Theory of mind in the early course of schizophrenia: stability, symptom and neurocognitive correlates, and relationship with functioning

2015 ◽  
Vol 45 (10) ◽  
pp. 2031-2043 ◽  
Author(s):  
J. Ventura ◽  
A. Ered ◽  
D. Gretchen-Doorly ◽  
K. L. Subotnik ◽  
W. P. Horan ◽  
...  
Keyword(s):  
Theory Of Mind ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
First Episode ◽  
Positive Symptoms ◽  
Healthy Controls ◽  
Role Functioning ◽  
Recent Onset ◽  
Early Course ◽  
The Relationship

BackgroundNumerous studies have reported links between theory of mind (ToM) deficits, neurocognition and negative symptoms with functional outcome in chronic schizophrenia patients. Although the ToM deficit has been observed in first-episode patients, fewer studies have addressed ToM as a possible trait marker, neurocognitive and symptom correlations longitudinally, and associations with later functioning.MethodRecent-onset schizophrenia patients (n = 77) were assessed at baseline after reaching medication stabilization, and again at 6 months (n = 48). Healthy controls (n = 21) were screened, and demographically comparable with the patients. ToM was assessed with a Social Animations Task (SAT), in which the participants’ descriptions of scenes depicting abstract visual stimuli ‘interacting’ in three conditions (ToM, goal directed and random) were rated for degree of intentionality attributed to the figures and for appropriateness. Neurocognition, symptoms and role functioning were also assessed.ResultsOn the SAT, patients had lower scores than controls for both intentionality (p < 0.01) and appropriateness (p < 0.01) during the ToM condition, at baseline and 6 months. The ToM deficit was stable and present even in remitted patients. Analyses at baseline and 6 months indicated that for patients, ToM intentionality and appropriateness were significantly correlated with neurocognition, negative symptoms and role functioning. The relationship between ToM and role functioning was mediated by negative symptoms.ConclusionsThe ToM deficit was found in recent-onset schizophrenia patients and appears to be moderately trait-like. ToM is also moderately correlated with neurocognition, negative and positive symptoms, and role functioning. ToM appears to influence negative symptoms which in turn makes an impact on role functioning.

Toxic psychosis? Duration of untreated psychosis, symptomatology and cognitive deterioration in first episode psychosis

2007 ◽  
Vol 24 (4) ◽  
pp. 145-148 ◽  
Author(s):  
Richard Lawoyin ◽  
Keith Gaynor ◽  
Barbara Dooley ◽  
Elizabeth Lawlor ◽  
Mary Clarke ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Cognitive Deterioration ◽  
Duration Of Untreated Psychosis ◽  
Episode Psychosis ◽  
The Relationship ◽  
Linear Regressions ◽  
Positive And Negative Symptoms

AbstractObjectives: To examine the relationship between cognitive deficits, the duration of untreated psychosis (DUP) and positive and negative symptoms in a first episode psychosis sample.Method: We assessed a consecutive sample of first episode psychosis participants from a catchment area service with a comprehensive neuropsychology battery, a family and service-user based measure of DUP and measures of symptomatology.Results: Using correlations and stepwise linear regressions, we found strong relationships between measures of DUP and positive symptomatology. We found that positive and negative symptoms were associated with different time periods within DUP. However, we did not find evidence of a relationship between DUP and cognitive factors.Conclusions: There was no evidence of a relationship between DUP and cognitive deterioration. However, there does appear to be evidence of a relationship between positive symptoms and aspects of DUP. These results highlight the importance of the heterogeneity of DUP and the potential to reduce positive symptoms through early intervention.

scholarly journals Executive functioning in schizophrenia and the relationship with symptom profile and chronicity

2008 ◽  
Vol 14 (5) ◽  
pp. 782-792 ◽  
Author(s):  
KATHRYN E. GREENWOOD ◽  
ROBIN MORRIS ◽  
THORDUR SIGMUNDSSON ◽  
SABINE LANDAU ◽  
TIL WYKES
Keyword(s):  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
First Episode ◽  
Executive Processes ◽  
Process Measures ◽  
Symptom Profile ◽  
Executive Process ◽  
Executive Impairment ◽  
The Relationship ◽  
Symptom Type

This study reports the executive function profile in people with schizophrenia, with a simultaneous comparison of chronicity and of those with predominately disorganization versus psychomotor poverty symptoms. The patients were split into one set defined according to symptoms (29 with disorganization, 29 with negative symptoms) and the other representing chronicity (22 first-episode, 35 chronic) and compared with 28 healthy controls on a broad range of executive process measures. Differences were investigated in both the severity and profile of impairments. Impairment patterns interacted with symptom groups, with disorganization and psychomotor poverty symptom groups showing different profiles of executive impairment. In contrast, across these same executive processes, impairment profiles were similar between first episode and chronic schizophrenia and became more similar, particularly for working memory, when controlling for disorganization symptoms. The executive profile, therefore, is related to symptom type rather than chronicity. (JINS, 2008, 14, 782–792.)

scholarly journals S79. REINFORCEMENT LEARNING ABNORMALITIES IN INDIVIDUALS AT CLINICAL HIGH RISK AND IN THE FIRST EPISODE OF PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S64-S64
Author(s):  
Raktima Datta ◽  
Gregory Strauss ◽  
Nina Kraguljac ◽  
Sydney Howie ◽  
Adrienne Lahti
Keyword(s):  
Reinforcement Learning ◽  
High Risk ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
First Episode ◽  
Healthy Controls ◽  
Clinical High Risk ◽  
Cross Sectional ◽  
Learning Deficits ◽  
Illness Onset

Abstract Background Prior studies indicate that chronic schizophrenia (SZ) is associated with a specific profile of reinforcement learning abnormalities. These impairments are characterized by: 1) reductions in learning rate, and 2) impaired Go learning and intact NoGo learning. Furthermore, each of these deficits are associated with greater severity of negative symptoms, consistent with theoretical perspectives positing that avolition and anhedonia are associated with deficits in generating, updating, and maintaining mental representations of reward value hat are needed to guide decision-making. However, it is unclear whether these deficits extend to earlier phases of psychotic illness and when individuals are unmedicated. Methods Two studies were conducted to examine reinforcement learning deficits in earlier phases of psychosis. In study 1, participants included 35 participants with first episode psychosis (FEP) and 25 healthy controls (HC). Study 2 included 17 antipsychotic naïve individuals who met criteria for attenuated psychosis syndrome (APS) (i.e., those with a prodromal syndrome) and 18 matched healthy controls (HC). In both studies, participants completed the Temporal Utility Integration Task, a measure of probabilistic reinforcement learning that contained Go and NoGo learning blocks. Participants in the clinical groups also completed neuropsychological testing and standard clinical interviews designed to determine symptom severity and diagnosis. Results FEP displayed impaired Go learning and intact NoGo learning. In contrast, APS did not display impairments in Go or NoGo learning at the group level. Negative symptoms were not significantly associated with reinforcement learning in APS participants. However, greater impairments in Go learning were associated with increased cross-sectional risk for conversion on the NAPLS risk calculator score in the APS group. Discussion Findings provide new evidence for areas of spared and impaired reinforcement learning in early phases of psychosis. Similar to chronic SZ, FEP was associated with impaired Go learning, and intact NoGo learning. Reinforcement learning is more spared in those at clinical high-risk, except those at greatest risk for conversion, where Go learning deficits are more pronounced. These findings suggest that reinforcement learning deficits may emerge early among those who are at clinical high risk for developing psychosis and that they are already pronounced by illness onset in the first episode. Importantly, these reinforcement learning deficits do not appear to be a byproduct of illness chronicity or antipsychotic medication use, but rather a consequence of the illness itself.

Changes in the Positive and Negative Symptoms of Schizophrenic In-patients in China

1991 ◽  
Vol 159 (2) ◽  
pp. 226-231 ◽  
Author(s):  
Michael R. Phillips ◽  
Zuan Zhao ◽  
Xianzhang Xiong ◽  
Xiufang Cheng ◽  
Guirong Sun ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Psychiatric Hospitals ◽  
Chronic Schizophrenia ◽  
First Episode ◽  
Positive Symptoms ◽  
Positive Type ◽  
Duration Of Illness ◽  
Assessment And Treatment ◽  
Schizophrenic Patients ◽  
Positive And Negative Symptoms

Positive and negative symptoms at admission and discharge of 401 unselected schizophrenic patients from four psychiatric hospitals around China were studied. On admission, 58% of patients had prominent negative symptoms and the overall severity of negative symptoms was similar to that of positive symptoms; at discharge, negative symptoms were more prevalent and more severe. The severity of negative symptoms was not significantly correlated with duration of illness or with dosage of medication; 48% of first-episode, drug-naive patients had prominent negative symptoms on admission. Negative symptoms responded to standard neuroleptic treatment, but the improvement was less marked than that in positive symptoms (47% v. 80%). The proportion of patients classified as positive type, negative type, and mixed type schizophrenia altered dramatically with treatment. These findings highlight the importance of negative symptoms in the assessment and treatment of both acute and chronic schizophrenia.

Do people with schizophrenia display theory of mind deficits in clinical interactions?

2004 ◽  
Vol 34 (3) ◽  
pp. 401-412 ◽  
Author(s):  
R. McCABE ◽  
I. LEUDAR ◽  
C. ANTAKI
Keyword(s):  
Theory Of Mind ◽  
Mental Health Professionals ◽  
Negative Symptoms ◽  
Experimental Studies ◽  
Chronic Schizophrenia ◽  
Mental States ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Clinical Interactions ◽  
Therapy Sessions

Background. Having a ‘theory of mind’ (ToM) means that one appreciates one's own and others' mental states, and that this appreciation guides interactions with others. It has been proposed that ToM is impaired in schizophrenia and experimental studies show that patients with schizophrenia have problems with ToM, particularly during acute episodes. The model predicts that communicative problems will result from ToM deficits.Method. We analysed 35 encounters (>80 h of recordings) between mental health professionals and people with chronic schizophrenia (out-patient consultations and cognitive behaviour therapy sessions) using conversation analysis in order to identify how the participants used or failed to use ToM relevant skills in social interaction.Results. Schizophrenics with ongoing positive and negative symptoms appropriately reported first and second order mental states of others and designed their contributions to conversations on the basis of what they thought their communicative partners knew and intended. Patients recognized that others do not share their delusions and attempted to reconcile others' beliefs with their own but problems arose when they try to warrant their delusional claims. They did not make the justification for their claim understandable for their interlocutor. Nevertheless, they did not fail to recognize that the justification for their claim is unconvincing. However, the ensuing disagreement did not lead them to modify their beliefs.Conclusions. Individuals with schizophrenia demonstrated intact ToM skills in conversational interactions. Psychotic beliefs persisted despite the realization they are not shared but not because patients cannot reflect on them and compare them with what others believe.

Evaluation of positive and negative symptoms in schizophrenia

1986 ◽  
Vol 1 (2) ◽  
pp. 108-122 ◽  
Author(s):  
Nancy C. Andreasen ◽  
William M. Grove
Keyword(s):  
Negative Symptoms ◽  
The United States ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
University Of Iowa ◽  
Normal Functions ◽  
Subsequent Investigation ◽  
The University ◽  
The Relationship ◽  
Positive And Negative Symptoms

SummaryMost investigators concur that schizophrenia is probably a heterogeneous group of disorders that share the common features of psychotic symptoms, partial response to neuroleptics, and a relatively poor outcome. The subdivision of schizophrenia into two subtypes, positive versus negative, has achieved wide acceptance throughout the world during recent years. This distinction has heuristic and theoretical appeal because it unites phenomenology, pathophysiology, and etiology into a single comprehensive hypothesis.In spite of its wide appeal, the distinction has a number of problems. These include the failure to distinguish between symptom syndromes and diseases; failure to deal with the mixed patient; failure to take longitudinal course into account; and failure to address conceptually and methodologically the distinction between positive and negative symptoms.This paper focuses primarily on the conceptual basis for two instruments designed to measure positive and negative symptoms, the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS), originally described in 1982. Since their description, these scales have been used in a variety of other centers. These scales are based on the hypothesis that negative symptoms represent a deficit or diminution in normal psychological functions wliile positive symptoms represent an excess or distortion of normal functions. Reliability data are now available from Italy, Spain, and Japan which suggest that these scales can be used reliably in cultural settings outside the United States. The results of these studies are summarized in this paper. In addition, a replication study involving a new sample of 117 schizophrenics collected at the University of Iowa is described. In this second study of the SANS and SAPS, internal consistency is found to be quite high in the SANS. Thus negative symptoms appear to be more internally correlated with one another than are positive symptoms. The implications of this result are discussed. A principal components analysis is used to explore the relationship between positive and negative symptoms. While the study reported in 1982 suggested that positive and negative symptoms are negatively correlated, in the present study they appear to be uncorrelated. Overall, the results suggest that the SANS and SAPS are useful comprehensive instruments for the evaluation of positive and negative symptoms. The relationship between these symptoms and external validators such as cognitive functioning or CT scan abnormalities will be reported in a subsequent investigation.

Panic Attacks in Chronic Schizophrenia

1990 ◽  
Vol 157 (3) ◽  
pp. 430-433 ◽  
Author(s):  
Nicholas Argyle
Keyword(s):  
Maintenance Therapy ◽  
Social Phobia ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
Panic Attacks ◽  
Psychotic Symptoms ◽  
Relationship Of ◽  
The Relationship

Of 20 patients attending a clinic for maintenance therapy of schizophrenia, seven had regular panic attacks, and these were often associated with agoraphobia and social phobia. Similar fears and avoidance in other cases were associated with paranoid ideas and negative symptoms. The relationship of panic to psychotic symptoms varied greatly. In two patients neuroleptics were associated with an increase in panic attacks.

Abnormal Emotional Responses to Pleasant and Unpleasant Visual Stimuli in First Episode Schizophrenia: f-MRI Investigation

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Casacchia ◽  
M. Mazza ◽  
A. Catalucci ◽  
R. Pollice ◽  
M. Gallucci ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Psychiatric Service ◽  
Visual Stimuli ◽  
Chronic Schizophrenia ◽  
Normal Subjects ◽  
Blood Oxygenation ◽  
First Episode ◽  
Affective Deficits ◽  
Oxygenation Level ◽  
Mri Study

Aims:Affective deficits (flat affect, a diminished expression of emotion, anhedonia, and lowered ability to experience pleasure) are very common in schizophrenia. In emotion feeling, the crucial role of the insula, rather than of the primary somatosensory cortices, strongly suggests that the neural substrate for emotions is not merely sensorial. It is more likely that the activation of the insula representation of the viscero-motor activity is responsible for feeling of disgust. A recent MRI study demonstrated specific left anterior insular volume reduction in chronic schizophrenia patients: sustainable is the suggestion that emotion of disgust or of taste may be related to the experience of pleasure, which probably is compromise in schizophrenics.We investigated fMRI brain activations in first episode schizophrenic subjects with negative symptoms and in healthy subjects elicited by pleasant and unpleasant visual stimuli.Method:Ten first-episode schizophrenic subjects with normal IQ were recruited from the psychiatric service “SMILE” of San Salvatore Hospital and 10 healthy volunteers matched for age and education were scanned during observation of pleasant and unpleasant visual stimuli. Functional images were acquired with a 1.5T MRI scanner. Blood oxygenation level dependent (BOLD) contrast was obtained using EPI T2* weighted images.Results:The most important result of the study was the demonstration that anterior insula was activated by the exposure to disgusting stimula in normal subjects but not in schizophrenic subjects.Conclusion:This failure of the neural systems used to support emotional attribution is consistent with pervasive problems in experiencing emotions by schizophrenics.

Predictors of outcome in first-episode schizophrenia over the first 4 years of illness

2008 ◽  
Vol 38 (8) ◽  
pp. 1141-1146 ◽  
Author(s):  
P. Whitty ◽  
M. Clarke ◽  
O. McTigue ◽  
S. Browne ◽  
M. Kamali ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
First Episode ◽  
Global Assessment Of Functioning ◽  
Methodological Issues ◽  
Course Of Illness ◽  
Dsm Iv ◽  
First Episode Schizophrenia ◽  
The Relationship ◽  
Positive And Negative Symptoms

BackgroundThe outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.MethodWe conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.ResultsThere were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=−3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=−2.77, p<0.01) significantly predicted a better outcome at follow-up.ConclusionsThe outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.

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