ◽

The Relationship

Background. The concept of duration of untreated psychosis (DUP) has recently attracted much interest because of its possible relationship to treatment outcome and implications for preventive efforts with reference to psychotic disorders, especially schizophrenia. In this paper we review critically the literature concerning the concept and its importance.Methods. Articles concerned with measuring DUP and those that have been suggested to provide indirect or direct evidence of the effect of DUP on treatment outcome are reviewed.Results. Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse. There has been little investigation of the relationship of DUP to other long-term outcomes such as negative symptoms and cognitive functioning neither have the possible confounds of DUP been widely investigated or controlled.Conclusions. It is important that there should be more thorough investigations of DUP, its correlates, and the extent to which it does mediate any advantages of earlier intervention.

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Relationship between heart rate variability and the severity of psychotic symptoms in schizophrenia

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2011.00549.x ◽

2011 ◽

Vol 23 (4) ◽

pp. 161-166 ◽

Cited By ~ 10

Author(s):

Jong-Hoon Kim ◽

Jun-Hyung Ann ◽

Jinyoung Lee

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Patient Group ◽

Factor Model ◽

Spectral Power ◽

Five Factor Model ◽

Approximate Entropy ◽

Psychotic Symptoms ◽

Symptom Dimensions ◽

The Relationship

Kim J-H, Ann J-H, Lee J. Relationship between heart rate variability and the severity of psychotic symptoms in schizophrenia.Objective: The relationship between autonomic neurocardiac function and schizophrenia remains elusive. This study investigated the relationship between the heart rate variability (HRV) parameters and the severity of psychotic symptoms in schizophrenic patients.Methods: Twenty-one patients receiving risperidone monotherapy and 21 matched normal control subjects were evaluated for HRV analysis. The severity of schizophrenic symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) and a five-factor model of the PANSS was used.Results: The value of the ratio of low-to-high frequency spectral power was significantly higher in the patient group. The patient group also showed a significantly lower value of approximate entropy. After controlling the dosage of risperidone, the PANSS total score had significant negative correlations with the standard deviation of all RR intervals (SDNN) and the square root of the mean squared differences of successive normal sinus intervals (RMSSD). With respect to the PANSS factors, the score of the PANSS cognitive/disorganisation factor had significant negative correlations with SDNN and RMSSD.Conclusion: These results provide some evidence that the severity of psychotic symptoms, especially cognitive/disorganisation symptom dimensions, may be associated with reduced HRV, suggesting a potential involvement of neuroautonomic dysfunction in the pathophysiology of specific symptoms of schizophrenia.

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Aberrant uncertainty processing is linked to psychotic-like experiences, autistic traits and reflected in pupil dilation

10.31219/osf.io/nc2rx ◽

2020 ◽

Author(s):

Isabel Kreis ◽

Lei Zhang ◽

Matthias Mittner ◽

Leonard Syla ◽

Claus Lamm ◽

...

Keyword(s):

Psychotic Disorders ◽

Computational Modelling ◽

Autistic Traits ◽

Learning Task ◽

Pupil Dilation ◽

Psychotic Symptoms ◽

Belief Updating ◽

The World ◽

Healthy Sample ◽

The Relationship

Misestimation of uncertainty and an increased perception of the world as volatile (i.e. unstable) have been linked to aberrant belief updating in autism and psychotic disorders. Pupil dilation tracks belief updating and volatility, but studies linking pupillometric data to autistic- or psychotic-like symptoms are scarce. Here we investigated the relationship between behavioral and pupillometric markers of subjective volatility (i.e. experience of the world as unstable), psychotic-like experiences, and autistic traits in a healthy sample with a probabilistic reversal learning task. Computational modelling revealed that participants with high psychotic-like experience scores overestimated volatility in low-volatile task periods and showed a decreased pupil response to stimuli that urged belief updating. For autistic-like traits, behavioral results indicated a reduced ability to differentiate between high- and low-risk trials. These findings provide new insights into the relationship between misestimation of uncertainties and autistic and psychotic symptoms.

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