[Show abstract][Hide abstract] ABSTRACT: Negative symptoms are a core feature of schizophrenia and have been grouped into two factors: a motivational factor, which we refer to as apathy, and a diminished expression factor. Recent studies have shown that apathy is closely linked to functional outcome. However, knowledge about its mechanisms and its relation to decision-making is limited. In the current study, we examined whether apathy in schizophrenia is associated with predecisional deficits, that is, deficits in the generation of options for action. We applied verbal protocol analysis to investigate the quantity of options generated in ill-structured real world scenarios in 30 patients with schizophrenia or schizoaffective disorder and 21 healthy control participants. Patients generated significantly fewer options than control participants and clinical apathy ratings correlated negatively with the quantity of generated options. We show that the association between measures of psychopathology and option generation is most pronounced in regard to apathy symptoms and that it is only partially mediated by deficits in verbal fluency. This study provides empirical support for dysfunctional option generation as a possible mechanism for apathy in schizophrenia. Our data emphasize the potential importance of predecisional stages in the development and persistence of apathy symptoms in neuropsychiatric disorders and might also inform the development of novel treatment options in the realm of cognitive remediation.
Journal of Abnormal Psychology 01/2015; DOI:10.1037/abn0000048 · 4.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is growing evidence that reward processing is disturbed in schizophrenia. However, it is uncertain whether this dysfunction predates or is secondary to the onset of psychosis. Studying 21 unmedicated persons at risk for psychosis plus 24 healthy controls (HCs) we used a incentive delay paradigm with monetary rewards during functional magnetic resonance imaging. During processing of reward information, at-risk individuals performed similarly well to controls and recruited the same brain areas. However, while anticipating rewards, the high-risk sample exhibited additional activation in the posterior cingulate cortex, and the medio-and superior frontal gyrus, whereas no significant group differences were found after rewards were administered. Importantly, symptom dimensions were differentially associated with anticipation and outcome of the reward. Positive symptoms were correlated with the anticipation signal in the ventral striatum (VS) and the right anterior insula (rAI). Negative symptoms were inversely linked to outcome-related signal within the VS, and depressive symptoms to outcome-related signal within the medial orbitofrontal cortex (mOFC). Our findings provide evidence for a reward-associated dysregulation that can be compensated by recruitment of additional prefrontal areas. We propose that stronger activations within VS and rAI when anticipating a reward reflect abnormal processing of potential future rewards. Moreover, according to the aberrant salience theory of psychosis, this may predispose a person to positive symptoms. Additionally, we report evidence that negative and depressive symptoms are differentially associated with the receipt of a reward, which might demonstrate a broader vulnerability to motivational and affective symptoms in persons at-risk for psychosis.
[Show abstract][Hide abstract] ABSTRACT: Cognitive remediation is a promising pathway for ameliorating cognitive impairment of patients with schizophrenia. Here, we investigate predictors of improvement in problem-solving ability for two different types of cognitive remediation - specific problem-solving training and training of basic cognition. For this purpose we conducted a re-analysis of a randomized controlled trial comparing these two training approaches. The main outcome measure was improvement in problem-solving performance. Correlational analyses were used to assess the contribution of clinical, cognitive and training-related predictors. In the problem-solving training group, impaired pre-training planning ability was associated with stronger improvement. In contrast, in the basic cognition training group antipsychotic medication dose emerged as a negative predictor. These results demonstrate that predictors for successful cognitive remediation depend on the specific intervention. Furthermore, our results suggest that at least in the planning domain patients with impaired performance benefit particularly from a specific intervention. (JINS, 2014, 20, 1-6).
Journal of the International Neuropsychological Society 03/2014; DOI:10.1017/S1355617714000162 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Schizophrenia is a chronic disorder, which severely limits the social and occupational functioning. Employment, education, relationships, housing and health are among the most frequently stated life and treatment goals among persons suffering from schizophrenia. Rehabilitation for persons with schizophrenia aims at preservation and improvement of psychosocial functions in areas such as work, social relationship and independent living skills, promotes recovery-oriented interventions and, therefore, serves the central goals of affected persons. Cognitive functioning, education, negative symptoms, social support and skills, age, work history, and rehabilitation service to restore community functioning have proven to be strong predictors for successful psychiatric rehabilitation. It makes sense to concentrate on these predictors when improvement of psychiatric rehabilitation is targeted. Cognitive remediation produces moderate improvements in cognitive performance and, when combined with functional training and embedded in comprehensive psychiatric rehabilitation, also enhances functional outcome. Germany provides a highly differentiated system of psychosocial support for schizophrenic patients. However, the "German disease" with different care providers being in charge in subsequent stages of recovery hampers efficient organisation of psychiatric rehabilitation. Improvement of overall organisation, i. e., configuration of interfaces, understanding of the complex interactions of measures, design of disease specific programmes, research and economic evaluation constitute major challenges in the field of psychiatric rehabilitation.
[Show abstract][Hide abstract] ABSTRACT: Although the effects of caffeine on basic cognitive functions are well-known, its effects on more complex decision making, particularly on option generation, is yet to be explored.
We examined the effects of caffeine on option generation in decision making using everyday life decisional situations.
In a double-blind placebo-controlled experiment, participants (N = 47) either received 300 mg of caffeine or a placebo. Participants had to generate choice options (things they could do) for a series of high and low familiar real-world scenarios and, subsequently, to decide among these options.
Analyses revealed that participants in the caffeine condition generated significantly fewer options than participants in the placebo condition. Moreover, caffeine significantly reduced the option generation onset time, that is, participants in the caffeine condition generated their first option significantly faster than participants in the placebo condition. Regarding subsequent choice, we found evidence supporting the "take-the-first" heuristic, that is, the tendency to select the first generated option. This tendency was neither affected by caffeine nor by the familiarity of the scenarios.
Caffeine results in fewer options generated in unconstrained real-life decision-making situations and decreases generation onset times.
[Show abstract][Hide abstract] ABSTRACT: Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with "heavy user" profiles. These individuals oftentimes change their residence and are extensively hospitalized on acute psychiatric wards. To date, little is known about the needs of providers of sheltered and supported housing concerning cooperation with psychiatric hospitals and support by psychiatric services.
An explorative survey was conducted among the sheltered and supported housing facilities in the canton of Zurich. A short questionnaire was distributed among all 140 institutions in written form. The responses were analyzed thematically with respect to four predefined categories.
Fifty-six institutions providing 1,600 places (about 50 % of the capacity in the canton of Zurich) responded. Experiences and problems with the focus group of residents as well as causes for problematic courses are described. A sound working routine with the psychiatric hospitals was considered as a precondition for the provision of high quality housing support. The needs concerned regular and flexible cooperation with psychiatric hospitals as well as open communication in particular at discharge from the clinic and intake at the housing facility.
Concentration of competencies and knowledge within psychiatric hospitals about sheltered housing institutions and their needs could improve service provision and may result in higher certitude of housing facilities. Thereby, their ability to manage patients with severe mental illness could be improved and extensive hospitalization of individuals from this group could be reduced.
Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 02/2014; DOI:10.1007/s40211-014-0099-5 · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: When humans and other animals make decisions in their natural environments prospective rewards have to be weighed against costs. It is well established that increasing costs lead to devaluation or discounting of reward. While our knowledge about discount functions for time and probability costs is quite advanced, little is known about how physical effort discounts reward. In the present study we compared three different models in a binary choice task in which human participants had to squeeze a handgrip to earn monetary rewards: a linear, a hyperbolic, and a parabolic model. On the group as well as the individual level, the concave parabolic model explained most variance of the choice data, thus contrasting with the typical hyperbolic discounting of reward value by delay. Research on effort discounting is not only important to basic science but also holds the potential to quantify aberrant motivational states in neuropsychiatric disorders.
[Show abstract][Hide abstract] ABSTRACT: Most empirical studies on decision-making start from a set of given options for action. However, in everyday life there is usually no one asking you to choose between A, B, and C. Recently, the question how people come up with options has been receiving growing attention. However, so far there has been neither a systematic attempt to define the construct of "option" nor an attempt to show why decision-making research really needs this construct. This paper aims to fill that void by developing definitions of "option" and "option generation" that can be used as a basis for decision-making research in a wide variety of decision-making settings, while clarifying how these notions relate to familiar psychological constructs. We conclude our analysis by arguing that there are indeed reasons to believe that option generation is an important and distinct aspect of human decision-making.
Frontiers in Psychology 08/2013; 4:555. DOI:10.3389/fpsyg.2013.00555 · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study investigated the specificity of planning impairments in schizophrenia compared to unipolar major depression. Multiple measures of planning ability were employed to assess the task independence of a planning deficit. Furthermore, the predictive power of planning ability with regard to functional outcome was analyzed. A total of 80 participants completed a comprehensive neuropsychological assessment with an emphasis on executive functions and planning ability. The sample consisted of 28 patients with schizophrenia, 28 patients with depression and 24 healthy controls. Both patient groups were impaired on measures of attention, working memory and planning, but only planning ability differentiated between patient groups. The deficit was evident across different measures of planning ability and was the best overall predictor of functional outcome. These results provide evidence for the relative specificity of a planning deficit in schizophrenia and show that the deficit is not task-specific but likely affects central cognitive control processes critical for planned behavior. The observed relation to functional outcome supports the clinical relevance of planning ability.
Schizophrenia Research 07/2013; DOI:10.1016/j.schres.2013.06.018 · 4.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Decision-making research has thoroughly investigated how people choose from a set of externally provided options. However, in ill-structured real-world environments, possible options for action are not defined by the situation but have to be generated by the agent. Here, we apply behavioral analysis (Study 1) and functional magnetic resonance imaging (Study 2) to investigate option generation and subsequent choice. For this purpose, we employ a new experimental task that requires participants to generate options for simple real-world scenarios and to subsequently decide among the generated options. Correlational analysis with a cognitive test battery suggests that retrieval of options from long-term memory is a relevant process during option generation. The results of the fMRI study demonstrate that option generation in simple real-world scenarios recruits the anterior prefrontal cortex. Furthermore, we show that choice behavior and its neural correlates differ between self-generated and externally provided options. Specifically, choice between self-generated options is associated with stronger recruitment of the dorsal anterior cingulate cortex. This impact of option generation on subsequent choice underlines the need for an expanded model of decision making to accommodate choice between self-generated options.
[Show abstract][Hide abstract] ABSTRACT: The acceptance and use of long-acting depot antipsychotics has been shown to be influenced by the attitudes of patients and clinicians. Depot treatment rates are low across countries and especially patients with first-episode psychosis are rarely treated with depot medication. The aim of this article was to review the literature on patients' and clinicians' attitudes towards long-acting depot antipsychotics in subjects with first-episode psychosis.
A systematic search of Medline, Embase, PsycINF and Google Scholar was conducted. Studies were included if they reported original data describing patients' and clinicians' attitudes towards long-acting depot antipsychotic in subjects with first-episode psychosis.
Six studies out of a total of 503 articles met the inclusion criteria. Four studies conveyed a negative and two a positive opinion of clinicians toward depot medication. No systematic study directly addressed the attitude of patients with first-episode psychosis. Psychiatrists frequently presume that patients with first-episode psychosis would not accept depot medication and that depots are mostly eligible for chronic patients.
Full information of all patients especially those with first episode psychosis in a therapeutic relationship that includes shared decision-making processes could reduce the negative image and stigmatization attached to depots.
[Show abstract][Hide abstract] ABSTRACT: Over the past years a growing research effort has investigated the relation between cannabis use and schizophrenia at a neurobiological, epidemiological and clinical level. A number of systematic reviews and meta analyses have summarized the available evidence in the field. Conversely the patient's perception of the link between cannabis use and psychosis has been under investigation. Since patient's beliefs and attitudes strongly correlate with adherence to all forms of treatment, we conducted a systematic PUBMED database search for any English and German-language articles published until January 2012 that addressed patient's perception of a cannabis psychosis link. Six studies including psychotic subjects met inclusion criteria yielding a total sample of 97. The vast majority of patients with either schizophrenia or a recent psychosis disagreed with a causal link between cannabis use and their mental illness. We qualitatively reviewed the explanatory models underlying their views, which were multi-factorial, psychological, social, biological, esoteric and irrational factors. Most patient's believed that the temporal sequence of events did not clearly indicate a causal relationship for them. They thus discarded the hypothesis of a causal link between cannabis use and psychosis. Despite the heterogeneity of the included studies, findings are comparable and support the robustness of this review. Limitations and implications for clinicians and psychosis research are discussed.
Current pharmaceutical design 06/2012; 18(32):5105-12. DOI:10.2174/138161212802884645 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent theories of schizophrenia have proposed a fundamental instability of information processing on a neurophysiological level, which can be measured as an increase in latency variability of event-related potentials (ERPs). If this reflects a fundamental deficit of the schizophrenic illness, it should also occur in high-functioning patients. These patients have also been observed to show a more diffuse activation pattern in neuroimaging studies, which is thought to reflect compensatory processes to maintain task performance. In the present study we investigated temporal variability and spatial diffusion of the visual N2 component in a group of high-functioning patients with preserved cognitive performance. 28 patients with schizophrenia and 28 control participants matched for gender, age and education participated in the study. Subjects performed a visual Go/Nogo task, while event-related potentials were obtained. Trial-to-trial latency variability was calculated with a Wavelet-based method. Patients with schizophrenia showed a robust increase in N2 latency variability at electrodes Fz and Cz in all task conditions. Regarding spatial distribution healthy participants showed a focused fronto-central N2 peak. In contrast, patients with schizophrenia showed a more diffuse pattern and additional negative peaks over lateral electrodes in the Nogo condition. These results clearly show that even in high-functioning patients with schizophrenia a higher temporal variability of ERPs can be observed. This provides support for temporal instability of information processing as a fundamental deficit associated with schizophrenia. The more diffuse scalp distribution might reflect processes that compensate for this instability when cognitive control is required.
Schizophrenia Research 09/2011; 131(1-3):206-13. DOI:10.1016/j.schres.2011.06.020 · 4.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study addresses the question of whether frontal activation in response-inhibition tasks is specifically associated with the suppression of a motor response. An alternative model suggests a role in the detection of behaviorally relevant or salient events. For this purpose, we used functional MRI with an auditory go/no-go paradigm. This paradigm allowed the disentangling of inhibition-related from salience-related effects, which were associated with different frontal regions. Importantly, the right ventrolateral prefrontal cortex consistently showed sensitivity for salience but not for inhibition requirements. This reflects a more general salience-detection mechanism, which is not specific for response-inhibition tasks.
[Show abstract][Hide abstract] ABSTRACT: Negative symptoms have been considered to be specific to schizophrenia or a subtype of schizophrenia: the deficit syndrome. In other words, these symptoms have been considered to be categorically different from other forms of human behavior and experience, whether they occur in healthy persons or patients with other psychiatric disorders. In this paper, we advocate a dimensional approach to negative symptoms, which is supported by two main arguments. First, enduring negative symptoms can even be observed in a variety of psychiatric disorders and they are not specific to schizophrenia. Second, we review evidence that negative symptoms show a continuous distribution from apparently healthy subjects to those with a fully developed clinical syndrome. Although the evidence does not allow for a definite decision concerning the dimensional distribution of negative symptoms, it certainly justifies exploring a dimensional approach with respect to its clinical and scientific utility. Understanding negative symptoms as a variation of normal mental processes will strengthen the development of neurocognitive models and treatment approaches.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to assess whether planning and problem-solving training is more effective in improving functional capacity in patients with schizophrenia than a training program addressing basic cognitive functions.
Eighty-nine patients with schizophrenia were randomly assigned either to a computer assisted training of planning and problem-solving or a training of basic cognition. Outcome variables included planning and problem-solving ability as well as functional capacity, which represents a proxy measure for functional outcome.
Planning and problem-solving training improved one measure of planning and problem-solving more strongly than basic cognition training, while two other measures of planning did not show a differential effect. Participants in both groups improved over time in functional capacity. There was no differential effect of the interventions on functional capacity.
A differential effect of targeting specific cognitive functions on functional capacity could not be established. Small differences on cognitive outcome variables indicate a potential for differential effects. This will have to be addressed in further research including longer treatment programs and other settings.