Publications by authors named "David L Penn"

201 Publications

Targeting Physical Health in Schizophrenia: Results from the Physical Activity Can Enhance Life (PACE-Life) 24-Week Open Trial.

Ment Health Phys Act 2021 Mar 20;20. Epub 2021 Apr 20.

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Poor health and low cardiorespiratory fitness (CRF) contribute substantially to the shortened lifespan of individuals with schizophrenia spectrum disorders (SSDs). Increasing physical activity has demonstrated value; however, there are limited interventions that are accessible and adequately address motivational challenges. This paper reports on an open trial of Physical Activity Can Enhance Life (PACE-Life), a motivational theory-based manualized multicomponent walking intervention. The primary aim was to examine the feasibility of implementing PACE-Life through meeting the recruitment target (n=14), attendance and adherence rates, and participant feedback. The secondary aim was to assess the impact of PACE-Life on intermediate targets (autonomous motivation and satisfaction of autonomy, relatedness, and competence needs), proximal outcomes (Fitbit steps/day and minutes spent walking), the primary outcome (CRF), and secondary outcomes (loneliness, symptoms, resting heart rate, blood pressure, weight, body mass index, and hip and waist circumference). Seventeen participants with SSDs enrolled in a 24-week open trial. Assessments occurred at baseline, midpoint, post-test, and one-month follow-up. The recruitment target was exceeded, the group attendance rate was 34%, Fitbit adherence rate was 54%, and participant feedback indicated satisfaction with the intervention as well as a positive group environment. There was a large improvement in the primary outcome of CRF with 77% of participants achieving clinically significant improvement at post-test. Small and medium effect size increases were observed in autonomous motivation and satisfaction of autonomy, relatedness, and competence needs. Fitbit data and secondary outcomes generally remained unchanged or worsened during the intervention. Results from this open trial indicate that PACE-Life leads to meaningful changes in CRF among people with SSDs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mhpa.2021.100393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224902PMC
March 2021

The Horyzons project: a randomized controlled trial of a novel online social therapy to maintain treatment effects from specialist first-episode psychosis services.

World Psychiatry 2021 Jun;20(2):233-243

Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.

This study aimed to determine whether, following two years of specialized support for first-episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single-blind randomized controlled trial. Participants were people with first-episode psychosis (N=170), aged 16-27 years, in clinical remission and nearing discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N=86) or TAU alone (N=84) between October 2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty-seven participants (55.5%) in the Horyzons plus TAU group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18-month follow-up, with no evidence of significant between-group differences (PSP mean difference: -0.29, 95% CI: -4.20 to 3.63, p=0.77). Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in TAU (odds ratio, OR=5.55, 95% CI: 1.09-28.23, p=0.04), with evidence of a dose-response effect. Moreover, participants in TAU were twice as likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR=0.31, 95% CI: 0.11-0.86, p=0.03, number needed to treat, NNT=5). There was a non-significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR=0.36, 95% CI: 0.11-1.08, p=0.07, NNT=7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key aim of specialized first-episode psychosis services. Horyzons holds significant promise as an engaging and sustainable intervention to provide effective vocational and relapse prevention support for young people with first-episode psychosis beyond specialist services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/wps.20858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129860PMC
June 2021

Computational methods for integrative evaluation of confidence, accuracy, and reaction time in facial affect recognition in schizophrenia.

Schizophr Res Cogn 2021 Sep 22;25:100196. Epub 2021 Apr 22.

School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States of America.

People with schizophrenia (SZ) process emotions less accurately than do healthy comparators (HC), and emotion recognition have expanded beyond accuracy to performance variables like reaction time (RT) and confidence. These domains are typically evaluated independently, but complex inter-relationships can be evaluated through machine learning at an item-by-item level. Using a mix of ranking and machine learning tools, we investigated item-by-item discrimination of facial affect with two emotion recognition tests (BLERT and ER-40) between SZ and HC. The best performing multi-domain model for ER40 had a large effect size in differentiating SZ and HC (d = 1.24) compared to a standard comparison of accuracy alone (d = 0.48); smaller increments in effect sizes were evident for the BLERT (d = 0.87 vs. d = 0.58). Almost half of the selected items were confidence ratings. Within SZ, machine learning models with ER40 (generally accuracy and reaction time) items predicted severity of depression and overconfidence in social cognitive ability, but not psychotic symptoms. Pending independent replication, the results support machine learning, and the inclusion of confidence ratings, in characterizing the social cognitive deficits in SZ. This moderate-sized study ( = 372) included subjects with schizophrenia (SZ,  = 218) and healthy controls (HC,  = 154).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scog.2021.100196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093458PMC
September 2021

The alliance-outcome relationship in individual psychosocial treatment for schizophrenia and early psychosis: A meta-analysis.

Schizophr Res 2021 05 15;231:154-163. Epub 2021 Apr 15.

Department of Psychology and Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA.

The therapeutic alliance, or client-provider relationship, has been associated with better treatment engagement and outcomes for persons with schizophrenia-spectrum disorders (SSDs) and early psychosis in some studies, but not others. We conducted a meta-analysis of the research on alliance in SSDs and early psychosis across a range of interventions and outcomes. Parallel literature searches were conducted in PubMed and PsycINFO databases for articles between inception and 6/11/2020. English-language studies were included if they evaluated the relationship between alliance and a prospective outcome (treatment engagement, medication adherence, functioning, or total, positive, negative, or depressive symptoms) in an individual clinical treatment for SSDs/early psychosis and contained analyzable data. Correlations and partial correlations were meta-analyzed with random effects models to calculate mean across-study correlations and to carry out subsequent homogeneity and moderator variable analyses. Fourteen studies consisting of 2968 participants that assessed six outcomes across six psychosocial treatments were included. Results indicated that better client-rated (r = 0.20) and other-rated (i.e., provider- or observer-rated; r = 0.25) alliance were associated with better treatment engagement. Treatment type and sample race/ethnicity, but not age, gender, or timing of alliance rating moderated the association between other-rated alliance and engagement. Further, better other-rated alliance was related to improvements in positive (r = -0.14) and negative (r = -0.22) symptoms. A strong therapeutic alliance is important for both engaging clients with SSDs and early psychosis in treatment and facilitating improvements in positive and negative symptoms. Delivery and monitoring of treatments for this population should include assessment of the therapeutic alliance from multiple perspectives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.schres.2021.04.002DOI Listing
May 2021

Situational context influences the degree of hostile attributions made by individuals with schizophrenia or autism spectrum disorder.

Br J Clin Psychol 2021 Jun 1;60(2):160-176. Epub 2021 Mar 1.

School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.

Objectives: Previous work has demonstrated that the tendency to make hostile attributions is not a stable trait but varies across different social situations. Therefore, we sought to investigate whether hostile attributions within clinical samples are better understood as a persistent characteristic or one that varies across contexts.

Methods: The current analyses investigated patterns of attributions among people diagnosed with schizophrenia (SCZ, n = 271) or autism spectrum disorder (ASD, n = 100) and non-clinical control participants (NCC, n = 233) in an existing data set.

Results: Results showed that specific relational features in vignettes portraying different social encounters influence the way people make attributions and that variability across contexts is present in both non-clinical and clinical populations. Like non-clinical participants, participants diagnosed with ASD ascribed the greatest hostility to a scene involving an authority figure. In contrast, SCZ participants reported the greatest hostility in response to a scene involving a friend.

Conclusions: These findings suggest that salient environmental factors should be considered when assessing social cognitive skills and biases.

Practitioner Points: Hostile attributions should be perceived as situational constructs rather than stable and persistent characteristics. Hostile attributions were most prevalent among persons diagnosed with schizophrenia; however, on average, all participants showed greater hostility for situations involving an authority figure, an acquaintance, or a friend relative to those involving a co-worker or stranger. Psychotherapists and clinicians working with people diagnosed with schizophrenia or autism spectrum disorder could work on identifying situation triggers, which may prompt hostile attributions. Psycho-educational and psychotherapeutic interventions can be altered based on individual triggers of hostile attributions, and attempts can be made to lessen these attributions. Paranoia appears to be linked to hostile attributions regardless of the specific clinical diagnosis and should be considered in the therapeutic process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bjc.12283DOI Listing
June 2021

Physical Activity Can Enhance Life (PACE-Life): results from a 10-week walking intervention for individuals with schizophrenia spectrum disorders.

J Ment Health 2021 Feb 2:1-9. Epub 2021 Feb 2.

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Background: Premature mortality in individuals with schizophrenia spectrum disorders (SSDs) is largely due to high rates of chronic health conditions. Although exercise has been shown to improve health in this population, scalable and accessible interventions are limited.

Aim: To examine the impact of Physical Activity Can Enhance Life (PACE-Life), a novel walking intervention, on physical activity, and on secondary outcomes of cardiorespiratory fitness (CRF), physical health, autonomous motivation, social support, and quality of life.

Method: Sixteen individuals with SSDs were enrolled in a 10-week open trial. The intervention included walking groups, home-based walks, Fitbit use, and goal-setting and if-then plans. Within-group effect sizes were calculated to represent changes from baseline to post-test and 1-month follow-up.

Results: Participants increased self-reported weekly walking minutes and decreased daily hours spent sitting; however, Fitbit-recorded exercise behavior changed only minimally. There were also improvements in secondary outcomes including autonomous motivation and hip circumference. CRF improved only minimally, and findings were relatively unchanged with outliers removed from the full sample.

Conclusions: This open trial demonstrates modest improvements in key parameters of exercise behavior and physical health from participating in PACE-Life. Future research should assess the efficacy of this intervention in a randomized controlled trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638237.2021.1875403DOI Listing
February 2021

Lifetime employment in schizophrenia: correlates of developing long term unemployment after being employed before.

Cogn Neuropsychiatry 2021 03 30;26(2):95-106. Epub 2020 Dec 30.

Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.

Background: Challenges in employment are highly prevalent among people with schizophrenia regardless of their employment history. Although supportive employment can be effective, few participants sustain meaningful competitive employment. Our goal was to identify the correlates of developing sustained unemployment.

Methods: We examined employment outcomes by comparing clinical, neurocognitive, and social cognitive features in 234 participants with Schizophrenia Spectrum Disorders across t competitive employment outcomes: currently employed, participants who had never worked for a year, and those who had been employed but developed long-term unemployment. We examined social cognition and neurocognition, as well as positive and negative schizophrenia symptoms, and premorbid functioning and demographic factors.

Results: We found significant differences in age, race, premorbid functioning, cognitive performance, and social cognition between currently and formerly employed patients. When individual tasks were examined, emotion recognition and verbal working memory performance were the domains differentiating the groups. Older African Americans were over-represented in the formerly employed group.

Conclusions: There were minimal differences other than age and race between formerly employed patients and those who had never worked. These data suggest the possibility that deterioration in employment outcomes may also co-occur with declines in other abilities. Opportunities and disparities may also be a contributor to re-entering the work force.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13546805.2020.1865896DOI Listing
March 2021

Neighborhood socioeconomic status and racial disparities in schizophrenia: An exploration of domains of functioning.

Schizophr Res 2020 10 24;224:95-101. Epub 2020 Oct 24.

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA; Australian Catholic University, School of Behavioural and Health Sciences, Melbourne, VIC, Australia.

Black Americans are disproportionately diagnosed with schizophrenia and experience worse objective functional outcomes (e.g., hospitalizations) than their White counterparts. However, we have a limited understanding of the psychological pathways through which Black Americans with schizophrenia reach worse outcomes. This study assessed race and domains of functioning (e.g., neurocognition, functional capacity) known to be associated with objective outcomes in a sample of 108 non-Hispanic Black and 61 non-Hispanic White individuals with schizophrenia-spectrum disorders from the Social Cognition Psychometric Evaluation (SCOPE) study. Three primary findings emerged: First, Black participants showed lower scores than White participants on measures of neurocognition(NC), social cognition(SC), and everyday living skills, but not social skills or community functioning. Second, neighborhood socioeconomic status (SES) explained 21% of the relationship between race and NC but did not mediate the relationship between race and SC or everyday living skills. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals with schizophrenia. In our sample, after controlling for neighborhood SES, race did not moderate the relationships of NC, SC, social skills, or everyday living skills to community functioning. This indicates that relationships between these domains are comparably strong across Black and White Americans. Taken together, these findings show that NC, SC, and everyday living skills may be important areas to explore in regards to racial disparities in schizophrenia. More research, especially incorporating nuanced race- and SES-related variables, is needed to understand how to best intervene and improve real-world outcomes for Black Americans with schizophrenia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.schres.2020.09.020DOI Listing
October 2020

How often do US-based schizophrenia papers published in high-impact psychiatric journals report on race and ethnicity?: A 20-year update of Lewine and Caudle (1999).

J Ment Health 2020 Nov 9:1-8. Epub 2020 Nov 9.

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Background: Racial and ethnic disparities have been clearly documented in schizophrenia studies, but it is unclear how much research attention they receive among US-based studies published in high-impact journals.

Aims: The current paper updates Lewine and Caudle's (1999) and Chakraborty and Steinhauer's (2010) works, which quantified how frequently schizophrenia studies included information on race and ethnicity in their analyses.

Method: We examined all US-based papers on schizophrenia-spectrum, first-episode psychosis, and clinical high-risk groups, published between 2014 to 2016 in four major psychiatric journals: - and

Results: Of 474 US-based studies, 62% ( = 295) reported analyses by race or ethnicity as compared to 20% in Lewine and Caudle's (1999) study. The majority of papers (59%) reported sample descriptions, a 42% increase from Lewine and Caudle's (1999) study. Additionally, 47% matched or compared the racial/ethnic composition of primary study groups and 12% adjusted for race (e.g., as a covariate). However, only 9% directly analyzed racial and/or ethnic identity in relation to the primary topic of the paper.

Conclusions: While schizophrenia studies report analyses by race and ethnicity more frequently than 20 years ago, there remains a strong need for systematic, nuanced research on this topic. The authors offer recommendations for how to conceptualize and report upon race and ethnicity in schizophrenia research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638237.2020.1837356DOI Listing
November 2020

Overconfidence in social cognitive decision making: Correlations with social cognitive and neurocognitive performance in participants with schizophrenia and healthy individuals.

Schizophr Res 2020 10 21;224:51-57. Epub 2020 Oct 21.

Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, USA; Research Service, Miami VA Healthcare System, Miami, FL, USA. Electronic address:

It has been reported that people with schizophrenia are frequently overconfident relative to their performance, a trait observed in healthy individuals as well. In schizophrenia, impaired self-assessments have been found to be associated with functional impairments in various domains. Previous studies examining the correlation of overconfidence and task performance within domains (e.g., social cognition) had found overconfidence was associated with particularly poor performance. This study examines how overconfidence on a social cognitive emotion recognition task is correlated with performance on other social cognitive tests, measures of neurocognition, and intelligence. The sample includes 154 healthy controls and 218 outpatient individuals diagnosed with schizophrenia. For the healthy controls, overconfidence was a significant predictor of poorer performance on social cognitive, but not neurocognitive tasks. For the participants with schizophrenia, overconfidence was a predictor of poorer performance on every performance-based task. In addition, overconfidence in healthy controls was more strongly correlated with intelligence than it was in participants with schizophrenia. The data suggest that a bias toward overestimation of performance aligns with poorer performance social cognitive domains, as well as neurocognitive domains in participants with schizophrenia. In healthy individuals, consistent with previous results, lower general intelligence seems to be a substantial predictor of overconfidence. These data suggest that attention to the accuracy of self-assessment is an area for future clinical interventions in people with schizophrenia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.schres.2020.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722219PMC
October 2020

Positive and meaningful lives: Systematic review and meta-analysis of eudaimonic well-being in first-episode psychosis.

Early Interv Psychiatry 2020 Oct 10. Epub 2020 Oct 10.

Orygen, The University of Melbourne, Melbourne, Victoria, Australia.

Background: First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP.

Aim: Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP.

Methods: Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants.

Results: Studies comprised six RCTs, eight prospective follow-up studies and three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent.

Conclusions: The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/eip.13049DOI Listing
October 2020

Dynamic Eye Tracking as a Predictor and Outcome Measure of Social Skills Intervention in Adolescents and Adults with Autism Spectrum Disorder.

J Autism Dev Disord 2021 Apr;51(4):1173-1187

Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.

To evaluate an eye tracking task as a predictor and outcome measure of treatment response for autism spectrum disorder (ASD) social skills interventions, adolescents and young adults with ASD completed the eye tracking task before, immediately after, and two months after completing Social Cognition and Interaction Training for Autism (SCIT-A). The study compared SCIT-A participants (n = 20) to participants with ASD who received treatment as usual (TAU; n = 21). Overall, increased visual attention to faces and background objects and decreased attention to hands playing with toys at baseline were associated with improved social functioning immediately following intervention, suggesting this eye tracking task may reliably predict ASD social intervention outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10803-020-04594-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855541PMC
April 2021

Autistic Symptoms and Social Cognition Predict Real-World Outcomes in Patients With Schizophrenia.

Front Psychiatry 2020 5;11:524. Epub 2020 Jun 5.

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.

Objective: Real-world functioning is a complex construct influenced by different factors. The impact of social cognition and autism spectrum disorder (ASD) symptoms on different aspects of the life of people with schizophrenia has been demonstrated independently, but it is unclear how these factors are related to functioning when considered concurrently. We hypothesized that ASD symptoms could play a major role in predicting real-world functioning in schizophrenia.

Methods: Existent databases from two studies (SCOPE Phase 3 and SCOPE Phase 5), in which a total of 361 patients (mean age 41.7 years; 117 females) were assessed with measures of symptom severity, neuro- and socio-cognitive abilities, functional capacity, social skills, and informant-reported real-world functioning outcomes, were analyzed.

Results: Active social avoidance, social skills, ASD symptoms, and emotion processing emerged as predictors of real-world interpersonal relationships. Cognitive performance, positive symptoms, and functional capacity emerged as predictors of real-world participation in daily activities. Cognitive performance, emotion processing, positive symptoms severity, and social skills emerged as predictors of real-world work outcomes.

Conclusion: Among other demographic, clinical, and functional capacity variables, increased ASD symptoms emerged as a significant predictor of poorer social relationships and may therefore represent a key factor in predicting real-world social functioning in schizophrenia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyt.2020.00524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294984PMC
June 2020

Randomized controlled trial of social cognition and interaction training compared to befriending group.

Br J Clin Psychol 2020 Sep 8;59(3):384-402. Epub 2020 Jun 8.

Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.

Background: Deficits in social cognition are common in people with schizophrenia and are associated with impaired functioning. Finding effective interventions to address these deficits is a priority. Social Cognition Interaction Training (SCIT) is a psychosocial intervention that has demonstrated acceptability and feasibility in various health care settings. Larger, well-designed randomized controlled trials are needed to examine the effectiveness of this intervention.

Design: A randomized controlled trial.

Methods: One hundred and twenty adults diagnosed with schizophrenia spectrum disorder were randomized to receive SCIT (n = 61) or Befriending Therapy (BT) (n = 59). Both intervention groups were delivered weekly for 2 hr over 12 weeks. Neurocognitive assessment was completed at baseline. Participants completed assessments of social cognition, social functioning, and meta-cognition at baseline, post-intervention, and 3-month follow-up.

Results: There were no clinically significant differences between group outcomes on any measure of social cognition or social functioning. There was a trend for both groups to improve over time but not at a level of statistical significance.

Conclusions: SCIT did not show any additional benefits on measures of social cognition compared to Befriending Therapy for people with schizophrenia spectrum disorder. The findings are discussed in terms of potential improvements to the programme.

Practitioner Points: Effective interventions for the social cognitive deficits of schizophrenia spectrum disorders are still being refined. Social Cognition Interaction Training is a promising therapy but requires further modifications to improve its effectiveness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bjc.12252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496415PMC
September 2020

Diabetes Insipidus After Endoscopic Transsphenoidal Surgery.

Neurosurgery 2020 10;87(5):949-955

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Background: Diabetes insipidus (DI) is a recognized transient or permanent complication following transsphenoidal surgery (TSS) for pituitary tumors.

Objective: To describe significant experience with the incidence of DI after TSS, identifying predictive characteristics and describing our diagnosis and management of postoperative DI.

Methods: A retrospective analysis was performed of 700 patients who underwent endoscopic TSS for resection of pituitary adenoma (PA), Rathke cleft cyst (RCC), or craniopharyngioma. Inclusion criteria included at least 1 wk of follow-up for diagnosis of postoperative DI. Permanent DI was defined as DI symptoms and/or need for desmopressin more than 1 yr postoperatively. All patients with at least 1 yr of follow-up (n = 345) were included in analyses of permanent DI. Multivariable logistic regression models were constructed to identify predictors of transient or permanent postoperative DI.

Results: The overall rate of any postoperative DI was 14.7% (103/700). Permanent DI developed in 4.6% (16/345). The median follow-up was 10.7 mo (range: 0.2-136.6). Compared to patients with PA, patients with RCC (odds ratio [OR] = 2.2, 95% CI: 1.2-3.9; P = .009) and craniopharyngioma (OR = 7.0, 95% CI: 2.9-16.9; P ≤ .001) were more likely to develop postoperative DI. Furthermore, patients with RCC (OR = 6.1, 95% CI: 1.8-20.6; P = .004) or craniopharyngioma (OR = 18.8, 95% CI: 4.9-72.6; P ≤ .001) were more likely to develop permanent DI compared to those with PA.

Conclusion: Although transient DI is a relatively common complication of endoscopic and microscopic TSS, permanent DI is much less frequent. The underlying pathology is an important predictor of both occurrence and permanency of postoperative DI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyaa148DOI Listing
October 2020

Measuring mentalizing: A comparison of scoring methods for the hinting task.

Int J Methods Psychiatr Res 2020 06 9;29(2):e1827. Epub 2020 May 9.

School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.

Objective: The Social Cognition Psychometric Evaluation (SCOPE) study supported the utility and practicality of the Hinting task as a measure of social cognition/mentalizing in clinical trials, specifically with the SCOPE authors' stringent scoring system. However, it remains unclear whether the SCOPE scoring system is necessary for the task to be judged as psychometrically sound.

Method: Independent raters rescored data from the three phases of SCOPE using the Hinting task's original scoring criteria. Psychometric properties of the task when scored with the original criteria versus more stringent SCOPE criteria were compared in a large sample of individuals with chronic schizophrenia (n = 397) and matched controls (n = 300) as well as a smaller sample of individuals with early psychosis (n = 38) and controls (n = 39).

Results: In both samples, SCOPE criteria resulted in lowered average scores and reduced ceiling effects. Further, revised scoring resulted in strengthened relationships between the hinting task and outcome measures in the chronic sample, and better differentiated early psychosis patients from controls. Conversely, test-retest reliability and internal consistency estimates were not improved using revised scoring and remained suboptimal, particularly for healthy controls.

Conclusion: Overall, SCOPE scoring criteria improved some psychometric properties and clinical utility, suggesting that these criteria should be considered for implementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/mpr.1827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301277PMC
June 2020

Dysregulation of the EphrinB2-EphB4 ratio in pediatric cerebral arteriovenous malformations is associated with endothelial cell dysfunction in vitro and functions as a novel noninvasive biomarker in patients.

Exp Mol Med 2020 04 14;52(4):658-671. Epub 2020 Apr 14.

Vascular Biology Program, Boston Children's Hospital, Boston, MA, USA.

We investigated (1) EphrinB2 and EphB4 receptor expression in cerebral AVMs, (2) the impact of an altered EphrinB2:EphB4 ratio on brain endothelial cell function and (3) potential translational applications of these data. The following parameters were compared between AVM endothelial cells (AVMECs) and human brain microvascular endothelial cells (HBMVECs): quantified EphrinB2 and EphB4 expression, angiogenic potential, and responses to manipulation of the EphrinB2:EphB4 ratio via pharmacologic stimulation/inhibition. To investigate the clinical relevance of these in vitro data, Ephrin expression was assessed in AVM tissue (by immunohistochemistry) and urine (by ELISA) from pediatric patients with AVM (n = 30), other cerebrovascular disease (n = 14) and control patients (n = 29), and the data were subjected to univariate and multivariate statistical analyses. Compared to HBMVECs, AVMECs demonstrated increased invasion (p = 0.04) and migration (p = 0.08), impaired tube formation (p = 0.06) and increased EphrinB2:EphB4 ratios. Altering the EphrinB2:EphB4 ratio (by increasing EphrinB2 or blocking EphB4) in HBMVECs increased invasion (p = 0.03 and p < 0.05, respectively). EphrinB2 expression was increased in AVM tissue, which correlated with increased urinary EphrinB2 levels in AVM patients. Using the optimal urinary cutoff value (EphrinB2 > 25.7 pg/μg), AVMs were detected with high accuracy (80% vs. controls) and were distinguished from other cerebrovascular disease (75% accuracy). Post-treatment urinary EphrinB2 levels normalized in an index patient. In summary, AVMECs have an EphrinB2:EphB4 ratio that is increased compared to that of normal HBMVECs. Changing this ratio in HBMVECs induces AVMEC-like behavior. EphrinB2 is clinically relevant, and its levels are increased in AVM tissue and patient urine. This work suggests that dysregulation of the EphrinB2:EphB4 signaling cascade and increases in EphrinB2 may play a role in AVM development, with potential utility as a diagnostic and therapeutic target.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s12276-020-0414-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210966PMC
April 2020

Hostile attribution bias in schizophrenia-spectrum disorders: narrative review of the literature and persisting questions.

J Ment Health 2020 Mar 31:1-18. Epub 2020 Mar 31.

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Social cognition is often aberrant or impaired in psychotic disorders and related to functional outcomes. In particular, one core social cognitive bias - hostile attribution bias - is proposed to be implicated in paranoia, anxiety, mood disturbances and interpersonal conflict outcomes. However, questions remain about this domain's specificity to psychosis and its relationship to general functional outcomes. The present paper offers a descriptive and critical review of the literature on hostile attribution bias in psychotic disorders, in order to examine (1) its impact on persecutory symptoms in schizophrenia-spectrum disorders, (2) impact on other related psychopathology among those experiencing psychosis and (3) relationship to functioning. Twenty-eight studies included in this review after parallel literature searches of PsycINFO and PubMed. Evidence from these studies highlighted that hostile attribution bias is elevated in schizophrenia, and that it is related to anxiety, depression and interpersonal conflict outcomes. While results suggest that hostile attributions are elevated in schizophrenia and associated with symptoms and functioning, there exist numerous persisting questions in the study of this area, including identifying which measures are most effective and determining how it presents: as a state or trait-like characteristic, via dual processes, and its situational variation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638237.2020.1739240DOI Listing
March 2020

Psychometric properties of the Observable Social Cognition Rating Scale (OSCARS): Self-report and informant-rated social cognitive abilities in schizophrenia.

Psychiatry Res 2020 Feb 26;286:112891. Epub 2020 Feb 26.

University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, United States; Australian Catholic University, School of Behavioural and Health Sciences, Melbourne, VIC, Australia.

Individuals with schizophrenia spectrum disorders (SSD) consistently show deficits in social cognition (SC) which is associated with real world outcomes. Psychosocial treatments have demonstrated reliable improvements in SC abilities, highlighting the need for accurate identification of SC deficits for efficient and individualized treatment planning. To this end, the Observable Social Cognition Rating Scale (OSCARS) is an 8-item scale with both self and informant versions. This study investigated psychometric properties of the OSCARS as both a self and informant-reported scale in a large sample of SSD (n = 382) and individuals without a psychiatric diagnosis (n = 289). A two-factor structure (Social Cognitive Bias and Social Cognitive Ability) of the OSCARS demonstrated acceptable model fit with good internal consistency for both self- and informant-report. The OSCARS had adequate convergent, external, and predictive validity. Area Under the Curve (AUC) values suggest the OSCARS has some value in identifying individuals with impaired SC and social competence, although stronger AUC values were demonstrated when identifying individuals with impaired real-world functioning. Overall, psychometric properties indicate the OSCARS may be a useful first-step tool for clinicians to detect functioning deficits in SSD and efficiently identify individuals in need of additional assessment or psychosocial interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2020.112891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483899PMC
February 2020

Horyzons USA: A moderated online social intervention for first episode psychosis.

Early Interv Psychiatry 2021 Apr 17;15(2):335-343. Epub 2020 Feb 17.

Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.

Aim: We evaluated the feasibility and acceptability of Horyzons, an online social media platform designed to facilitate relationship development among, and introduce therapeutic content to, first-episode psychosis (FEP) clients. We also evaluated whether participation in the platform was related to reduced loneliness, improved social integration and increased psychological well-being.

Methods: Twenty-six participants diagnosed with a schizophrenia spectrum disorder were provided access to the moderated Horyzons platform for 12 weeks. During the intervention period, participants were encouraged to access therapeutic content and social components embedded within the site. Participants were recruited from three first-episode coordinated specialty care clinics in North Carolina and assessed at four time points: baseline, mid-treatment, post-treatment and 1-month follow-up.

Results: Findings indicated that Horyzons was both feasible and very well tolerated, with a 92.3% retention rate and 79.2% of participants actively engaged in the platform. The most commonly identified personal strengths selected by Horyzons users were creativity (61.5%), curiosity (42.3%) and courage (38.5%). Feedback from participants indicated Horyzons could be improved by the development of a smartphone application, expanding the size of the Horyzons community and facilitating private messages between users. Preliminary results with engaged participants showed the greatest improvements in psychosis-related symptoms, followed by self-reported experience of negative emotions, depressive symptoms and loneliness.

Conclusions: This open trial found that Horyzons is both feasible and acceptable to FEP persons early in the course of illness living in the United States.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/eip.12947DOI Listing
April 2021

Confidence, performance, and accuracy of self-assessment of social cognition: A comparison of schizophrenia patients and healthy controls.

Schizophr Res Cogn 2020 Mar 8;19:002-2. Epub 2019 Feb 8.

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America.

Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that reduced awareness of performance may be associated with disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on a social cognitive test, confidence in performance, effort allocated to the task, and correlates of confidence in patients with schizophrenia and healthy controls (HC). Measures included self-reports of depression, social cognitive ability, and social functioning. A performance-based emotion recognition test assessed social cognitive performance and provided the basis for confidence judgments. Although schizophrenia patients had reduced levels of overall confidence, there was a substantial subset of schizophrenic patients who manifested extreme overconfidence and these people had the poorest performance and reported the least depression. Further, a substantial number of HC over-estimated their performance as well. Patients with schizophrenia, in contrast to HC, did not adjust their effort to match task difficulty. Confidence was minimally related to task performance in patients but was associated with more rapid decisions in HC, across both correct and incorrect responses. Performance on social cognitive measures was minimally related to self-reports of social functioning in both samples. These data suggest global self-assessments are based on multiple factors, with confidence affecting self-assessments in the absence of feedback about performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scog.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889550PMC
March 2020

Autistic symptoms predict social cognitive performance in patients with schizophrenia.

Schizophr Res 2020 01 25;215:113-119. Epub 2019 Nov 25.

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Miami VA Healthcare System, USA. Electronic address:

Schizophrenia spectrum disorders and Autism Spectrum Disorders (ASD) share many similarities. Among those features, social cognitive impairment is recognized as a key characteristic of both ASD and schizophrenia. In this study, the role of ASD symptoms, measured with the PANSS Autism Severity Score (PAUSS), was investigated as a predictor of social cognitive performance in patients with Schizophrenia spectrum disorders. Existent databases from 2 studies (SCOPE Phase 3 and SCOPE Phase 5), in which a total of 361 patients (mean age 41.7 years; 117 females) were assessed with tests of mental state attribution and emotion recognition, were analyzed. Less severe ASD symptoms, as well as younger age, better premorbid IQ, and neurocognition were identified as individual predictors of better social cognitive performance. These results suggest a role of ASD symptoms in affecting social cognitive performance in schizophrenia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.schres.2019.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035981PMC
January 2020

Depression predicts self assessment of social function in both patients with schizophrenia and healthy people.

Psychiatry Res 2020 02 6;284:112681. Epub 2019 Nov 6.

Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA; Research Service, Miami VA Healthcare System, Miami, FL, USA. Electronic address:

Background: Impairments in social functioning are central to Schizophrenia (SCZ). Patients with SCZ have challenges in the ability to evaluate their functioning. A correlate of self-assessments in SCZ is depression, wherein negligible depression predicts overestimation. Healthy individuals misestimate their functioning, but mild dysthymia predicts accuracy. We examined depression, gender, and schizophrenia as predictors of self-reported everyday functioning.

Methods: 218 people with SCZ and 154 healthy controls self-reported their social functioning. They self-reported their depression with the Beck Depression Inventory (BDI) and their social cognitive ability on the Observable Social Cognition Rating Scale (OSCARS).

Results: 64% of subjects were male. Schizophrenia patients reported more depression, poorer social functioning, and worse social cognition. Linear regression analyses revealed significant correlations between self-reported social functioning and BDI scores, which also predicted self-reported social cognition. There was no significant effect of sex on self-reports of social functioning or social cognition. Finally, when BDI and OSCARS were directly compared to diagnosis and sex for prediction of self-reported social functioning, there was no impact of diagnosis or sex.

Implications: Self-reported interpersonal functioning is determined by current depression. Both healthy people and people with schizophrenia index their social functioning and their social cognitive by their level of depression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2019.112681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012719PMC
February 2020

Correlates of loneliness among persons with psychotic disorders.

Soc Psychiatry Psychiatr Epidemiol 2020 May 30;55(5):549-559. Epub 2019 Oct 30.

Department of Psychology and Neuroscience, University of North Carolina, 235 E. Cameron Avenue, 258 Davie Hall, Chapel Hill, NC, 27599, USA.

Introduction: Persons diagnosed with schizophrenia spectrum disorders (SSDs) often experience pervasive feelings of loneliness, which are considered a significant barrier to treatment and recovery.

Aim: As impaired social cognition may contribute to increased loneliness and less skillful social interactions, this study examines the relationships between loneliness and measures of social cognition and functional outcome from the Social Cognition Psychometric Evaluation (SCOPE) study.

Methods: This study evaluated the relationship between loneliness, social cognitive ability, and social functioning in the context of a large-scale psychometric investigation. We also explored the associations of select demographic characteristics and clinical variables on the endorsement of loneliness in persons diagnosed with a psychotic disorder.

Results: Seventy-four stable outpatients with SSDs and 58 healthy controls completed the UCLA Loneliness Scale in addition to the standard SCOPE battery. Our findings support prior research indicating persons diagnosed with a psychotic disorder experience greater levels of loneliness than normative groups. However, the results also indicate that self-reported loneliness is not associated with social cognitive abilities or functional outcome in psychosis. Regression analyses indicate that roughly half the variance in loneliness endorsed by persons with SSDs is accounted for by clinical variables, with loneliness most strongly associated with guilt and self-esteem.

Conclusion: These findings suggest that treatments aiming to reduce perceived social isolation in psychosis should incorporate techniques to bolster selfesteem, reduce guilt, and improve depressive symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00127-019-01789-5DOI Listing
May 2020

Comprehensive comparison of social cognitive performance in autism spectrum disorder and schizophrenia.

Psychol Med 2020 11 2;50(15):2557-2565. Epub 2019 Oct 2.

School of Behavioral and Brain Sciences, The University of Texas At Dallas, Richardson, TX, USA.

Background: Autism spectrum disorder (ASD) and schizophrenia (SCZ) are separate neurodevelopmental disorders that are both characterized by difficulties in social cognition and social functioning. Due to methodological confounds, the degree of similarity in social cognitive impairments across these two disorders is currently unknown. This study therefore conducted a comprehensive comparison of social cognitive ability in ASD and SCZ to aid efforts to develop optimized treatment programs.

Methods: In total, 101 individuals with ASD, 92 individuals with SCZ or schizoaffective disorder, and 101 typically developing (TD) controls, all with measured intelligence in the normal range and a mean age of 25.47 years, completed a large battery of psychometrically validated social cognitive assessments spanning the domains of emotion recognition, social perception, mental state attribution, and attributional style.

Results: Both ASD and SCZ performed worse than TD controls, and very few differences were evident between the two clinical groups, with effect sizes (Cohen's d) ranging from 0.01 to 0.34. For those effects that did reach statistical significance, such as greater hostility in the SCZ group, controlling for symptom severity rendered them non-significant, suggesting that clinical distinctions may underlie these social cognitive differences. Additionally, the strength of the relationship between neurocognitive and social cognitive performance was of similar, moderate size for ASD and SCZ.

Conclusions: Findings largely suggest comparable levels of social cognitive impairment in ASD and SCZ, which may support the use of existing social cognitive interventions across disorders. However, future work is needed to determine whether the mechanisms underlying these shared impairments are also similar or if these common behavioral profiles may emerge via different pathways.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0033291719002708DOI Listing
November 2020

A Pilot Digital Intervention Targeting Loneliness in Youth Mental Health.

Front Psychiatry 2019 23;10:604. Epub 2019 Aug 23.

School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.

Loneliness is an emerging issue for young people, but yet many interventions to address loneliness in this group focus on providing social opportunities. While these sorts of interventions may appear to increase social connections, loneliness is more related to quality rather than quantity of social relationships. Thus, interventions addressing loneliness should focus on maximizing the quality of current relationships. Together with youth consumers both with mental ill health and those without, we developed a digital smartphone application (app) called +Connect. The 6-week program delivers positive psychology content designed to improve relationship quality. We tested the acceptability, feasibility, and safety of the program in lonely young people with or without a mental health diagnosis of social anxiety disorder. We used a mixed method study design to triangulate pilot quantitative and qualitative data in young people with and without social anxiety disorder (SAD). Nine participants with a diagnosis of social anxiety disorder ( = 21.00; = 1.41) and 11 participants with no mental health conditions ( = 20.36; = 2.16) completed the +Connect digital intervention. Those with social anxiety disorder reported less acceptable ratings on outcomes. Feasibility ratings, measured by uptake and app completion, met threshold criteria in both groups. Those with social anxiety disorder yielded more attrition, with almost double the attrition rate compared with those without the disorder. There were no safety issues elicited during the pilot study. In terms of outcomes, exploratory analyses indicated that the app itself is likely to be beneficial rather than cause harm. Our qualitative data indicated both groups reported no negative outcomes and noted that positive outcomes were driven by three processes: reflection, learning, and real-life application. Further exploratory data on usability indicated room for improvement in terms of giving more support for different components of the app (i.e., challenges). The pilot findings of this proof-of-concept app indicates some promise in terms of a second iterative version of +Connect.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyt.2019.00604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716464PMC
August 2019

Pathways to functional outcomes in schizophrenia spectrum disorders: Meta-analysis of social cognitive and neurocognitive predictors.

Neurosci Biobehav Rev 2019 10 12;105:212-219. Epub 2019 Aug 12.

University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC 27599, USA; Australian Catholic University, School of Behavioural and Health Sciences, Melbourne, VIC, Australia.

The current meta-analysis explored relationships between functional outcomes in schizophrenia spectrum disorders and different domains of neurocognition and social cognition. Literature searches were conducted in PsycINFO, PubMed, and ProQuest to identify articles reporting correlations between cognition domains and functional outcomes. Of 1361 articles identified, 166 met all inclusion criteria (12,868 participants; 518 correlations). Fifty-three random-effects meta-analyses yielded mean correlation estimates for relationships between neurocognition and social cognition and functional outcomes. Overall, associations between social cognition and neurocognition, and functional outcomes demonstrated significant small-to-medium effect sizes. Social cognition explained more unique variance in functioning than neurocognition (7.3% vs. 4.4%; 9.2% total average variance). Social cognition also mediated the relationship between neurocognition and functional outcomes. A significant proportion of the variance in the relationships between cognition and functional outcomes remained unexplained. These findings suggest that integrated interventions targeting both neurocognition and social cognition may optimally improve functional outcomes. Standardized measurement of cognition and functioning, longitudinal studies, and tests of additional moderators (e.g., first episode samples) in future research were identified as important future directions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neubiorev.2019.07.020DOI Listing
October 2019

Using Optical Coherence Tomography to Make Needle Biopsies Safer.

Neurosurgery 2019 08;85(2):E212-E213

Department of Neurosurgery Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyz170DOI Listing
August 2019

The therapeutic alliance in individual resiliency training for first episode psychosis: Relationship with treatment outcomes and therapy participation.

J Consult Clin Psychol 2019 Aug 20;87(8):734-744. Epub 2019 Jun 20.

Department of Psychology and Neuroscience.

Objective: The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP).

Method: The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes.

Results: Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment.

Conclusions: A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/ccp0000418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625906PMC
August 2019

Prolactinomas and nonfunctioning adenomas: preoperative diagnosis of tumor type using serum prolactin and tumor size.

J Neurosurg 2019 Jun 14:1-8. Epub 2019 Jun 14.

2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.

Objective: Prolactinoma and nonfunctioning adenoma (NFA) are the most common sellar pathologies, and both can present with hyperprolactinemia. There are no definitive studies analyzing the relationship between the sizes of prolactinomas and NFAs and the serum prolactin level. Current guidelines for serum prolactin level cutoffs to distinguish between pathologies are suboptimal because they fail to consider the adenoma volume. In this study, the authors attempted to describe the relationship between serum prolactin level and prolactinoma volume. They also examined the predictive value that can be gained by considering tumor volume in differentiating prolactinoma from NFA and provide cutoff values based on a large sample of patients.

Methods: A retrospective analysis of consecutive patients with prolactinomas (n = 76) and NFAs (n = 217) was performed. Patients were divided into groups based on adenoma volume, and the two pathologies were compared.

Results: A strong correlation was found between prolactinoma volume and serum prolactin level (r = 0.831, p < 0.001). However, there was no significant correlation between NFA volume and serum prolactin level (r = -0.020, p = 0.773). Receiver operating characteristic curve analysis of three different adenoma volume groups was performed and resulted in different serum prolactin level cutoffs for each group. For group 1 (≤ 0.5 cm3), the most accurate cutoff was 43.65 μg/L (area under the curve [AUC] = 0.951); for group 2 (> 0.5 to 4 cm3), 60.05 μg/L (AUC = 0.949); and for group 3 (> 4 cm3), 248.15 μg/L (AUC = 1.0).

Conclusions: Prolactinoma volume has a significant impact on serum prolactin level, whereas NFA volume does not. This finding indicates that the amount of prolactin-producing tissue is a more important factor regarding serum prolactin level than absolute adenoma volume. Hence, volume should be a determining factor to distinguish between prolactinoma and NFA prior to surgery. Current serum prolactin threshold level guidelines are suboptimal and cannot be generalized across all adenoma volumes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2019.3.JNS19121DOI Listing
June 2019