A Group Intervention for Motivational Deficits: Preliminary Investigation of a Blended Care Approach Using Ambulatory Assessment

2021 ◽  
pp. 014544552110476
Author(s):  
Bénédicte Thonon ◽  
Marie-Noëlle Levaux ◽  
Evelyne van Aubel ◽  
Frank Larøi
Keyword(s):  
Group Intervention ◽  
Functional Outcomes ◽  
Negative Symptoms ◽  
Preliminary Investigation ◽  
Activity Level ◽  
Ambulatory Assessment ◽  
Specific Effects ◽  
Daily Step Count ◽  
Care Approach ◽  
Blended Care

Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of “Switch,” an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants’ smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants’ activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.

scholarly journals Histamine H1 receptor deletion in cholinergic neurons induces sensorimotor gating ability deficit and social impairments in mice

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Li Cheng ◽  
Cenglin Xu ◽  
Lu Wang ◽  
Dadao An ◽  
Lei Jiang ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Negative Symptoms ◽  
Cholinergic Neurons ◽  
Sensorimotor Gating ◽  
Social Impairment ◽  
H1 Receptor ◽  
Behavioral Deficits ◽  
Social Impairments ◽  
Cholinergic Projections ◽  
Functional Deficiency

AbstractNegative symptoms in schizophrenia strongly contribute to poor functional outcomes, however its pathogenesis is still unclear. Here, we found that histamine H1 receptor (H1R) expression in basal forebrain (BF) cholinergic neurons was decreased in patients with schizophrenia having negative symptoms. Deletion of H1R gene in cholinergic neurons in mice resulted in functional deficiency of cholinergic projections from the BF to the prefrontal cortex and in the formation of sensorimotor gating deficit, social impairment and anhedonia-like behavior. These behavioral deficits can be rescued by re-expressing H1R or by chemogenetic activation of cholinergic neurons in the BF. Direct chemogenetic inhibition of BF cholinergic neurons produced such behavioral deficits and also increased the susceptibility to hyperlocomotion. Our results suggest that the H1R deficiency in BF cholinergic neurons is critical for sensorimotor gating deficit, social impairments and anhedonia-like behavior. This finding may help to understand the genetic and biochemical bases of negative symptoms in schizophrenia.

scholarly journals Childhood adversity and psychosis: generalised or specific effects?

2015 ◽  
Vol 25 (4) ◽  
pp. 349-359 ◽  
Author(s):  
E. Longden ◽  
M. Sampson ◽  
J. Read
Keyword(s):  
Sexual Abuse ◽  
Physical Abuse ◽  
Negative Symptoms ◽  
Childhood Adversity ◽  
Clinical Intervention ◽  
Current Data ◽  
Psychotic Symptoms ◽  
Multiple Exposures ◽  
Specific Effects ◽  
The Impact

Background.This study examines relationships between childhood adversity and the presence of characteristic symptoms of schizophrenia. It was hypothesised that total adversity exposures would be significantly higher in individuals exhibiting these symptoms relative to patients without. Recent proposals that differential associations exist between specific psychotic symptoms and specific adversities was also tested, namely: sexual abuse and hallucinations, physical abuse and delusions, and fostering/adoption and delusions.Method.Data were collected through auditing 251 randomly selected medical records, drawn from adult patients in New Zealand community mental health centres. Information was extracted on presence and subtype of psychotic symptoms and exposure to ten types of childhood adversity, including five types of abuse and neglect.Results.Adversity exposure was significantly higher in patients experiencing hallucinations in general, voice hearing, command hallucinations, visions, delusions in general, paranoid delusions and negative symptoms than in patients without these symptoms. There was no difference in adversity exposure in patients with and without tactile/olfactory hallucinations, grandiose delusions or thought disorder. Indication of a dose–response relationship was detected, in that total number of adversities significantly predicted total number of psychotic symptoms. Although fostering/adoption was associated with paranoid delusions, the hypothesised specificity between sexual abuse and hallucinations, and physical abuse and delusions, was not found. The two adversities showing the largest number of associations with psychotic symptoms were poverty and being fostered/adopted.Conclusions.The current data are consistent with a model of global and cumulative adversity, in which multiple exposures may intensify psychosis risk beyond the impact of single events. Implications for clinical intervention are discussed.

scholarly journals Modeling the schizophrenias: subunit-specific NMDAR antagonism dissociates frontal δ and hippocampal θ modulation of ~140 Hz oscillations

2017 ◽  
Author(s):  
Benjamin Pittman-Polletta ◽  
Kun Hu ◽  
Bernat Kocsis
Keyword(s):  
Negative Symptoms ◽  
Paradoxical Sleep ◽  
Positive Symptom ◽  
Saline Control ◽  
Cortical Function ◽  
Specific Effects ◽  
High Frequency Oscillations ◽  
Dopaminergic Tone ◽  
Phase Amplitude ◽  
The Impact

ABSTRACTNMDAR antagonism alters mesolimbic, hippocampal, and cortical function, acutely reproducing the positive, cognitive, and negative symptoms of schizophrenia. These physiological and behavioral effects may depend differentially on NMDAR subtype-and region-specific effects. The dramatic electrophysiological signatures of NMDAR blockade in rodents include potentiated high frequency oscillations (HFOs, ~140 Hz), likely generated in mesolimbic structures, and increased HFO phase-amplitude coupling (PAC), a phenomenon related to goal-directed behavior and dopaminergic tone. This study examined the impact of subtype-specific NMDAR antagonism on HFOs and PAC. We found that positive-symptom-associated NR2A-preferring antagonism (NVP-AAM077), but not NR2B-specific antagonism (Ro25-6985) or saline control, replicated increases in HFO power seen with nonspecific antagonism (MK-801). However, PAC following NR2A-preferring antagonism was distinct from all other conditions. While θ-HFO PAC was prominent or potentiated in other conditions, NVP-AAM077 increased δ-HFO PAC and decreased θ-HFO PAC. Furthermore, active wake epochs exhibiting narrowband frontal δ oscillations, and not broadband sleep-associated δ, selectively exhibited δ-HFO coupling, while paradoxical sleep epochs having a high CA1 θ to frontal δ ratio selectively exhibited θ-HFO coupling. Our results suggest: (1) NR2A-preferring antagonism induces oscillopathies reflecting frontal hyperfunction and hippocampal hypofunction; and (2) HFO PAC indexes cortical vs. hippocampal control of mesolimbic circuits.

scholarly journals The Clinical Course and Prognostic Problems of Youth Depressions with Attenuated Schizophrenic Symptoms

2021 ◽  
pp. 42-52
Author(s):  
V. G. Kaleda ◽  
M. A. Omelchenko
Keyword(s):  
Depressive Episode ◽  
Functional Outcomes ◽  
Negative Symptoms ◽  
Clinical Course ◽  
Control Group ◽  
Youth Depression ◽  
Early Markers ◽  
Spectrum Disorders

Objective Clinical and follow-up verification of Attenuated Schizophrenic Symptoms (ASS) in the first youth depressive episode as early markers of the schizophrenic process, establishing further variants of the course of the disorder and its outcomes.Materials and methods. 124 young inpatients (averaged age 19,6±2,3 years) with the first depressive episode with ASS were examined. The control group consisted of 27 patients with youth depression without ASS. All patients have been tracked for at least five years. The average follow-up period was 7,1±1,6 years. The HDRS, SOPS, SANS and PSP scales were used to assess the symptomatic and functional outcomes. Statistical analysis was carried out using STATISTICA 12.Results. The typological classification of youth depressions (ASD) with ASS has been developed with the identification of three main types: (1) with attenuated positive symptoms (APS), (2) with attenuated negative symptoms (ANS), and (3) with attenuated symptoms of disorganization. Youth depression with ASS, compared to the control group, is more likely to move into chronic forms, has reliably worse functional and symptomatic outcomes, and is more associated with the diagnosis of schizophrenic spectrum disorders at five years follow-up.Conclusion. Attenuated schizophrenic symptoms in the structure of youth depressions have high affinity to each other, indicating a common pathogenic mechanism of their formation, and also have predicate value as risk factors for schizophrenia.

scholarly journals The Role of Daytime Sleepiness in Psychosocial Outcomes after Treatment for Obstructive Sleep Apnea

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Esther Yuet Ying Lau ◽  
Gail A. Eskes ◽  
Debra L. Morrison ◽  
Malgorzata Rajda ◽  
Kathleen F. Spurr
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Functional Outcomes ◽  
Psychosocial Outcomes ◽  
Activity Level ◽  
Cpap Treatment ◽  
Obstructive Sleep

We investigated the role of daytime sleepiness and sleep quality in psychosocial outcomes of patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Thirty-seven individuals with moderate to severe OSA and compliant with CPAP treatment for at least 3 months were compared to 27 age- and education-matched healthy controls. The OSA group and the control group were studied with overnight polysomnography (PSG) and compared on measures of daytime sleepiness (Epworth Sleepiness Scale), sleep quality (Pittsburg Sleep Quality Index), mood (Beck Depression Inventory, Profile of Mood States), and functional outcomes (Functional Outcomes of Sleep Questionnaire). After CPAP treatment, the OSA group improved on sleep quality and sleepiness. As a group, they did not differ from controls on sleep architecture after CPAP. The OSA group also showed significant improvements in functional outcomes and was comparable to controls on mood and functional outcomes. Persistent difficulties included lowered activity level and residual sleepiness in some individuals. Sleepiness was found to be a significant predictor of mood and affective states, while both sleepiness and sleep quality predicted functional outcomes. These results highlight the importance of assessment and intervention targeting psychosocial functioning and sleepiness in individuals with OSA after treatment.

BATTLING BOREDOM: GROUP COGNITIVE BEHAVIOUR THERAPY FOR NEGATIVE SYMPTOMS OF SCHIZOPHRENIA

2002 ◽  
Vol 30 (3) ◽  
pp. 341-346 ◽  
Author(s):  
Louise C. Johns ◽  
William Sellwood ◽  
John McGovern ◽  
Gillian Haddock
Keyword(s):  
Group Intervention ◽  
Negative Symptoms ◽  
Control Design ◽  
Inclusion Criteria ◽  
Behaviour Therapy ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
The Subject ◽  
Clinically Significant ◽  
Group Cbt

We conducted a pilot group intervention for negative symptoms, particularly targeting avolition/apathy. A baseline control design was used. Six patients were recruited, and four completed the group. The main inclusion criteria were clinically significant negative symptoms, plus associated distress and concern. The group involved 16 sessions, which were cognitive behavioural in approach. The main outcome measures were the Scale for the Assessment of Negative Symptoms, and the Subject Experience of Negative Symptoms Scale. Patients showed a reduction in avolition/apathy, and two patients reported reduced distress. These preliminary results suggest that group CBT is a possible intervention for negative symptoms.

scholarly journals Activity Levels in Healthy Older Adults: Implications for Joint Arthroplasty

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Laura E. Thorp ◽  
Diego Orozco ◽  
Joel A. Block ◽  
Dale R. Sumner ◽  
Markus A. Wimmer
Keyword(s):  
Older Adults ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Activity Level ◽  
Implant Design ◽  
Activity Levels ◽  
Healthy Older Adults ◽  
Daily Step Count ◽  
Steps Per Day

This work evaluated activity levels in a group of healthy older adults to establish a target activity level for adults of similar age after total joint arthroplasty (TJA). With the decreasing age of TJA patients, it is essential to have a reference for activity level in younger patients as activity level affects quality of life and implant design. 54 asymptomatic, healthy older adults with no clinical evidence of lower extremity OA participated. The main outcome measure, average daily step count, was measured using an accelerometer-based activity monitor. On average the group took steps per day, approximately 4000 more steps per day than has been previously reported in patients following total joint arthroplasty. The present work provides a reference for activity after joint arthroplasty which is relevant given the projected number of people under the age of 65 who will undergo joint arthroplasty in the coming years.

scholarly journals Update on cell therapy for stroke

2017 ◽  
Vol 2 (2) ◽  
pp. 59-64 ◽  
Author(s):  
Cynthia L Kenmuir ◽  
Lawrence R Wechsler
Keyword(s):  
Cell Therapy ◽  
Ischaemic Stroke ◽  
Functional Outcomes ◽  
Treatment Options ◽  
Cell Delivery ◽  
Delivery Methods ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Specific Effects ◽  
New Treatment

Ischaemic stroke remains a leading cause of death and disability. Current stroke treatment options aim to minimise the damage from a pending stroke during the acute stroke period using intravenous thrombolytics and endovascular thrombectomy; however, there are no currently approved treatment options for reversing neurological damage once a stroke is completed. Preclinical studies suggest that cell therapy may be safe and effective in improving functional outcomes. Several recent clinical trials have reported safety and some improvement in outcomes following cell therapy administration in ischaemic stroke, which are reviewed. Cell therapy may provide a promising new treatment for stroke reducing stroke-related disability. Further investigation is needed to determine specific effects of cell therapy and to optimise cell delivery methods, cell dosing, type of cells used, timing of delivery, infarct size and location of infarct that are likely to benefit from cell therapy.

scholarly journals Issues and developments related to assessing function in serious mental illness

2016 ◽  
Vol 18 (2) ◽  
pp. 135-144 ◽  
Keyword(s):  
Mental Illness ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Serious Mental Illness ◽  
Daily Activity ◽  
Functional Outcomes ◽  
Negative Symptoms ◽  
Functional Disability ◽  
Assessment Instruments ◽  
Novel Treatments

Serious mental illness (SMI) results in functional disability that imposes a significant burden on individuals, caregivers, and society. Development of novel treatments is under way in an effort to improve the illness domains of cognitive impairment and negative symptoms and subsequently to improve functional outcomes. The assessment of functional outcomes in SMI faces a number of challenges, including the proliferation of assessment instruments and the differential prioritization of functional goals among stakeholder groups. Functional assessments relying on self- and informant report present a number of limitations. Identifying alternative strategies to assess functioning that are reliable, valid, and sensitive to change is necessary for use in clinical trials. Measures of functional capacity have been proposed for clinical trials investigating compounds to treat cognitive impairment in schizophrenia. Alternative approaches employing effort-based decision making or daily activity recording using instruments such as the Daily Activity Report may be more appropriate for studies focused on improving negative symptoms.

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