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ABSTRACT: ObjectiveTo examine the nature and clinical correlates of insight in first-episode schizophrenia, and how these differ from findings
in established schizophrenia.
MethodInsight (and insight dimensions), clinical symptoms, neurocognitive function and social function were assessed in 94 patients
with first-episode schizophrenia or schizophreniform disorder according to DSM-IV criteria.
ResultsGreater global insight was associated with more severe depression. Poor overall insight was associated significantly with
more severe negative and disorganisation symptoms as well as poor working memory, and at a trend level with lower current
IQ. Patients with poor insight perceived themselves to have a better level of independent performance at daily living activities.
ConclusionIn first-episode psychosis, the clinical correlates of poor insight are similar to those reported for established schizophrenia.
Those patients with greater insight may be at risk of depression. The complex relationships between insight, positive and
negative symptoms, neurocognitive dysfunction and social function may reflect the multidimensional nature of insight.
European Archives of Psychiatry and Clinical Neuroscience 04/2012; 256(6):356-363. · 3.49 Impact Factor
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ABSTRACT: During recognition memory tests participants' pupils dilate more when they view old items compared to novel items. We sought to replicate this "pupil old/new effect" and to determine its relationship to participants' responses. We compared changes in pupil size during recognition when participants were given standard recognition memory instructions, instructions to feign amnesia, and instructions to report all items as new. Participants' pupils dilated more to old items compared to new items under all three instruction conditions. This finding suggests that the increase in pupil size that occurs when participants encounter previously studied items is not under conscious control. Given that pupil size can be reliably and simply measured, the pupil old/new effect may have potential in clinical settings as a means for determining whether patients are feigning memory loss.
Memory 05/2011; 19(4):398-405. · 2.09 Impact Factor
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ABSTRACT: Studies of established schizophrenia have consistently found that cognitive function predicts social and clinical outcomes. The findings from first-episode studies have been more variable, with only some studies reporting predictive relationships. We tested the possibility that an index of general cognitive ability, IQ, may be a more sensitive and reliable predictor of outcome in first-episode schizophrenia than specific measures of memory and executive function. Fifty-four patients with first-episode schizophrenia or schizoaffective disorder were assessed for cognitive and social function as well as symptoms at three time points over the four years following first presentation of their psychotic illness. Regression analyses were performed to determine whether IQ and specific neuropsychological measures at first episode and one-year follow-up predicted four-year social function and residual symptoms. The effects of premorbid and concurrent IQ on outcome were also assessed. Premorbid IQ and IQ at each assessment significantly predicted social function at four-year follow-up. This relationship remained significant after the social function or symptom scores at first presentation were accounted for in the regression. Specific measures predicted certain domains of social function, but these were weaker and less consistent than IQ. The predictive values of cognition on residual symptoms were less strong; the most consistent finding was a relationship between IQ and the negative syndrome. This study suggests that early in the course of schizophrenia, general cognitive ability, as measured by IQ, is a more sensitive and reliable predictor of functional outcome than measures of specific ability.
Schizophrenia Research 10/2008; 107(1):55-60. · 4.75 Impact Factor
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ABSTRACT: In first-episode schizophrenia, longer duration of untreated psychosis (DUP) predicts poorer outcomes.
To address whether the relationship between DUP and outcome is a direct causal one or the result of association between symptoms and/or cognitive functioning and social functioning at the same time point.
Symptoms, social function and cognitive function were assessed in 98 patients with first-episode schizphrenia at presentation and 1 year later.
There was no significant clinical difference between participants with short and long DUP at presentation. Linear regression analyses revealed that longer DUP significantly predicted more severe positive and negative symptoms and poorer social function at 1 year, independent of scores at presentation. Path analyses revealed independent direct relationships between DUP and social function, core negative symptoms and positive symptoms. There was no significant association between DUP and cognition.
Longer DUP predicts poor social function independently of symptoms. The findings underline the importance of taking account of the phenomenological overlap between measures of negative symptoms and social function when investigating the effects of DUP.
The British Journal of Psychiatry 10/2008; 193(3):203-9. · 6.62 Impact Factor
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ABSTRACT: Research suggests that a person's emotion recognition declines with advancing years. We examined whether or not this age-related decline was attributable to a tendency to overlook emotion information in the eyes. In Experiment 1, younger adults were significantly better than older adults at inferring emotions from full faces and eyes, though not from mouths. Using an eye tracker in Experiment 2, we found young adults, in comparison with older adults, to have superior emotion recognition performance and to look proportionately more to eyes than mouths. However, although better emotion recognition performance was significantly correlated with more eye looking in younger adults, the same was not true in older adults. We discuss these results in terms of brain changes with age.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 02/2007; 62(1):P53-60. · 2.62 Impact Factor
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ABSTRACT: To examine the nature and clinical correlates of insight in first-episode schizophrenia, and how these differ from findings in established schizophrenia.
Insight (and insight dimensions), clinical symptoms, neurocognitive function and social function were assessed in 94 patients with first-episode schizophrenia or schizophreniform disorder according to DSM-IV criteria.
Greater global insight was associated with more severe depression. Poor overall insight was associated significantly with more severe negative and disorganisation symptoms as well as poor working memory, and at a trend level with lower current IQ. Patients with poor insight perceived themselves to have a better level of independent performance at daily living activities.
In first-episode psychosis, the clinical correlates of poor insight are similar to those reported for established schizophrenia. Those patients with greater insight may be at risk of depression. The complex relationships between insight, positive and negative symptoms, neurocognitive dysfunction and social function may reflect the multidimensional nature of insight.
European Archives of Psychiatry and Clinical Neuroscience 10/2006; 256(6):356-63. · 3.49 Impact Factor
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ABSTRACT: Many forms of human conditioned behaviour depend upon explicit knowledge of the predictive contingency between stimuli, responses and the reinforcer. However, it remains uncertain whether the conditioning of three key behaviours in drug addiction-selective attention, instrumental drug-seeking behaviour and emotional state--are dependent upon contingency knowledge. To test this possibility, we employed an avoidance procedure to generate rapidly these three forms of conditioned behaviour without incurring the methodological problems of drug conditioning.
In two experiments, participants (16 students) were trained on a schedule in which one stimulus (S +) predicted the occurrence of a startling noise, which could be cancelled by performing an instrumental avoidance response.
The allocation of attention to the S + and the rate and probability of the avoidance response in the presence of S + were measured. Following training, participants were tested for their knowledge of the stimulus-noise contingencies arranged in the study and rated the emotional qualities of the stimuli.
Both experiments showed that S + gained control of selective attention, instrumental avoidance behaviour and subjective anxiety, but only in participants who reported explicit knowledge of the Pavlovian contingency between the S + and the startling noise.
The implication of the present findings is that the control of selective attention, instrumental drug-seeking behaviour and emotional state by drug-paired stimuli is mediated by cognitive knowledge of the predictive contingency between the stimulus and the drug.
Addiction 09/2006; 101(8):1153-66. · 4.31 Impact Factor
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ABSTRACT: It has been suggested that drug-paired stimuli (S+) control addictive behaviour by eliciting an explicit mental representation or expectation of drug availability.
The aim of the present study was to test this hypothesis by determining whether the behavioural control exerted by a tobacco-paired S+ in human smokers would depend upon the S+ eliciting an explicit expectation of tobacco.
In each trial, human smokers (n=16) were presented with stimuli for which attention was measured with an eyetracker. Participants then reported their cigarette reward expectancy before performing, or not, an instrumental tobacco-seeking response that was rewarded with cigarette gains if the S+ had been presented or punished with cigarette losses if the S- had been presented. Following training, participants rated the pleasantness of stimuli.
The S+ only brought about conditioned behaviour in an aware group (those who expected the cigarette reward outcome when presented with the S+). This aware group allocated attention to the S+, performed the instrumental tobacco-seeking response selectively in the presence of the S+ and rated the S+ as pleasant. No conditioned behaviour was seen in the unaware group (those who did not expect the cigarette reward outcome in the presence of the S+).
Drug-paired stimuli control selective attention, instrumental drug-seeking behaviour and positive emotional state by eliciting an explicit expectation of drug availability.
Psychopharmacologia 06/2006; 185(4):495-504. · 4.08 Impact Factor
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ABSTRACT: Substance use may be a risk factor for the onset of schizophrenia.
To examine the association between substance use and age at onset in substance use and age at onset in a UK, inner-city sample of people with recent-onset schizophrenia.
The study sample consisted of 152 people recruited to the West London First-Episode Schizophrenia Study. Self-reported data on drug and alcohol use, as well as information on age at onset of psychosis, were collected. Mental state, cognition (IQ, memory and executive function) and social function were also assessed.
In total, 60% of the participants were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use (not including alcohol), and 68% reported lifetime substance use (cannabis and psychostimulants were most commonly used). Cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs.
The strong association between self-reported cannabis use and earlier onset of psychosis provides further evidence that schizophrenia may be precipitated by cannabis use and/or that the early onset of symptoms is a risk factor for cannabis use.
The British Journal of Psychiatry 04/2006; 188:237-42. · 6.62 Impact Factor
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ABSTRACT: Studies of chronic schizophrenia suggest that there are subgroups with different profiles of cognitive impairment.
To determine whether such heterogeneity is present at illness onset and any relationship to clinical variables.
Ninety-three community patients with first-episode schizophrenia and 50 healthy volunteers were assessed for premorbid (Revised National Adult Reading Test) and current IQ, memory and executive function.
Half of those with schizophrenia had preserved IQ in the normal range but there was evidence of a specific impairment in spatial working memory even in those with high/average IQ; 37 out of 93 (40%) had generalised cognitive decline. Those with low premorbid IQ were significantly younger at illness onset. For the entire group, age at onset correlated positively with premorbid but not current IQ.
At illness onset, cognitive heterogeneity is present in people with schizophrenia, with a high proportion having undergone general cognitive decline. However, working memory impairment may be a common feature. Lower premorbid IQ is a risk factor for an earlier onset.
The British Journal of Psychiatry 01/2006; 187:516-22. · 6.62 Impact Factor
