Article

Assessment of subjective cognitive and emotional effects of antipsychotic drugs. Effect by defect?

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... To address this limitation we carried out a self-report study (Moritz et al., 2013). A 49-item questionnaire, the Effect of Antipsychotic Medication on Emotion and Cognition (EAMEC), was administered to 95 individuals with or without psychosis who all had been prescribed antipsychotic agents. ...
... A 49-item questionnaire, the Effect of Antipsychotic Medication on Emotion and Cognition (EAMEC), was administered to 95 individuals with or without psychosis who all had been prescribed antipsychotic agents. Factor analysis of a subset of 30 items showing a clear association with antipsychotic medication revealed three dimensions: (self-)doubt, cognitive and emotional numbing, and social withdrawal (see also Belmaker and Wald, 1977;Moncrieff et al., 2009;Moritz et al., 2013;Saeedi et al., 2006). Speaking for the validity of the final item set, none of the subscales were correlated with psychopathology, suggesting that the factors reflected symptoms elicited by antipsychotics and not psychopathology. ...
... For the present study, we investigated whether a revised version of the EAMEC questionnaire (Moritz et al., 2013) is sensitive to the acute effects of dopamine in nonclinical participants. We predicted that haloperidol would lead to a reduction of subjective emotionality and cognition and that participants would report greater doubt when under haloperidol. ...
Article
Antipsychotics represent the first-choice treatment for schizophrenia. However, the cognitive and emotional pathways through which symptom reduction is achieved have remained unclear. We recently proposed that the induction of doubt is a core mechanism of action of antipsychotics. In the framework of a randomized, double-blind, placebo-controlled, crossover design, 39 nonclinical participants filled out a questionnaire tapping into cognitive and emotional changes (Effect of Antipsychotic Medication on Emotion and Cognition-revised (EAMEC-r)) each time they had received one of three substances (haloperidol, placebo, L-dopa). Participants reported more doubt under haloperidol than under L-dopa lending support to the theory that antipsychotics decrease delusional conviction via the reduction of confidence. Key points from this study are: (a) antipsychotics induce doubt, and (b) doubt may represent a core mechanism of action for the reduction of delusional ideas.
... The impact of medication on test performance and training effects must always be considered. It has been suggested that antipsychotic medication can generally dampen effects on cognitive test performance (Kane, 2011;Moritz et al., 2013). However, a recent meta--analysis found no difference in cognitive test performance in medicated and drug--naïve SZ (Fatouros--Bergman et al., 2014). ...
... Another issue was that an impact of medication on test performance and learning cannot be ruled out, although evidence for this is diverse: report a significant association between serum anticholinergic activity, MCCB test performance, and cognitive training. Moritz et al. (2013) emphasize the dampening effect of antipsychotic mediation on test performance, while a meta--analysis (Fatouros--Bergman et al., 2014) could not substan-tiate such medication effects. In our study, no relationship between test--performance and amount of medication was found, although potential effects can only be studied by the di-rect comparison of drug--naïve with medicated patients. ...
... Combining a similar training protocol to the one described here with other CRT components, Vinogradov and colleagues realized between 40 and 100 sessions in an outpatient context (e.g.,Fisher et al., 2009Fisher et al., , 2015Hooker et al., 2014;Panizzutti et al., 2013). Finally, the impact of medication on test performance and learning cannot be ruled out, although evidence for this is diverse: report a significant associ-ation between serum anticholinergic activity, MCCB test performance, and TT;Moritz et al. (2013) emphasize the dampening effect of antipsychotic mediation on test performance, while a meta--analysis (Fatouros--Bergman et al., 2014) could not substantiate such medica-tion effects. ...
... For example, neuroimaging studies implicate the cingulate cortex in overconfidence (Chen et al., 2013; Moritz et al., 2006). On a biochemical level, dopamine seems to moderate confidence: hyperdopaminergic transmission may trigger overconfidence (Corlett et al., 2010, p. 360; Lou et al., 2011), while neuroleptic agents blunt confidence according to a recent experimental study (Andreou et al., 2014) as well as self-report investigation (Moritz et al., 2013). Recent models attribute error prediction a central role for explaining the long-held relationship between dopamine and positive symptoms (Fletcher and Frith, 2009; Pankow et al., 2012): spontaneous aberrant dopamine release makes otherwise neutral stimuli salient/meaningful, thereby triggering inferential processes that aim to explain these phenomena. ...
... In other words, participants who improved on paranoia were less certain about their judgments than those whose paranoia worsened or remained the same on the paranoia checklist upon retest. This is in line with the approach adopted by metacognitive training for people with psychosis (MCT), an example of a bias modification program (see also Ross et al., 2011; Waller et al., 2011), which confronts schizophrenia patients with exercises that lure into false and high confident erroneous responses (Moritz et al., 2013, 2010). Patients are encouraged to consider alternative hypotheses, as well as weighing up supporting and disconfirmatory evidence. ...
... While expert assessment is usually favored over self-rating in clinical research (Coyne, 1994), it may also induce biases. For example, participants may not disclose ideas because they fear they could be viewed as strange or repelling by the interviewer (Moritz et al., 2013), or because of distrust (especially in participants high on paranoia). High test retest reliability and good internal consistencies suggest that the quality of the data was high. ...
... Moritz et al. [37] conducted an online survey in which psychotic (n = 69; 3 with BD diagnosis) and nonpsychotic patients (N = 26) taking AP were inquired about the emotional and cognitive effects of these drugs. The survey used the Effect of Antipsychotic Medication on Emotion and Cognition questionnaire (EAMEC), which contains 49 items on the subjective effects of AP. ...
... Finally, although all diagnostic groups reported highest scores of SWN-K (better SRA) throughout follow-up, bipolar patients' well-being improved less than that of the schizophrenics and schizo-affective disorders patients. [37] Online Survey, (EAMEC) 3 psychotic BD patients Sedation, cognitive impairment and emotional flattening due to AP. Non difference between psychotic and non psychotic ...
Article
Background: The term "subjective response to antipsychotic" (SRA) refers to changes in the subjective state experienced due to antipsychotic (AP) exposition that is independent of the therapeutic or physical side effects of these drugs. This dimension of analysis has been extensively explored in schizophrenic disorders, finding that negative SRA is an early and independent predictor of compliance as well as a successful pathway to construct current theoretical frameworks of these disorders. There is an increasing use of AP in bipolar disorders' treatment (BD) but no reviews on the topic have been published to date in this population. The aim of this work is to review published data of SRA in BD patients and to discuss their clinical and theoretical implications. Methods: An extensive search in online databases was performed. Reports were reviewed and included if they described SRA in BD or included instruments aimed to assess it. Reports of cognitive, sexual, motor autonomic side effects were excluded. Findings were summarized in a narrative fashion. Results: Nine reports fulfilled the inclusion criteria and were included in the revision, reporting data from 1282 BD patients. Among these, three were prospective studies and three explored relations between SRA and treatment compliance. Conclusions: There is an asymmetry between the increase in the use of antipsychotics in BD and the lack of data regarding the SRA. Phenomenologically, SRA in BD is similar to that found in schizophrenic subjects. Some of these symptoms may be misdiagnosed as depressive symptoms. The existing data show that SRA has a strong correlation with treatment compliance as well as a promising way to develop theoretical paradigms for these disorders.
... Aktuell erfolgt die Primärbehandlung der Schizophrenie mit Antipsychotika, deren Wirkung in einer Blockade der dopaminergen Neurotransmission begründet liegt. Die emotionalen und kognitiven Wirkmechanismen der Antipsychotika sind bislang noch weitgehend ungeklärt, aber es wird vermutet, dass sie zur Senkung einer erhöhten Urteilssicherheit führen (Andreou et al. 2013;Moritz et al. 2013b) sowie eine emotionale Distanzierung von wahnhaften Überzeugungen bewirken (Mizrahi et al. 2006). Allerdings werden diese Effekte von den Patienten häufig als emotionale Betäubung wahrgenommen (Moritz et al. 2009;Moritz et al. 2013b) und können, v. a. in Kombination mit mangelnder Krankheitseinsicht und weiteren belastenden Nebenwirkungen, zu einer mangelnden Therapieadhärenz führen (Barkhof et al. 2012;Lambert et al. 2010). ...
... Die emotionalen und kognitiven Wirkmechanismen der Antipsychotika sind bislang noch weitgehend ungeklärt, aber es wird vermutet, dass sie zur Senkung einer erhöhten Urteilssicherheit führen (Andreou et al. 2013;Moritz et al. 2013b) sowie eine emotionale Distanzierung von wahnhaften Überzeugungen bewirken (Mizrahi et al. 2006). Allerdings werden diese Effekte von den Patienten häufig als emotionale Betäubung wahrgenommen (Moritz et al. 2009;Moritz et al. 2013b) und können, v. a. in Kombination mit mangelnder Krankheitseinsicht und weiteren belastenden Nebenwirkungen, zu einer mangelnden Therapieadhärenz führen (Barkhof et al. 2012;Lambert et al. 2010). Hinzu kommt, dass durch Antipsychotika in Bezug auf den Rückgang der Positivsymptomatik auch bei verschreibungskonformer Einnahme nur moderate Effektgrößen erreicht werden (Leucht et al. 2009) und eine vollständige Remission selten erfolgt (Jääskeläinen et al. 2013). ...
Article
Hintergrund Die Schizophrenie ist ein komplexes psychiatrisches Störungsbild, dessen Primärbehandlung aktuell mit Antipsychotika erfolgt. Ziel der Arbeit Das Metakognitive Training (MKT), das als Gruppen- und Einzeltraining zur Verfügung steht, hat zum Ziel, den Patienten in spielerischer Atmosphäre für kognitive Verzerrungen, z. B. voreiliges Schlussfolgern oder Unkorrigierbarkeit, denen ein Einfluss bei der Entstehung und Aufrechterhaltung der Schizophrenie zugesprochen wird, zu sensibilisieren. Material und Methode In diesem Beitrag wird ein Überblick über den Hintergrund und die Inhalte des MKT bei Schizophrenie sowie über die aktuelle Forschungslage zum MKT gegeben. Ergebnisse Die Mehrzahl der bislang durchgeführten Studien bestätigt die Effektivität des MKT in Bezug auf Positivsymptomatik und kognitive Verzerrungen. Weitere Forschung ist nötig, um die langfristige Effektivität des MKT zu bestätigen und genauere Kenntnisse über die genauen Wirkmechanismen des MKT zu erhalten. Schlussfolgerungen Das MKT kann als vielversprechende Komplementärmaßnahme zur pharmakologischen Therapie angesehen werden.
... Conventionally, delusional beliefs are treated with antipsychotic agents that act through a blockade of dopaminergic (mainly D2receptor mediated) neurotransmission. While the exact cognitive pathways through which antipsychotics exert their effects have not been fully unraveled, recent data suggest that antipsychotics promote doubt (Andreou, Moritz, Veith, Veckenstedt, & Naber, 2014;Moritz, Andreou, Klingberg, Thoering, & Peters, 2013;Moritz, Woodward, Jelinek, & Klinge, 2008;Moritz, Woodward, & Ruff, 2003) and lead to emotional detachment (Mizrahi et al., 2006). Despite their partial efficacy, discontinuation rates of antipsychotic medication are typically quite high due to several factors such as lack of insight and adverse effects (Byerly, Nakonezny, & Lescouflair, 2007;Lambert et al., 2010;Lieberman et al., 2005). ...
... The training (2 sets of 8 modules each for most language versions) capitalizes on the finding that patients display increased cognitive biases, which according to recent reviews, are putatively involved in the formation and maintenance of psychosis (e.g., Garety & Freeman, 2013;Moritz, Andreou, et al., 2013;Moritz, Veckenstedt, Bohn, Hottenrott, et al., 2013;Moritz, Veckenstedt, Bohn, Köther, et al., 2013). Importantly, patients are often unaware of these biases as well as cognitive impairments (Freeman, 2007;Moritz, Ferahli, & Naber, 2004). ...
... This is not entirely surprising given the fact that the items which compose the PANSS cognitive factor are difficulty in abstract thinking, poor attention and conceptual disorganization [23]. Also, the treatment explains part of the variance in the regression model, and it seems plausible that the treatment and its side effects such as sedation, dizziness, drowsiness can be at least partly responsible for a decreased neurocognitive performance [23,24,25]. ...
... The novel scales for negative symptoms have solved a number of these issues, in particular making a clearer distinction between cognitive performance, disorganization, social functioning and negative symptoms. [25,26] Up to present the research for effective treatments for this particular category of symptoms has not yielded efficient therapies [27,28]. ...
Article
Full-text available
Background and aims The relationship between negative symptoms and cognition in schizophrenia is not clear, inconsistent findings have been reported by multiple authors and meta analyses. The aim of this study was to investigate the relationship between cognition and primary negative symptoms. Methods 67 outpatients diagnosed with schizophrenia were evaluated using PANSS and the NSA-16 scale. Correlation and regression analyses were used in the present study to investigate the relationship between the primary negative symptoms and cognition. Results No relationship was found between the PANSS Cognitive factor and Negative factor, but when investigating the relationship of the Cognitive PANSS factor with the negative symptoms evaluated with the NSA-16 scale, it was shown that there is a significant association between cognition and motor retardation. Conclusions Our study reveals the relative independence of cognitive factor from the global negative domain of the psychopathology, even though the association with motor retardation was clear. These findings also support the need of using appropriate assessment tools in order to gain a more refined understanding of the phenomenology of schizophrenia.
... Most existing antipsychotic medications interact primarily with dopamine D 2 receptors to, theoretically, normalize dopamine signaling. Approximately twothirds of patients, however, are noncompliant or cease taking their neuroleptic medication (Bellack, 2006), typically attributed to serious side effects that include weight gain, diabetes, high cholesterol, extrapyramidal symptoms, sedation, lethargy, and emotional dampening (NIMH, 2010;Moritz et al., 2013). Furthermore, extant antipsychotic drugs have limited efficacy in approximately one-third of patients (Lindenmayer, 2000), and so-called second-generation antipsychotic drugs do not have superior efficacy compared with their firstgeneration predecessors (Lieberman et al., 2005). ...
... *Significantly lower levels of consumption relative to vehicle administration. effects in humans, a side effect that may translate to the oftreported "empty-headed" sensation caused by available antipsychotic drugs (Moritz et al., 2013). It is noteworthy that a recent paper reports that the hypolocomotion effect of clozapine, which is a 5-HT 2A receptor inverse agonist of the canonical 5-HT 2 -G q signaling pathway (Vanover et al., 2004), is mediated by 5-HT 2A receptors (Williams et al., 2012). ...
Article
Full-text available
Development of 5-HT2C agonists for treatment of neuropsychiatric disorders, including psychoses, substance abuse, and obesity, has been fraught with difficulties, because the vast majority of reported 5-HT2C selective agonists also activate 5-HT2A and/or 5-HT2B receptors, potentially causing hallucinations and/or cardiac valvulopathy. Herein is described a novel, potent, and efficacious human 5-HT2C receptor agonist, (-)-trans-(2S,4R)-4-(3'[meta]-bromophenyl)-N,N-dimethyl-1,2,3,4-tetrahydronaphthalen-2-amine ((-)-MBP), that is a competitive antagonist and inverse agonist at human 5-HT2A and 5-HT2B receptors, respectively. In three C57Bl/6 mouse models of drug-induced psychoses ([2,5]-dimethoxy-4-iodoamphetamine elicited head-twitch response, MK-801-induced hyperlocomotion, and amphetamine-induced hyperlocomotion), (-)-MBP has efficacy comparable to the prototypical second-generation antipsychotic drug, clozapine. (-)-MBP, however, does not alter locomotion when administered alone, distinguishing it from clozapine, which suppresses locomotion. Finally, consumption of highly palatable food by mice was not increased by (-)-MBP at a dose that produced at least 50% maximal efficacy in the psychoses models. Compared to (-)-MBP, (+)-MBP was much less active across in vitro affinity and functional assays using mouse and human receptors, and also translated in vivo with comparably lower potency and efficacy. Results indicate a 5-HT2C receptor-specific agonist, such as (-)-MBP, may be pharmacotherapeutic for psychoses, without liability for obesity, hallucinations, heart disease, sedation or motoric disorders.
... Conventionally, delusional beliefs are treated with antipsychotic agents that act through a blockade of dopaminergic (mainly D2receptor mediated) neurotransmission. While the exact cognitive pathways through which antipsychotics exert their effects have not been fully unraveled, recent data suggest that antipsychotics promote doubt (Andreou, Moritz, Veith, Veckenstedt, & Naber, 2014;Moritz, Andreou, Klingberg, Thoering, & Peters, 2013;Moritz, Woodward, Jelinek, & Klinge, 2008;Moritz, Woodward, & Ruff, 2003) and lead to emotional detachment (Mizrahi et al., 2006). Despite their partial efficacy, discontinuation rates of antipsychotic medication are typically quite high due to several factors such as lack of insight and adverse effects (Byerly, Nakonezny, & Lescouflair, 2007;Lambert et al., 2010;Lieberman et al., 2005). ...
... The training (2 sets of 8 modules each for most language versions) capitalizes on the finding that patients display increased cognitive biases, which according to recent reviews, are putatively involved in the formation and maintenance of psychosis (e.g., Garety & Freeman, 2013;Moritz, Andreou, et al., 2013;Moritz, Veckenstedt, Bohn, Hottenrott, et al., 2013;Moritz, Veckenstedt, Bohn, Köther, et al., 2013). Importantly, patients are often unaware of these biases as well as cognitive impairments (Freeman, 2007;Moritz, Ferahli, & Naber, 2004). ...
Article
Full-text available
Opinion statement Metacognitive training (MCT) is a treatment approach aimed at correcting cognitive biases and reducing positive symptoms in nonaffective psychosis. Patients are taught to withhold overconfident and hasty decisions by becoming aware of the fallibility of human cognition and the advantages of balanced and particularly well-founded judgments for (social) decision-making. The present review reports on new findings on cognitive biases in psychosis. While a number of cognitive theories have been corroborated over the years, other assumptions have become more equivocal. We present new studies on the efficacy of MCT, as well as its individualized variant, termed MCT+. Although two recent meta-analyses arrived at somewhat different conclusions, they agree that group MCT exerts a small or small to medium effect. For individualized MCT, the effects are stronger. It seems that patients who fare the best in the group setting are those who already have at least partial insight. If these preconditions are not met, individualized therapy is deemed more beneficial. Dismantling studies are needed to elucidate core mechanisms of change. Recently, the program, which was initially directed at the reduction of positive symptoms only, has been expanded with modules addressing self-esteem and stigma as for many patients these domains represent a high treatment priority.
... Conventionally, delusional beliefs are treated with antipsychotic agents that act through a blockade of dopaminergic (mainly D2receptor mediated) neurotransmission. While the exact cognitive pathways through which antipsychotics exert their effects have not been fully unraveled, recent data suggest that antipsychotics promote doubt (Andreou, Moritz, Veith, Veckenstedt, & Naber, 2014;Moritz, Andreou, Klingberg, Thoering, & Peters, 2013;Moritz, Woodward, Jelinek, & Klinge, 2008;Moritz, Woodward, & Ruff, 2003) and lead to emotional detachment (Mizrahi et al., 2006). Despite their partial efficacy, discontinuation rates of antipsychotic medication are typically quite high due to several factors such as lack of insight and adverse effects (Byerly, Nakonezny, & Lescouflair, 2007;Lambert et al., 2010;Lieberman et al., 2005). ...
... The training (2 sets of 8 modules each for most language versions) capitalizes on the finding that patients display increased cognitive biases, which according to recent reviews, are putatively involved in the formation and maintenance of psychosis (e.g., Garety & Freeman, 2013;Moritz, Andreou, et al., 2013;Moritz, Veckenstedt, Bohn, Hottenrott, et al., 2013;Moritz, Veckenstedt, Bohn, Köther, et al., 2013). Importantly, patients are often unaware of these biases as well as cognitive impairments (Freeman, 2007;Moritz, Ferahli, & Naber, 2004). ...
... This finding can be explained by the hindered ability of some people with psychosis to express themselves (Islam et al., 2010). In addition, some antipsychotics were found to decrease creativity, as antipsychotic treatment appears to be connected to a number of negative subjective effects on cognition and emotion (Moritz et al., 2013). ...
... This issue can be explained by the hampered ability of some people with psychosis to express themselves (Islam et al., 2010). In addition, some antipsychotics were found to decrease creativity, as antipsychotic treatment appears to be connected to a number of negative subjective effects on cognition and emotion (Moritz et al., 2013). Therefore, it is important to consider alternative methods to explore participatory design, namely, using visual aids, inviting artists to aid creative flow, and organising workshops with service users and other experts. ...
Conference Paper
Serious videogames are games that aim to teach, train and/or inform, as well as provide a source of entertainment. These games are designed to engage players in a playful, stimulating manner to achieve a particular goal. Over the past decade, there has been a steady increase in the use of serious videogames for beneficial health reasons, in both physical and mental health domains, due to games’ potential to engage the populations that are typically hard to motivate; one such population being those with a diagnosis of psychosis. However, due to the lack of the research specifically into the serious videogame’s domain for people with psychosis, we will report existing evidence for serious videogames effectiveness in promoting mental health-related outcomes, and their potential to engage and motivate the service user. In addition, we will summarise what factors should be targeted in such a game to promote engagement with self-management, as well as what is potentially the best method to design a serious videogame for psychosis using existing game design frameworks. Inspiration for the serious videogame design and development will be drawn from existing research into serious videogames for physical and other mental health conditions. In addition to the above, this thesis will report views and opinion of key stakeholders and how a game can potentially be tested and researched further. The views and opinions are collected to inform of the best methods to design the serious videogame. We will present the final game design idea at the end of the thesis, along with the future implications and recommendations for practice and the research.
... Antipsychotic medication remains the first-line treatment of psychiatric disorders such as schizophrenia and bipolar mania (Moritz et al, 2013). Despite the reported advantage of second-generation (atypical) antipsychotics (AAPs) over the first-generation (typical) antipsychotics in terms of higher efficacy and better tolerability (Barnes and McPhillips, 1999;Breier et al, 1994;Kane et al, 1988), only moderate symptom reduction (Leucht et al, 2009) and distressing side effects (eg, neurologic, metabolic, emotional) may decrease the quality of life for patients and increase the problem of noncompliance (Moritz et al, 2013;Schimmelmann et al, 2005). ...
... Antipsychotic medication remains the first-line treatment of psychiatric disorders such as schizophrenia and bipolar mania (Moritz et al, 2013). Despite the reported advantage of second-generation (atypical) antipsychotics (AAPs) over the first-generation (typical) antipsychotics in terms of higher efficacy and better tolerability (Barnes and McPhillips, 1999;Breier et al, 1994;Kane et al, 1988), only moderate symptom reduction (Leucht et al, 2009) and distressing side effects (eg, neurologic, metabolic, emotional) may decrease the quality of life for patients and increase the problem of noncompliance (Moritz et al, 2013;Schimmelmann et al, 2005). Therefore, unmet medical needs for the treatment of schizophrenia spectrum disorders exist and novel neuropsychopharmacologic treatment strategies with improved efficacy/side-effect ratios are needed (Breier, 2005;Leucht et al, 2009). ...
Article
Full-text available
Despite advances in treatment of schizophrenia spectrum disorders with atypical antipsychotics (AAPs), there is still need for compounds with improved efficacy/side-effect ratios. Evidence from challenge studies suggests that the assessment of gating functions in humans and rodents with naturally low gating levels might be a useful model to screen for novel compounds with antipsychotic properties. To further evaluate and extend this translational approach, three AAPs were examined. Compounds without antipsychotic properties served as negative control treatments. In a placebo-controlled within-subjects design, healthy males received either single doses of aripiprazole and risperidone (n=28), amisulpride and lorazepam (n=30), or modafinil and valproate (n=30), and placebo. Prepulse inhibiton (PPI) and P50-suppression were assessed. Clinically associated symptoms were evaluated using the SCL-90-R. Aripiprazole, risperidone, and amisulpride increased P50-suppression in low P50 gaters. Lorazepam, modafinil, and valproate did not influence P50-suppression in low gaters. Furthermore, low P50 gaters scored significantly higher on the SCL-90-R than high P50 gaters. Aripiprazole increased PPI in low PPI gaters while modafinil and lorazepam attenuated PPI in both groups. Risperidone, amisulpride, and valproate did not influence PPI. P50-suppression in low gaters appears to be an antipsychotic-sensitive neurophysiologic marker. This conclusion is supported by the association of low P50-suppression and higher clinically associated scores. Furthermore, PPI might be sensitive for atypical mechanisms of antipsychotic medication. The translational model investigating differential effects of AAPs on gating in healthy subjects with naturally low gating can be beneficial for phase I/II development-plans by providing additional information for critical decision-making.Neuropsychopharmacology accepted article preview online, 07 May 2014; doi:10.1038/npp.2014.102.
... Conventionally, delusional beliefs are treated with antipsychotic agents that act through a blockade of dopaminergic (mainly D2receptor mediated) neurotransmission. While the exact cognitive pathways through which antipsychotics exert their effects have not been fully unraveled, recent data suggest that antipsychotics promote doubt (Andreou, Moritz, Veith, Veckenstedt, & Naber, 2014;Moritz, Andreou, Klingberg, Thoering, & Peters, 2013;Moritz, Woodward, Jelinek, & Klinge, 2008;Moritz, Woodward, & Ruff, 2003) and lead to emotional detachment (Mizrahi et al., 2006). Despite their partial efficacy, discontinuation rates of antipsychotic medication are typically quite high due to several factors such as lack of insight and adverse effects (Byerly, Nakonezny, & Lescouflair, 2007;Lambert et al., 2010;Lieberman et al., 2005). ...
... The training (2 sets of 8 modules each for most language versions) capitalizes on the finding that patients display increased cognitive biases, which according to recent reviews, are putatively involved in the formation and maintenance of psychosis (e.g., Garety & Freeman, 2013;Moritz, Andreou, et al., 2013;Moritz, Veckenstedt, Bohn, Hottenrott, et al., 2013;Moritz, Veckenstedt, Bohn, Köther, et al., 2013). Importantly, patients are often unaware of these biases as well as cognitive impairments (Freeman, 2007;Moritz, Ferahli, & Naber, 2004). ...
Article
The present article provides a narrative review of empirical studies on metacognitive training in psychosis (MCT). MCT represents an amalgam of cognitive-behavioral therapy (CBT), cognitive remediation (CRT) and psychoeducation. The intervention is available in either a group (MCT) or individualized (MCT +) format. By sowing the seeds of doubt in a playful and entertaining fashion, the program targets positive symptoms, particularly delusions. It aims to raise patients' awareness for common cognitive traps or biases (e.g., jumping to conclusions, overconfidence in errors, bias against disconfirmatory evidence) that are implicated in the formation and maintenance of psychosis. The majority of studies confirm that MCT meets its core aim, the reduction of delusions. Problems (e.g., potential allegiance effects) and knowledge gaps (i.e., outcome predictors) are highlighted. The preliminary data suggest that the individual MCT format is especially effective in addressing symptoms, cognitive biases and insight. We conclude that MCT appears to be a worthwhile complement to pharmacotherapy and may act as a facilitator to individualized psychotherapy.
... Consequently, it is unclear to what extent antipsychotic medication effects impacted patient performance. This is noteworthy in light of research showing that antipsychotics may be associated with a generally subdued emotional state (Belmaker and Wald, 1977;Fakra et al., 2008;Kapur et al., 2005;Moncrieff et al., 2009;Moritz et al., 2013;Saeedi et al., 2006;Schneider et al., 1992). Given that all patients within the current sample were taking at least one antipsychotic, it is possible they were not sufficiently antagonized by emotional stimuli. ...
... Nevertheless, different medications have been used and all of them may affect cognitive and social cognitive functioning (e.g. [45][46][47]). Lazarus, Cheavens, Festa, & Rosenthal [48]emphasized that the effect of different psychotropic substances may interact with symptoms of both BPD and co-morbid disorders, and may result in potentially opposite effects on performance in social cognitive tasks across subjects. ...
Article
Full-text available
Previous research has suggested that patients meeting criteria for borderline personality disorder (BPD) display altered self-related information processing. However, experimental studies on dysfunctional self-referential information processing in BPD are rare. In this study, BPD patients (N = 30) and healthy control participants (N = 30) judged positive, neutral, and negative words in terms of emotional valence. Referential processing was manipulated by a preceding self-referential pronoun, an other-referential pronoun, or no referential context. Subsequently, patients and participants completed a free recall and recognition task. BPD patients judged positive and neutral words as more negative than healthy control participants when the words had self-reference or no reference. In BPD patients, these biases were significantly correlated with self-reported attributional style, particularly for negative events, but unrelated to measures of depressive mood. However, BPD patients did not differ from healthy control participants in a subsequent free recall task and a recognition task. Our findings point to a negative evaluation bias for positive, self-referential information in BPD. This bias did not affect the storage of information in memory, but may be related to self-attributions of negative events in everyday life in BPD.
... There are disorder-specific factors that can interfere with affective self-report in schizophrenia, and relatives may present with fewer of these factors. For example, antipsychotic use in people with schizophrenia is associated with significantly increased self-reported subjective emotional numbing (Moritz et al., 2013). This could impact the extent to which individuals are emotionally detached and less engaged in a task, and/or inclined to respond the way they think they "should" respond. ...
... Antipsychotics (AP) have been shown to be effective in the treatment of symptoms in several mental disorders, as schizophrenia or bipolar disorder [1,2,3]. However, they cause important side effects that limit compliance with the treatment. ...
Conference Paper
Extrapyramidal symptoms (EPS) associated with antipsychotic medi-cation can provoke severe discomfort and disability. Some instruments have been proposed to assess EPS, but they are not widely used in clinical settings. This paper aims to provide a translational tool for the detection of EPS: lacunarity of patients’ handwritings. Lacunarity is a measure, taken from fractals studies, that describes the spatial complexity of an image. 63 patients and 50 controls partici-pated in the study. Patients were divided into: patients under typical antipsychot-ics, under atypical antipsychotics, and without antipsychotics. Participants were asked to write down a story. The texts were binarized and lacunarity was calcu-lated. Results showed higher heterogeneity in handwritings from all patients groups, relative to the control group. Moreover, handwritings from the patients who were on typicals showed a significantly higher lacunarity than handwritings from patients on atypicals. The lacunarity of written texts appears to be a prom-ising measure for the detection and quantification of EPS.
... As delusions are thought to result from abnormally increased dopaminergic activity, we investigated the effect of dopaminergic manipulation on delusionassociated reasoning biases. We observed that dopamine antagonists (i.e., antipsychotics) reduced overconfidence in errors in healthy participants , and increased subjective doubt in patients with psychotic and other psychiatric disorders (Moritz et al., 2013). Thus, the same neurochemical abnormality, aberrant dopamine activity, might be responsible for abnormalities in both lower-level (sensory perception and salience) and higher-level processing (overconfidence in errors). ...
Article
Full-text available
Delusions are defined as fixed erroneous beliefs that are based on misinterpretation of events or perception, and cannot be corrected by argumentation to the opposite. Cognitive theories of delusions regard this symptom as resulting from specific distorted thinking styles that lead to biased integration and interpretation of perceived stimuli (i.e., reasoning biases). In previous studies, we were able to show that one of these reasoning biases, overconfidence in errors, can be modulated by drugs that act on the dopamine system, a major neurotransmitter system implicated in the pathogenesis of delusions and other psychotic symptoms. Another processing domain suggested to involve the dopamine system and to be abnormal in psychotic disorders is sensory perception. The present study aimed to investigate whether (lower-order) sensory perception and (higher-order) overconfidence in errors are similarly affected by dopaminergic modulation in healthy subjects. Thirty-four healthy individuals were assessed upon administration of l-dopa, placebo, or haloperidol within a randomized, double-blind, cross-over design. Variables of interest were hits and false alarms in an illusory perception paradigm requiring speeded detection of pictures over a noisy background, and subjective confidence ratings for correct and incorrect responses. There was a significant linear increase of false alarm rates from haloperidol to placebo to l-dopa, whereas hit rates were not affected by dopaminergic manipulation. As hypothesized, confidence in error responses was significantly higher with l-dopa compared to placebo. Moreover, confidence in erroneous responses significantly correlated with false alarm rates. These findings suggest that overconfidence in errors and aberrant sensory processing might be both interdependent and related to dopaminergic transmission abnormalities in patients with psychosis.
... The current FDA-approved antipsychotic drugs (APDs) show efficacy in treating positive symptoms (Leucht et al, 2009(Leucht et al, , 2013; however, they have limited efficacy with negative and/or cognitive symptoms (Miyamoto et al, 2012;Citrome, 2014). APDs can induce a wide range of motor, metabolic, cardiovascular, and/or emotional side effects that lower the quality of life and lead to treatment noncompliance (Kroeze et al, 2003;Schimmelmann et al, 2005;Leucht et al, 2013;Moritz et al, 2013). Hence, the development of novel pharmacotherapies that have higher efficacies for treating schizophrenic symptoms and possess a low profile for side effects is urgently needed. ...
Article
Full-text available
Current antipsychotic drugs (APDs) show efficacy with positive symptoms, but are limited in treating negative or cognitive features of schizophrenia. While all currently FDA-approved medications target primarily the dopamine D2 receptor (D2R) to inhibit Gi/o-mediated adenylyl cyclase, a recent study has shown that many APDs affect not only Gi/o- but they can also influence β-arrestin- (βArr) mediated signaling. The ability of ligands to differentially affect signaling through these pathways is termed functional selectivity. We have developed ligands that are devoid of D2R-mediated Gi/o protein signaling, but are simultaneously partial agonists for D2R/βArr interactions. The purpose of present study was to test the effectiveness of UNC9975 or UNC9994 on schizophrenia-like behaviors in phencyclidine-treated or NR1-knockdown hypoglutamatergic mice. We have found the UNC compounds reduce hyperlocomotion in the open field, restore PPI, improve novel object recognition memory, partially normalize social behavior, decrease conditioned avoidance responding, and elicit a much lower level of catalepsy than haloperidol. These preclinical results suggest that exploitation of functional selectivity may provide unique opportunities to develop drugs with fewer side effects, greater therapeutic selectivity, and enhanced efficacy for treating schizophrenia and related conditions than medications that are currently available.Neuropsychopharmacology accepted article preview online, 01 July 2015. doi:10.1038/npp.2015.196.
... Some recent studies suggest that (conventional) antipsychotics impair brain functioning (Ukai et al., 2004;Ho et al., 2011;Gasso et al., 2012), which in turn hampers neurocognition. While antipsychotic-induced cognitive deficits are clearly non-desired and thus usually considered a side-effect, there is emerging, albeit not yet conclusive, evidence that such secondary cognitive deficits may in fact be one mechanism through which antipsychotics reduce positive symptoms ("effect by defect" hypothesis; Moritz et al., 2013a). In other words, there may be two sides of the same coin: doubt and reduced speed of information processing induced by antipsychotics may be a prerequisite for the dissolution of delusions. ...
Article
Full-text available
The majority of patients with schizophrenia display neurocognitive deficits (e.g. memory deficits) as well as inflated cognitive biases (e.g. jumping to conclusions). Both cognitive domains are implicated in the pathogenesis of the disorder and are known to compromise functional outcome. At present, there is a dearth of effective treatment options. A total of 90 patients with schizophrenia were recruited online (a diagnosis of schizophrenia had been confirmed in a large subgroup during a previous hospital admission). Subsequent to a baseline assessment encompassing psychopathology, self-reported cognition as well as objective memory and reasoning tests, patients were randomized to one of three conditions: standard cognitive remediation (mybraintraining), metacognition-augmented cognition remediation (CR) condition (variant of mybraintraining which encouraged patients to reduce speed of decision-making and attenuate response confidence when they made high-confidence judgements and hasty incorrect decisions) and a waitlist control group. Patients were retested after six weeks and again three months after the second assessment. Groups did not differ on psychopathology and neurocognitive parameters at any timepoint. However, at follow-up the metacognitive-augmented CR group displayed a significant reduction on jumping to conclusions and overconfidence. Treatment adherence correlated with a reduction of depression; gains in the training exercises from the standard mybraintraining condition were correlated with improved objective memory performance. The study suggests that metacognition-augmented CR may ameliorate cognitive biases but not neurocognition. The study ties in well with prior research showing that neurocognitive dysfunctions are rather resistant to change; the failure to detect significant improvement of CR or metacognition-augmented CR on psychopathology and neurocognition over time may partly be attributed to a number of methodological limitations of our s
... Despite the induction of side effects, continuous treatment with antipsychotics significantly reduces the risk of relapse relative to placebo or intermittent treatment with antipsychotics (DeHert et al., 2015) and helps many patients to lead a relatively stable life. Moritz, Andreou, Klingberg, Thoering, and Peters (2013) showed that antipsychotics promote doubt and decrease emotionality. Antipsychotics are also an efficacious treatment for negative symptoms and for depressive symptoms in patients with schizophrenia, -this is especially true for second generation antipsychotics (Leucht, Corves et al., 2009), while older agents sometimes even aggravate affective symptoms. ...
... Despite the induction of side effects, continuous treatment with antipsychotics significantly reduces the risk of relapse relative to placebo or intermittent treatment with antipsychotics (DeHert et al., 2015) and helps many patients to lead a relatively stable life. Moritz, Andreou, Klingberg, Thoering, and Peters (2013) showed that antipsychotics promote doubt and decrease emotionality. Antipsychotics are also an efficacious treatment for negative symptoms and for depressive symptoms in patients with schizophrenia, -this is especially true for second generation antipsychotics (Leucht, Corves et al., 2009), while older agents sometimes even aggravate affective symptoms. ...
Thesis
Full-text available
Objectives: Metacognitive training is a new, widely used intervention for psychosis. The present meta-analysis examines the efficacy of metacognitive training in schizophrenia. Methods: Studies comparing effects of metacognitive training on positive symptoms, delusions or acceptance of metacognitive training with a control group were included in this meta-analysis. The moderating effects of masking of outcome assessment, randomization, incomplete outcome data, use of an active control intervention and individual versus group metacognitive intervention were investigated. Possible effects of sensitivity analyses and publication bias were also examined. Results: There was a significant overall effect of metacognitive training for positive symptoms (g = -0.34, 95% CI [-0.53, -0.15]), delusions (g = -.41, 95% CI [-0.74, -0.07]) and acceptance of the intervention (g = -0.84, 95% CI [-1.37, -0.31]). Using only studies being at low risk for bias regarding randomization, masking and incomplete outcome data reduced effect sizes for positive symptoms and delusions (g = -0.28, 95% CI [-0.50, -0.06] and g = -0.18, 95% CI [-0.43, 0.06]), respectively. Adjusting for publication bias reduced the effect on positive symptoms to g = -0.29, 95% CI [-0.50, -0.07]. There was no evidence of a publication bias for delusions or acceptance of the intervention. Conclusions: Metacognitive training exerts a small to moderate effect on delusions and positive symptoms and a large effect on acceptance of the intervention. The effect on delusions is reduced, but remains significant when potential biases are considered. Key words: Metacognitive training, psychosis, schizophrenia, delusions, acceptance
... Despite the induction of side effects, continuous treatment with antipsychotics significantly reduces the risk of relapse relative to placebo or intermittent treatment with antipsychotics (DeHert et al., 2015) and helps many patients to lead a relatively stable life. Moritz, Andreou, Klingberg, Thoering, and Peters (2013) showed that antipsychotics promote doubt and decrease emotionality. Antipsychotics are also an efficacious treatment for negative symptoms and for depressive symptoms in patients with schizophrenia, -this is especially true for second generation antipsychotics (Leucht, Corves et al., 2009), while older agents sometimes even aggravate affective symptoms. ...
... indeed, antipsychotics have been reported to attenuate overconfidence and induce doubt (Andreou, Moritz, Veith, Veckenstedt, & Naber, 2014;Moritz, Andreou, Klingberg, Thoering, & Peters, 2013;Moritz et al., 2008;Moritz et al., 2003). ...
Article
Overconfidence in errors is a well-replicated cognitive bias in psychosis. However, prior studies have sometimes failed to find differences between patients and controls for more difficult tasks. We pursued the hypothesis that overconfidence in errors is exaggerated in participants with a liability to psychosis relative to controls only when they feel competent in the respective topic and/or deem the question easy. Whereas subjective competence likely enhances confidence in those with low psychosis liability as well, we still expected to find more 'residual' caution in the latter group. We adopted a psychometric high-risk approach to circumvent the confounding influence of treatment. A total of 2321 individuals from the general population were administered a task modeled after the "Who wants to be a millionaire" quiz. Participants were requested to endorse one out of four response options, graded for confidence, and were asked to provide ratings regarding subjective competence for the knowledge domain as well as the subjective difficulty of each item. In line with our assumption, overconfidence in errors was increased overall in participants scoring high on the Paranoia Checklist core paranoia subscale (2 SD above the mean). This pattern of results was particularly prominent for items for which participants considered themselves competent and which they rated as easy. Results need to be replicated in a clinical sample. In support of our hypothesis, subjective competence and task difficulty moderate overconfidence in errors in psychosis. Trainings that teach patients the fallibility of human cognition may help reduce delusional ideation. Copyright © 2015. Published by Elsevier Ltd.
... Despite the relative efficacy of these combined approaches, the side-effects of antipsychotic treatment can prove debilitating to schizophrenia patients. Antipsychotic side-effects may include physical symptoms, such as movement disturbances, metabolic derangements and weight gain, sedation, and drooling (15,16,(17)(18)(19), as well as emotional and cognitive blunting (20). As a result, the integration of alternative interventions may prove useful in reducing the side-effect burden of antipsychotics. ...
Article
Full-text available
Introduction Despite existing work examining the effectiveness of smartphone digital interventions for schizophrenia at the group level, response to digital treatments is highly variable and requires more research to determine which persons are most likely to benefit from a digital intervention. Materials and methods The current work utilized data from an open trial of patients with psychosis ( N = 38), primarily schizophrenia spectrum disorders, who were treated with a psychosocial intervention using a smartphone app over a one-month period. Using an ensemble of machine learning models, pre-intervention data, app use data, and semi-structured interview data were utilized to predict response to change in symptom scores, engagement patterns, and qualitative impressions of the app. Results Machine learning models were capable of moderately ( r = 0.32–0.39, R ² = 0.10–0.16, MAE norm = 0.13–0.29) predicting interaction and experience with the app, as well as changes in psychosis-related psychopathology. Conclusion The results suggest that individual smartphone digital intervention engagement is heterogeneous, and symptom-specific baseline data may be predictive of increased engagement and positive qualitative impressions of digital intervention in patients with psychosis. Taken together, interrogating individual response to and engagement with digital-based intervention with machine learning provides increased insight to otherwise ignored nuances of treatment response.
... We assume that response confidence is attenuated first and that a decrement in delusion conviction and intensity follows. Interestingly, this may be a common pathway shared with antipsychotic agents: a recent survey (Moritz et al., 2013) of patients prescribed antipsychotic agents found a clear response pattern of increased doubt and lowered certainty in response to antipsychotics for both psychosis and nonpsychosis patients. Attenuated response confidence may open the minds of patients to alternative scenarios, delay decision-making and decrease behavioral consequences for momentous decisions (e.g., aggression towards oneself or others). ...
... It could therefore be that antipsychotic medication partly dampens emotional and psychotic stress reactivity, resulting in the difference observed between our patient groups. Some evidence comes from a recent study (58) in which psychotic patients who use antipsychotic medication subjectively reported dampened emotional experience. However, as not all our psychotic patients were using antipsychotic medication and some of the CHR patients have been using medication, use of antipsychotics is unlikely to fully explain the difference in stress reactivity between the groups. ...
Article
Objective: The aim of this study was to assess associations between momentary stress and both affective and psychotic symptoms in everyday life of individuals at clinical high risk (CHR), compared to chronic psychotic patients and healthy controls, in search for evidence of early stress sensitization. It also assessed whether psychotic experiences were experienced as stressful. Method: The experience sampling method was used to measure affective and psychotic reactivity to everyday stressful activities, events and social situations in 22 CHR patients, 24 patients with a psychotic disorder and 26 healthy controls. Results: Multilevel models showed significantly larger associations between negative affect (NA) and activity-related stress for CHR patients than for psychotic patients (P = 0.008) and for CHR compared to controls (P < 0.001). Similarly, the association between activity-related stress and psychotic symptoms was larger in CHR than in patients (P = 0.02). Finally, the association between NA and symptoms (P < 0.001) was larger in CHR than in patients. Conclusion: Stress sensitization seems to play a role particularly in the early phase of psychosis development as results suggest that CHR patients are more sensitive to daily life stressors than psychotic patients. In this early phase, psychotic experiences also contributed to the experience of stress.
... One possible reason for nonengagement with services and/or treatment is a concern about losing positive voices or those found to be useful (Jenner et al., 2008). Medication non-compliance within patient groups can also relate to fears of losing the benefits of positively perceived symptoms (Moritz et al., 2013). Mental health professionals can additionally exacerbate these problems by de-emphasising positive VH experiences and focusing on eliminating VH as the overall treatment goal (e.g. ...
Article
Full-text available
Background Many individuals have positive experiences of voice-hearing (VH). However, current assessment tools do not capture positive aspects of VH as comprehensively as they do negative aspects. This may limit assessment and formulation of VH when people seek support from mental health services. Our review question was therefore:- ‘Do voice-hearing assessment measures capture the positive experiences of individuals, and to what extent?’ Method We conducted a systematic review of assessment measures which included at least one item on VH. We developed a novel framework to define “positive VH experiences”, which was co-produced by clinical experts in psychosis and people with VH experiences. This framework was then used to identify and map items relating to positive aspects of VH. Results Thirty-three measures were identified, of which twenty incorporated positive VH experiences. Measures published within the last decade (2009-2019) captured a greater number and diversity of positive VH experiences, compared to measures published prior to 2009. Items relating to the function/intention of voices and the emotional impact, were most commonly identified. Conclusions Results suggest that research perceptions around VH are broadening and the nuances of experiences are increasingly considered alongside everyday and positive psychological functioning. Implications for both services and voice-hearers are discussed in the paper.
... This has resulted in large-scale correlational studies that focus on identifying factors that are associated with non-adherence. These studies are often framed within a language of non-compliance, non-adherence and medication refusal (Flore et al., 2019;Ascher-Svanum et al., 2010;Moritz et al., 2013;Sapra et al., 2014), with a view to developing more robust medication adherence strategies. Rather than perceiving an individual's decision to discontinue medication as a rationally thought out personal choice, decisions to manage mental distress without medication tends to be viewed as a consequence of an individual's "lack of insight" into the nature of their problems (Bulow et al., 2016;Chakrabarti, 2014). ...
Article
Full-text available
Background The use of psychotropic medication is often the first line of treatment for people with mental distress. However, many service users discontinue their prescribed medication, and little is known about their experiences or the reasons why they choose to stop taking medication. Aim The aim of this review is to synthesize research literature focused on the experiences of people who decided to discontinue taking medication for their mental health problem. Methods A systematic review of qualitative studies was conducted. Data bases were searched for qualitative research which explored participants’ motivations for discontinuing medication and their experiences of the process. Results Six themes were identified: (1) Taking medications: a loss of autonomy, (2) Discontinuing medication: a thought-out process, (3) Factors influencing the decision to discontinue medication, (4) Discontinuing medication: experiences of the process, (5) Outcomes of discontinuing medication, (6) Managing mental distress in the absence of medication. Conclusion Service providers need to be aware that for some service user’s psychotropic medication is not deemed a suitable treatment approach. Those who wish to discontinue medication need to be supported in the context of positive, therapeutic risk where their mental and physical health can be monitored and the likelihood of success increased.
... These same drugs also increase social motivation and sensitivity to emotional expression in nonpsychotic individuals . Conversely, antagonism of D 2 dopamine receptors in the mesolimbic pathway by antipsychotic medication reduces the intensity of delusional beliefs (Kaar et al., 2019), reduces social engagement, and induces indifference (Gerlach & Larsen, 1999;Moritz et al., 2013). Furthermore, a wealth of evidence from human and animal studies suggests that the mesolimbic dopamine system mediates various aspects of coalitional cognition, including perception and response to social hierarchy, social defeat, and social dominance (Báez-Mendoza & Schultz, 2013;Ghosal et al., 2019;Krach et al., 2010;O'Connell & Hofmann, 2011). ...
Article
Full-text available
Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition—processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organization and the ongoing reconceptualization of belief as serving a social organizational function.
... First our schizophrenia patients were chronically medicated. Known side effects of antipsychotic medications include emotional numbness and social withdrawal (Moritz et al., 2013). In other words, medications effects could underlie some of the reported deficits in embodied emotions. ...
Thesis
Full-text available
Selfhood is experienced at multiple levels in healthy individuals with the minimal, unconscious self providing the building block for self-identity. In control populations, emotional experiences and awareness of physiological sensations play a key role in translating these pre- reflexive bodily processes into an explicit self-awareness integrated in autobiographical memories. The ability to create and recall accurate memories, in turn, is essential to develop a stable sense of identity and acquire adequate social skills. Individuals with schizophrenia routinely demonstrate disturbances in all of the above: weakened sense of self, anomalous bodily experiences, and impaired autobiographic memory. However, not much is known about the embodiment of emotions, a mechanism laying at the intersection of the minimal self and the narrative self, in this population. The onset of self-disturbances in the schizophrenia spectrum is also largely unknown. In Study 1, we used a novel topographical tool to examine embodied emotions in schizophrenia and found that individuals with schizophrenia experience anomalous bodily sensation of emotions. In Study 2, we investigated minimal self-disturbances (interoception), emotional embodiment, and disturbances of the narrative self (autobiographical memory) in a group of individuals at high-risk for schizophrenia. We found impaired interoceptive accuracy and emotional embodiment in high risk individuals, although their autobiographical memory and narrative identity remains intact. Together, our results suggest that self-disturbances appear progressively in schizophrenia, starting with disturbances of the minimal self and evolving to disturbances of the narrative, social self.
... Al igual que sucede con los síntomas negativos primarios, la mayoría de estudios que evalúan la eficacia de los fármacos antipsicóticos para mejorar la cognición en esquizofrenia, cuando se tiene en cuenta la mejora secundaria a la reducción de la sintomatología positiva, no encuentran resultados positivos sobre este dominio 128 . Es más, tanto en modelos animales como en personas sanas, el bloqueo de receptores dopaminérgicos parece empeorar el rendimiento cognitivo 129 . Ante las limitaciones de los tratamientos farmacológicos, se ha propuesto como tratamiento coadyuvante para los trastornos cognitivos las terapias de rehabilitación neuropsicológicas englobadas dentro del término «técnicas de rehabilitación cognitiva» (CRT) 70 . ...
Article
Schizophrenia is a clinically heterogeneous syndrome affecting multiple dimensions of patients’ life. Therefore, its treatment might require a multidimensional approach that should take into account the efficacy (the ability of an intervention to get the desired result under ideal conditions), the effectiveness (the degree to which the intended effect is obtained under routine clinical practice conditions or settings) and the efficiency (value of the intervention as relative to its cost to the individual or society) of any therapeutic intervention. In a first step of the process, a group of 90 national experts from different areas of health-care and with a multidimensional and multidisciplinary perspective of the disease, defined the concepts of efficacy, effectiveness and efficiency of established therapeutic interventions within 7 key dimensions of the illness: symptomatology; comorbidity; relapse and adherence; insight and subjective experience; cognition; quality of life, autonomy and functional capacity; and social inclusion and associated factors. The main conclusions and recommendations of this stage of the work are presented herein.
... This further justifies the rationale for the careful study of avolition and anhedonia in genetically and behaviourally high-risk populations. These non-clinical groups also provide an opportunity to examine anheodonia and avolition in the absence of confounders such as institutionalisation and medication effects (Moritz et al. 2013). ...
Article
Background The neuropsychological origins of negative syndrome of schizophrenia remain elusive. Evidence from behavioural studies, which utilised emotion-inducing pictures to elicit motivated behaviour generally reported that that schizophrenia patients experienced similar affective experience as healthy individuals but failed to translate emotional salience to motivated behaviour, a phenomenon called emotion–behaviour decoupling. However, a few studies have examined emotion–behaviour decoupling in non-psychotic high-risk populations, who are relatively unaffected by medication effects. Methods In this study, we examined the nature and extent of emotion–behaviour decoupling in in three independent samples (65 schizophrenia patients v. 63 controls; 40 unaffected relatives v. 45 controls; and 32 individuals with social anhedonia v. 32 controls). We administered an experimental task to examine their affective experience and its coupling with behaviour, using emotion-inducing slides, and allowed participants to alter stimulus exposure using button-pressing to seek pleasure or avoid aversion. Results Schizophrenia patients reported similar affective experiences as their controls, while their unaffected relatives and individuals with high levels of social anhedonia exhibited attenuated affective experiences, in particular in the arousal aspect. Compared with their respective control groups, all of the three groups showed emotion–behaviour decoupling. Conclusions Our findings support that both genetically and behaviourally high-risk groups exhibit emotion–behaviour decoupling. The familial association apparently supports its role as a putative trait marker for schizophrenia.
... Multiple qualitative studies have included descriptions of "hell" and becoming a "zombie" (Angermeyer, Löffler, Müller, Schulze, & Priebe, 2001;Moncrieff et al., 2009;Rogers et al., 1998;Wallace, 1994;Waterreus et al., 2012) and point to subjective experiences of social withdrawal or disconnection, self-doubt (Moritz et al., 2013), interference with identity and understanding of self (Titelman, 2001), difficulty with daily functioning (Gibson et al., 2013;Naber, 1998;Rofail et al., 2009), and distress regarding adverse effects (Chiang, Klainin-Yobas, Ignacio, & Chng, 2011;Morrison et al., 2015b). Some may be ambivalent towards AMs or view them as a form of punishment and describe experiences of accepting or becoming resigned to taking them (Morrison et al., 2015b;Titelman, 2001). ...
Thesis
Full-text available
Antipsychotic medications (AM) are the designated first-line intervention for psychosis in international best-practice guidelines and are prescribed for a range of other mental-health problems. Relatively little is known about how people subjectively experience AMs and attempted discontinuation or about the role psycho-social factors play in recovery outcomes. This research explores how people experience AMs, use psycho-social strategies and, where relevant, manage discontinuation. An anonymous online survey was completed by 144 New Zealand adults who had ever taken oral AMs for any reason for more than 3 months. Seven in-depth interviews were conducted to explore experiences of people who had discontinued AMs for over one year. In Study One, survey participants reported a range of diagnoses including schizophrenia spectrum disorders, bipolar disorder, and depression. Half described a primarily negative first prescription experience. Other treatment options were rarely offered at first prescription but were nevertheless used by many. Few people reported being well-informed of the potential benefits and risks. Descriptions of taking AMs ranged from “life-saver” and “useful tool” to “mixed bag” and “hell”. Most experienced both benefits and adverse effects. Most (79%) had contemplated stopping AMs, and 73% reported making at least one attempt, with variable preparations, methods and outcomes described. Hierarchical multiple regression suggested social support, active coping and avoidant coping were independently predictive of quality of life but current use of AMs was not. In Study Two, the interviewees revealed that maintaining wellbeing during and after withdrawal from AMs was primarily a function of coming to understand themselves and their needs, connecting with supports, and finding strategies that worked for them, which included accepting symptoms and signs of distress. Conclusions include that AMs can be experienced as crucial lifesavers, useful tools with drawbacks and/or destructive forces to endure or escape. Attempted discontinuation is common and some people succeed in their efforts to stop, although withdrawal can be risky and is often poorly supported. Multiple psycho-social strategies are helpful additions or alternatives to AMs. Since quality of life is associated with coping and social support, treatment systems cannot rely solely on medication to produce positive outcomes for those who take AMs.
... Al igual que sucede con los síntomas negativos primarios, la mayoría de estudios que evalúan la eficacia de los fármacos antipsicóticos para mejorar la cognición en esquizofrenia, cuando se tiene en cuenta la mejora secundaria a la reducción de la sintomatología positiva, no encuentran resultados positivos sobre este dominio 128 . Es más, tanto en modelos animales como en personas sanas, el bloqueo de receptores dopaminérgicos parece empeorar el rendimiento cognitivo 129 . Ante las limitaciones de los tratamientos farmacológicos, se ha propuesto como tratamiento coadyuvante para los trastornos cognitivos las terapias de rehabilitación neuropsicológicas englobadas dentro del término «técnicas de rehabilitación cognitiva» (CRT) 70 . ...
Article
Schizophrenia is a clinically heterogeneous syndrome affecting multiple dimensions of patients' life. Therefore, its treatment might require a multidimensional approach that should take into account the efficacy (the ability of an intervention to get the desired result under ideal conditions), the effectiveness (the degree to which the intended effect is obtained under routine clinical practice conditions or settings) and the efficiency (value of the intervention as relative to its cost to the individual or society) of any therapeutic intervention. In a first step of the process, a group of 90 national experts from different areas of health-care and with a multidimensional and multidisciplinary perspective of the disease, defined the concepts of efficacy, effectiveness and efficiency of established therapeutic interventions within 7 key dimensions of the illness: symptomatology; comorbidity; relapse and adherence; insight and subjective experience; cognition; quality of life, autonomy and functional capacity; and social inclusion and associated factors. The main conclusions and recommendations of this stage of the work are presented herein. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.
... Mounting evidence suggests that apart from emotional detachment (Mizrahi et al., 2006;Moritz, Andreou, Klingberg, Thoering, & Peters, 2013) one of the mechanisms of action of antipsychotic agents, whose common denominator is a dopamine receptor antagonism, is the induction of "doubt" (however see also Mizrahi et al., 2006). This has been shown both at a subjective as well as objective level in dopamine challenge studies (Andreou, Moritz, Veith, Veckenstedt, & Naber, 2013;Andreou et al., 2015). ...
Article
Objectives: We outline a two-stage heuristic account for the pathogenesis of the positive symptoms of psychosis. Methods: A narrative review on the empirical evidence of the liberal acceptance (LA) account of positive symptoms is presented. Hypothesis: At the heart of our theory is the idea that psychosis is characterized by a lowered decision threshold, which results in the premature acceptance of hypotheses that a nonpsychotic individual would reject. Once the hypothesis is judged as valid, counterevidence is not sought anymore due to a bias against disconfirmatory evidence as well as confirmation biases, consolidating the false hypothesis. As a result of LA, confidence in errors is enhanced relative to controls. Subjective probabilities are initially low for hypotheses in individuals with delusions, and delusional ideas at stage 1 (belief formation) are often fragile. In the course of the second stage (belief maintenance), fleeting delusional ideas evolve into fixed false beliefs, particularly if the delusional idea is congruent with the emotional state and provides “meaning”. LA may also contribute to hallucinations through a misattribution of (partially) normal sensory phenomena. Interventions such as metacognitive training that aim to “plant the seeds of doubt” decrease positive symptoms by encouraging individuals to seek more information and to attenuate confidence. The effect of antipsychotic medication is explained by its doubt-inducing properties. Limitations: The model needs to be confirmed by longitudinal designs that allow an examination of causal relationships. Evidence is currently weak for hallucinations. Conclusions: The theory may account for positive symptoms in a subgroup of patients. Future directions are outlined
... Moreover, some of these side-effects, e.g. sedation, emotional numbing, and reduced speed of processing (Faber et al., 2012;Moncrieff et al., 2009;Moritz et al., 2013;Saeedi et al., 2006), may undermine the possibility of patients to benefit from TF treatment, e.g. by interfering with the ability to follow treatment procedures, or difficulty to activate the 'fear structure' (Rauch and Foa, 2006). Indeed, the use of psychotropic medication in a sample of veterans was found to be associated with less PTSD symptom reduction during TF treatment (Goodson et al., 2013). ...
... Mounting evidence suggests that apart from emotional detachment (Mizrahi et al., 2006;Moritz, Andreou, Klingberg, Thoering, & Peters, 2013) one of the mechanisms of action of antipsychotic agents, whose common denominator is a dopamine receptor antagonism, is the induction of "doubt" (however see also Mizrahi et al., 2006). This has been shown both at a subjective as well as objective level in dopamine challenge studies (Andreou, Moritz, Veith, Veckenstedt, & Naber, 2013;Andreou et al., 2015). ...
Article
Objectives: Among people with psychosis, those with a history of childhood trauma are likely to experience trauma-related symptoms, such as trauma memory intrusions. Irrespective of whether these individuals continue to remember and re-experience trauma, their treatment very often includes alleviating psychotic symptoms through the use of antipsychotic medication. Antipsychotics, while primarily used to treat psychotic symptoms, can influence non-psychotic symptoms and alter how people think and feel. We thus aimed to explore how people with childhood trauma and psychosis experience the effects that antipsychotics have on their (1) thoughts, images, and memories, (2) emotions, and (3) physical responses, related to their childhood trauma. Design: A qualitative phenomenological research design using semi-structured interviews was implemented. Methods: Data were analysed using interpretative phenomenological analysis. Results: Nineteen participants were interviewed. Two super-ordinate themes were conceptualized. Many participants spoke about the impact of antipsychotics on trauma-related experiences (Theme 1). Some indicated that antipsychotics alleviated the intensity and frequency of trauma-related thoughts, emotions, and physical symptoms. A few others reported that their trauma-related flashbacks, thoughts, and physical symptoms intensified while taking antipsychotics. Participants spoke about the role of antipsychotics in confronting and processing trauma (Theme 2). A few participants reported that by suppressing trauma-related thoughts and emotions antipsychotics prevented them from confronting their trauma. Conclusions: The effects of antipsychotics can be subjectively experienced as beneficial or detrimental depending on how they influence trauma-related thoughts, emotions, and physical responses. Intervention studies are needed to determine how people with childhood trauma and psychosis respond to antipsychotic drugs. Practitioner points: Antipsychotics may alter the way in which people with childhood trauma and psychosis remember and re-experience trauma. These alterations can be beneficial or detrimental, and thus play a role in whether people consider their medication helpful. By suppressing trauma-related thoughts and emotions, antipsychotics can prevent people from confronting their trauma. This may be considered beneficial to some, but other people may need or want to confront their trauma to heal. The effectiveness of trauma-focused psychological therapies may be influenced by the emotional, cognitive, and physiological effects of antipsychotic medications. The ability of antipsychotics to suppress people's trauma memories may contribute to post-traumatic avoidance. People with post-traumatic stress symptoms and psychosis should be provided with psycho-education about post-traumatic avoidance and its role in the maintenance of post-traumatic stress disorder.
Chapter
En el siguiente capítulo se revisan algunas de las nuevas intervenciones psicológicas aplicadas a las psicosis y que se apoyan en el uso de herramientas tecnológicas. Uno de los programas que está obteniendo mejores resultados empíricos es el entrenamiento metacognitivo (MCT) para la esquizofrenia (Moritz y Woodward, 2005, 2007), una novedosa intervención basada en la psicoeducación, la rehabilitación cognitiva, la cognición social y la terapia cognitivo-conductual que ha demostrado eficacia en la reducción de los síntomas psicóticos a través de la modificación de estilos cognitivos disfuncionales (Moritz, Andreou, Schneider et al., 2014; McLeod, Gumley, Macbeth, Schwannauer y Lysaker, 2014). Otra de las novedades que consideraremos es el uso de la realidad virtual, más concretamente de la terapia con avatar que, por un lado, se ha utilizado para el tratamiento de las alucinaciones auditivas (Leff, Williams, Huckvale, Arbuthnot, 2013) y, por otro, para la mejora de las habilidades sociales (Rus-Calafell, Gutiérrez-Maldonado y Ribas-Sabaté, 2013).
Article
Practitioners lack guidance on how to support discontinuation of psychotropic medication. An understanding of what constitutes discontinuation success that encompasses the patients’ perspective could advance knowledge in this clinically relevant area. Here, we report the development and validation of a scale to assess subjective discontinuation success. Participants who attempted discontinuing antidepressants and/or antipsychotics during the past 5 years (n=396) completed a questionnaire on subjective discontinuation success (Discontinuation Success Scale, DSS) developed in consultation with people with lived experience of discontinuation. Construct validity was tested by exploratory and confirmatory factor analysis. Criterion validity was tested by assessing DSS-scores’ associations with objective success (i.e., full cessation, reduced dose) in combination with scoring above a predefined criterion on the Well-Being Index. Factor analyses yielded a three-dimensional scale reflecting subjective discontinuation success, positive effects, and negative effects of discontinuation. A 24-item DSS demonstrated sufficient model fit for the participants discontinuing antidepressants or antipsychotics, respectively. Significant associations with objective success and well-being were found. Participants who had achieved full cessation and scored high on well-being reached the highest DSS scores. The DSS is a viable tool for future research aimed at identifying predictors of discontinuation success in order to inform recommendations related to discontinuation
Chapter
Unabhängig von Kultur und ethnischer Zugehörigkeit erkrankt ca. 1 % der Bevölkerung einmal im Leben an einer Schizophrenie (oft auch als schizophrene Psychose oder auch nur Psychose bezeichnet); die Inzidenz liegt nach einer Metaanalyse bei 15,2:100.000 Personen im Jahr (McGrath et al. 2008). Obwohl eine Untergruppe von Patienten nur einmal im Leben erkrankt und manchmal etliche Jahre zwischen den einzelnen Krankheitsepisoden verstreichen, stellt die Psychose für viele Patienten eine lebenslange Bürde dar, welche die Lebensqualität – oft auch der Angehörigen – erheblich reduzieren kann und mit hohen sozioökonomischen Kosten einhergeht (Kennedy et al. 2014). Die Suizidrate bei Patienten mit Schizophrenie ist nach neueren Schätzungen zwar nach unten korrigiert worden (Hor u. Taylor 2010), liegt aber mit ca. 5 % immer noch um ein Vielfaches höher als in der Normalbevölkerung.
Article
Reasoning biases such as jumping-to-conclusions (JTC) and incorrigibility have been suggested to contribute to the generation and maintenance of delusions. However, it is still debated whether these biases represent stable traits of patients with delusions, or are related to state fluctuations of delusion severity. The present study aimed to elucidate this question by combining a cross-sectional with a longitudinal approach. JTC, incorrigibility and delusion severity were assessed in 79 patients with a history of delusions over a 6-month period. To allow for a differentiated look into effects of time vs. symptom changes, patients were divided into patients with (D+) and without (D-) current delusions at baseline. Significant improvement of delusions was noted in D+ at follow-up. JTC did not differ between the two patient groups either at baseline or over time. In contrast, incorrigibility was significantly higher in D+ than D- at baseline; this difference remained stable throughout the 6-month follow-up period. The two biases did not significantly co-vary over time. Our results suggest a dissociation between incorrigibility and JTC as regards their relation to current presence of delusions, and tentatively support theoretical accounts attributing different roles to the two biases in the generation (JTC) and maintenance (incorrigibility) of delusions.
Article
Full-text available
Introducción: El programa de entrenamiento metacognitivo (MCT) es una intervención dirigida a los sesgos, creencias y errores cognitivos en la esquizofrenia. Con el objeti-vo de evaluar la eficacia de esta intervención en la sintomatología de dos sujetos, se hipotetizó que el MCT: 1) disminuirá los síntomas psicóticos positivos y negativos 2) fomentará interpretaciones y atribuciones apropiadas y 3) mejorará la calidad de vida, conciencia de enfermedad y estado de ánimo. método: Diseño de caso único subtipo a b (pre y post evaluación) y posterior seguimiento. Se utilizaron los siguientes instrumentos: Escala de síntomas positivo y negativo (PANSS), Inventario de ideas de-lirantes de Peters-21 (PDI-21), Inventario de depresión de Beck ii (BDI-II), Escala de la Calidad de Vida (QLS) y Escala de la discapacidad (WHO/DAS). La intervención fue apli-cada a dos varones diagnosticados de: a) Esquizofrenia de tipo indiferenciado y b) esquizofrenia paranoide. resultados: Se observaron cambios clínicamente signifi-cativos en la psicopatología y el funcionamiento psicosocial de ambos sujetos. Se observó una reducción más significativa para los síntomas positivos e ideas delirantes. La evaluación psicosocial destacó por una mejoría de la conciencia de enfermedad, funciones intrapsíquicas e interpersonales y funcionamiento familiar. conclusiones: El MCT fue eficaz en ambos casos, mejorando los síntomas positivos (ideas delirantes), el insight y la conciencia de enfermedad, y la calidad de vida y el funcionamiento psi-cosocial general de ambos sujetos.palabras clave: metacognitivo, MCT, esquizofrenia, caso único
Article
Full-text available
Effects of both domain-specific and broader cognitive remediation protocols have been reported for neural activity and overt performance in schizophrenia (SZ). Progress is limited by insufficient knowledge of relevant neural mechanisms. Addressing neuronal signal resolution in the auditory system as a mechanism contributing to cognitive function and dysfunction in schizophrenia, the present study compared effects of two neuroplasticity-based training protocols targeting auditory–verbal or facial affect discrimination accuracy and a standard rehabilitation protocol on magnetoencephalographic (MEG) oscillatory brain activity in an auditory paired-click task. SZ were randomly assigned to either 20 daily 1-hour sessions over 4 weeks of auditory–verbal training (N = 19), similarly intense facial affect discrimination training (N = 19), or 4 weeks of treatment as usual (TAU, N = 19). Pre-training, the 57 SZ showed smaller click-induced posterior alpha power modulation than did 28 healthy comparison participants, replicating Popov et al. (2011b). Abnormally small alpha decrease 300–800 ms around S2 improved more after targeted auditory–verbal training than after facial affect training or TAU. The improvement in oscillatory brain dynamics with training correlated with improvement on a measure of verbal learning. Results replicate previously reported effects of neuroplasticity-based psychological training on oscillatory correlates of auditory stimulus differentiation, encoding, and updating and indicate specificity of cortical training effects.
Article
Aripiprazole was the first antipsychotic developed to possess agonist properties at dopamine D2 autoreceptors, a groundbreaking strategy that presented a new vista for schizophrenia drug discovery. The dopamine D2 receptor is the crucial target of all extant antipsychotics, and all developed prior to aripiprazole were D2 receptor antagonists. Extensive blockade of these receptors, however, typically produces extrapyramidal (movement) side effects which plagued first-generation antipsychotics, such as haloperidol. Second-generation antipsychotics, such as clozapine, with unique polypharmacology and D2 receptor binding kinetics, have significantly lower risk of movement side effects, but can cause myriad additional ones, such as severe weight gain and metabolic dysfunction. Aripiprazole's polypharmacology-characterized by its unique agonist activity at dopamine D2, D3 and serotonin 5-HT1A receptors as well as antagonist activity at serotonin 5-HT2A receptors-translates to successful reduction of positive, negative, and cognitive symptoms of schizophrenia, while also mitigating risk of weight gain and movement side effects. New observations, however, link aripiprazole to compulsive behaviors in a small group of patients, an unusual side effect for antipsychotics. In this review, we discuss the chemical synthesis, pharmacology, pharmacogenomics, drug metabolism, and adverse events of aripiprazole, and we present a current understanding of aripiprazole's neurotherapeutic mechanisms, as well as the history and importance of aripiprazole to neuroscience.
Article
Full-text available
Many individuals living with severe mental illness, such as schizophrenia, present cognitive deficits and reasoning biases negatively impacting clinical and functional trajectories. Remote cognitive assessment presents many opportunities for advancing research and treatment but has yet to be widely used in psychiatric populations. We conducted a scoping review of remote cognitive assessment in severe mental illness to provide an overview of available measures and guide best practices. Overall, 34 studies ( n = 20,813 clinical participants) were reviewed and remote measures, psychometrics, facilitators, barriers, and future directions were synthesized using a logic model. We identified 82 measures assessing cognition in severe mental illness across 11 cognitive domains and four device platforms. Remote measures were generally comparable to traditional versions, though psychometric properties were infrequently reported. Facilitators included standardized procedures and wider recruitment, whereas barriers included imprecise measure adaptations, technology inaccessibility, low patient engagement, and poor digital literacy. Our review identified several remote cognitive measures in psychiatry across all cognitive domains. However, there is a need for more rigorous validation of these measures and consideration of potentially influential factors, such as sex and gender. We provide recommendations for conducting remote cognitive assessment in psychiatry and fostering high-quality research using digital technologies.
Article
Full-text available
Objective: To explore how reasoning biases in schizophrenic patients respond to treatment. Patients with schizophrenia, especially those with delusions, show not only cognitive deficits but also "reasoning biases," namely, "jumping to conclusions," reduced belief flexibility, an externalizing attributional style, and an impaired "theory of mind." Methods: This is a systematic review of 17 longitudinal and cross-sectional studies. Results: "Jumping to conclusions" and reduced "belief flexibility" are most closely related to the severity of delusions, whereas "theory of mind" is better related to negative symptoms and "attributional style" to overall psychopathology. Antipsychotic treatment leads to an improvement in belief flexibility and theory of mind, with the suggestion that "belief flexibility" may be mediating the treatment response. On the other hand, the "jumping to conclusions" bias is likely a stable "trait" factor, which does not change with treatment, although it may moderate the outcome of response. The findings above are offered with the caveat that most of the available studies are small, often uncontrolled, few are longitudinal, that the measurement of some of the reasoning measures varies across studies, and that their relationship to the more established "cognitive" deficits remains unclear. Conclusions: The fact that these reasoning biases could be moderators and mediators of treatment outcome provides a greater impetus to study them systematically.
Article
Full-text available
Two reasoning biases, jumping to conclusions (JTC) and belief inflexibility, have been found to be associated with delusions. We examined these biases and their relationship with delusional conviction in a longitudinal cohort of people with schizophrenia-spectrum psychosis. We hypothesized that JTC, lack of belief flexibility, and delusional conviction would form distinct factors, and that JTC and lack of belief flexibility would predict less change in delusional conviction over time. Two hundred seventy-three patients with delusions were assessed over twelve months of a treatment trial (Garety et al., 2008). Forty-one percent of the sample had 100% conviction in their delusions, 50% showed a JTC bias, and 50%–75% showed a lack of belief flexibility. Delusional conviction, JTC, and belief flexibility formed distinct factors although conviction was negatively correlated with belief flexibility. Conviction declined slightly over the year in this established psychosis group, whereas the reasoning biases were stable. There was little evidence that reasoning predicted the slight decline in conviction. The degree to which people believe their delusions, their ability to think that they may be mistaken and to consider alternative explanations, and their hastiness in decision making are three distinct processes although belief flexibility and conviction are related. In this established psychosis sample, reasoning biases changed little in response to medication or psychological therapy. Required now is examination of these processes in psychosis groups where there is greater change in delusion conviction, as well as tests of the effects on delusions when these reasoning biases are specifically targeted. The Diagnostic and Statistical Manual, Fourth Edition, (Amer-ican Psychiatric Association, 2000) defines delusion as "A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary" (p. 765). Thus, a delusional belief is incorrect; it is based on erroneous judgments about the world, and it is unresponsive to countervailing evidence. Biases of reasoning have been invoked to understand the process of delusion forma-tion, and limited data-gathering (jumping to conclusions; JTC) and a failure to think of alternative accounts to the delusion (a lack of belief flexibility) have previously been shown to be related to how
Article
Full-text available
Online studies are increasingly utilized in applied research. However, lack of external diagnostic verification in many of these investigations is seen as a threat to the reliability of the data. The present study examined the robustness of internet studies on psychosis against simulation. We compared the psychometric properties of the Community Assessment of Psychic Experiences scale (CAPE), a self-report instrument measuring psychotic symptoms, across three independent samples: (1) participants with a confirmed diagnosis of schizophrenia, (2) participants with self-reported schizophrenia who were recruited over the internet, and (3) clinical experts on schizophrenia as well as students who were asked to simulate a person with schizophrenia when completing the CAPE. The CAPE was complemented by a newly developed 4-item psychosis lie scale. Results demonstrate that experts asked to simulate schizophrenia symptoms could be distinguished from real patients: simulators overreported positive symptoms and showed elevated scores on the psychosis lie scale. The present study suggests that simulated answers in online studies on psychosis can be distinguished from authentic responses. Researchers conducting clinical online studies are advised to adopt a number of methodological precautions and to compare the psychometric properties of online studies to established clinical indices to assert the validity of their results.
Article
Full-text available
Kognitive Umstrukturierung von Wahn und dysfunktionalen Kognitionen wird zunehmend in der Schizophreniebehandlung eingesetzt. Bisherige Meta-Analysen zur Wirksamkeit von CBT integrieren jedoch sehr heterogene Interventionen, was Schlussfolgerungen auf die Wirksamkeit kognitiver Elemente erschwert. Die vorliegende Meta-Analyse analysiert kurz- und langfristige Effekte aus 18 randomisiert-kontrollierten Studien zu kognitiven Interventionen für Schizophrenie. Im Bezug auf die Gesamtsymptomatik bestanden im Vergleich zu Standardbehandlung signifikante kleine Effekte zum Behandlungsende (n = 908) und zum Follow-Up (n = 663). Im Vergleich zu aktiven Kontrollinterventionen war CBT zum Behandlungsende nicht signifikant überlegen (n = 559), jedoch zum Follow-up (n = 416). CBT zeigte sich auch für die Reduktion von Rehospitalisierungen einer Standardbehandlung, nicht aber alternativen Therapien, überlegen. Eine kognitive Schwerpunktsetzung der Interventionen korrelierte – auch nach Kontrolle der methodischen Qualität – positiv mit der präpost Effektstärke. Es erscheint aussichtsreich, weiter zu untersuchen, ob die Effektivität von CBT durch einen verstärkten Einsatz kognitiver Elemente gesteigert werden kann.
Article
Full-text available
Antipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinue medication with antipsychotics after some time, a fact which is traditionally ascribed to side-effects, mistrust against the clinician and poor illness insight. The present study investigated whether positive attitudes toward psychotic symptoms (ie, gain from illness) represent a further factor for medication noncompliance. An anonymous online survey was set up in order to prevent conservative response biases that likely emerge in a clinical setting. Following an iterative selection process, data from a total of 113 patients with a likely diagnosis of schizophrenia and a history of antipsychotic treatment were retained for the final analyses (80%). While side-effect profile and mistrust emerged as the most frequent reasons for drug discontinuation, 28% of the sample reported gain from illness (eg, missing voices, feeling of power) as a motive for noncompliance. At least every fourth patient reported the following reasons: stigma (31%), mistrust against the physician/therapist (31%), and rejection of medication in general (28%). Approximately every fifth patient had discontinued antipsychotic treatment because of forgetfulness. On average, patients provided 4 different explanations for noncompliance. Ambivalence toward symptoms and treatment should thoroughly be considered when planning treatment in psychosis. While antipsychotic medication represents the evidence-based cornerstone of the current treatment in schizophrenia, further research is needed on nonpharmacological interventions for noncompliant patients who are willing to undergo intervention but refuse pharmacotherapy.
Article
Full-text available
Although antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months. Twenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning. T tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen's d effect sizes were moderate to large [for PANSS total, d=0.85, 95% confidence interval (CI) 0.32-1.35 at end of treatment; d=1.26, 95% CI 0.66-1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly. This study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.
Article
Full-text available
Two reasoning biases, jumping to conclusions (JTC) and belief inflexibility, have been found to be associated with delusions. We examined these biases and their relationship with delusional conviction in a longitudinal cohort of people with schizophrenia-spectrum psychosis. We hypothesized that JTC, lack of belief flexibility, and delusional conviction would form distinct factors, and that JTC and lack of belief flexibility would predict less change in delusional conviction over time. Two hundred seventy-three patients with delusions were assessed over twelve months of a treatment trial (Garety et al., 2008). Forty-one percent of the sample had 100% conviction in their delusions, 50% showed a JTC bias, and 50%-75% showed a lack of belief flexibility. Delusional conviction, JTC, and belief flexibility formed distinct factors although conviction was negatively correlated with belief flexibility. Conviction declined slightly over the year in this established psychosis group, whereas the reasoning biases were stable. There was little evidence that reasoning predicted the slight decline in conviction. The degree to which people believe their delusions, their ability to think that they may be mistaken and to consider alternative explanations, and their hastiness in decision making are three distinct processes although belief flexibility and conviction are related. In this established psychosis sample, reasoning biases changed little in response to medication or psychological therapy. Required now is examination of these processes in psychosis groups where there is greater change in delusion conviction, as well as tests of the effects on delusions when these reasoning biases are specifically targeted.
Article
Full-text available
In the UK and in Sweden, cognitive behavior therapy (CBT) has been recommended for schizophrenia. The two recent meta-analyses examined results soon after treatment and not at follow-up. To determine the effectiveness of CBT in people with schizophrenia, both after treatment and at follow-up, and to compare it with treatment as usual (TAU) and other psychological treatments. The search was carried in the databases CENTRAL (Cochrane Central Register of Controlled Trials), PsycINFO and PubMed (Medline). Inclusion criteria were randomized controlled trials (RCTs) with low risk of bias. Two reviewers, working independently, extracted data. The results were analyzed using risk ratio (RR), risk difference (RD), mean difference (MD), or standardized mean difference (SMD). Outcome measures were symptoms, use of medication, relapse and clinically important improvement. When CBT was compared with other psychological treatments at follow-up, there was strong evidence (with small treatment effect) that intervention has an effect with positive symptoms (P = 0.02), negative symptoms (P = 0.03) and general symptoms (P = 0.003). After treatment, there was a trend in favor of CBT, but not statistically significantly so. It appears that the effect of CBT is delayed; it could be seen a few months after the treatment had terminated. Therapies for patients with schizophrenia that were 20 sessions long or more had better outcomes than those that were shorter.
Article
Full-text available
Delusions are often resistant to change, persisting despite successful antipsychotic treatment or Cognitive Behavioural Therapy. This study aimed to target reasoning processes, particularly the ‘Jumping to Conclusions’ (JTC) bias and belief flexibility, which are thought to play a part in maintaining delusional conviction. 13 participants with a diagnosis of psychosis and high levels of conviction in their delusions completed a one-off computerised training package, lasting approximately 1.5 h. Outcomes were assessed at baseline, pre-intervention (two weeks later), post-intervention (immediately after completing the training) and at 1 month follow-up. The package was well received by participants. There were improvements in JTC, belief flexibility and delusional conviction between pre- and post-intervention measures. Controlled studies powered to detect changes in key outcomes are warranted in order to evaluate the efficacy of the programme.
Article
Full-text available
Liberal acceptance, overconfidence, and increased activity of the neurotransmitter dopamine have been proposed to account for abnormal sensory experiences, for instance, hallucinations in schizophrenia. In normal subjects, increased sensory experience in Yoga Nidra meditation is linked to striatal dopamine release. We therefore hypothesize that the neurotransmitter dopamine may function as a regulator of subjective confidence of visual perception in the normal brain. Although much is known about the effect of stimulation by neurotransmitters on cognitive functions, their effect on subjective confidence of perception has never been recorded experimentally before. In a controlled study of 24 normal, healthy female university students with the dopamine agonist pergolide given orally, we show that dopaminergic activation increases confidence in seeing rapidly presented words. It also improves performance in a forced-choice word recognition task. These results demonstrate neurotransmitter regulation of subjective conscious experience of perception and provide evidence for a crucial role of dopamine.
Article
Full-text available
It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention. The POSITIVE study is a multicenter, prospective, single-blind, parallel group, randomised clinical trial, comparing CBT and ST with respect to the efficacy in reducing positive symptoms in psychotic disorders. CBT as well as ST consist of 20 sessions altogether, 165 participants receiving CBT and 165 participants receiving ST. Major methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, analysis by intention to treat, data management using remote data entry, measures of quality assurance (e.g. on-site monitoring with source data verification, regular query process), advanced statistical analysis, manualized treatment, checks of adherence and competence of therapists. Research relating the psychotherapy process with outcome, neurobiological research addressing basic questions of delusion formation using fMRI and neuropsychological assessment and treatment research investigating adaptations of CBT for adolescents is combined in this network. Problems of transfer into routine clinical care will be identified and addressed by a project focusing on cost efficiency. This clinical trial is part of efforts to intensify psychotherapy research in the field of psychosis in Germany, to contribute to the international discussion on psychotherapy in psychotic disorders, and to help implement psychotherapy in routine care. Furthermore, the study will allow drawing conclusions about the mediators of treatment effects of CBT of psychotic disorders.
Article
Full-text available
Neuroleptic non-compliance remains a serious challenge for the treatment of psychosis. Non-compliance is predominantly attributed to side effects, lack of illness insight, reduced well-being or poor therapeutic alliance. However, other still neglected factors may also play a role. Further, little is known about whether psychiatric patients without psychosis who are increasingly prescribed neuroleptics differ in terms of medication compliance or about reasons for non-compliance by psychosis patients. As direct questioning is notoriously prone to social desirability biases, we conducted an anonymous survey. After a strict selection process blind to results, 95 psychiatric patients were retained for the final analyses (69 participants with a presumed diagnosis of schizophrenia psychosis, 26 without psychosis). Self-reported neuroleptic non-compliance was more prevalent in psychosis patients than non-psychosis patients. Apart from side effects and illness insight, main reasons for non-compliance in both groups were forgetfulness, distrust in therapist, and no subjective need for treatment. Other notable reasons were stigma and advice of relatives/acquaintances against neuroleptic medication. Gain from illness was a reason for non-compliance in 11-18% of the psychosis patients. Only 9% of all patients reported no side effects and full compliance and at the same time acknowledged that neuroleptics worked well for them. While pills were preferred over depot injections by the majority of patients, depot was judged as an alternative by a substantial subgroup. Although many patients acknowledge the need and benefits of neuroleptic medication, non-compliance was the norm rather than the exception in our samples.
Article
Full-text available
We explored the subjective effects associated with olanzapine, risperidone and older antipsychotics. We conducted a content analysis of an Internet database of comments about prescribed medications. We analysed 223 comments on risperidone, 170 on olanzapine and 46 relating to three older antipsychotics. The predominant subjective effects produced by all drugs consisted of sedation, cognitive impairment and emotional flattening or indifference. Connections appeared between these effects and Parkinsonian-like symptoms with the older drugs, sexual impairment with risperidone and metabolic effects with olanzapine. The experience of akathisia was frequently linked to suicidal thoughts. Some respondents described how the drugs' subjective effects helped to reduce symptoms of mania, psychosis and anxiety. The generalisability of Internet data is uncertain. However, the data suggest that adverse subjective effects play a central role in the experience of taking antipsychotic drugs and may be related to the drugs' desired benefits.
Article
Full-text available
Current psychological models of psychotic symptoms suggest that metacognitive beliefs impact on an individual's appraisal of anomalous experiences, and thereby influence whether these lead to distress and become clinical symptoms. This study examined the relationship between maladaptive metacognitive beliefs, anomalous experiences, anomaly-related distress, anxiety and depression and diagnostic status. The Metacognitions Questionnaire (MCQ), Symptom Checklist 90 - Revised, and Appraisals of Anomalous Experiences interview were administered to 27 people diagnosed with a psychotic disorder, 32 people meeting At Risk Mental State (ARMS) criteria, 24 people with psychotic-like experiences but no need for care, and 32 healthy volunteers. The two clinical groups scored higher than non-patient controls and individuals experiencing psychotic-like anomalies with no need for care on most subscales of the MCQ, particularly the 'general negative beliefs about thoughts' (NEG) subscale. However, most group differences became non-significant when anxiety and depression were controlled for. Few relationships were found between the MCQ subscales and psychotic-like anomalies and anomaly-related distress. Cognitive/attentional difficulty was the only type of anomaly to be significantly associated with maladaptive metacognitive beliefs. Anomaly-related distress was associated with only the NEG subscale of the MCQ. Maladaptive metacognitive beliefs, as measured by the MCQ, appear to be related more to elevated levels of general psychopathology in psychotic and at-risk groups than to the presence of, and distress associated with, psychotic experiences. Processes by which metacognitions may impact upon the need for care are discussed.
Article
Full-text available
An experiment is described in which deluded subjects with a diagnosis of schizophrenia or of delusional disorder (paranoia) were compared with a nondeluded psychiatric control group and a normal control group on a probabilistic inference task. Factors relevant to belief formation and maintenance were investigated. Deluded subjects requested less information before reaching a decision and were more ready to change their estimates of the likelihood of an event when confronted with potentially disconfirmatory information. No differences were found between the two diagnostic groups of deluded subjects. The results are discussed in light of prevailing theories of the importance of abnormal experience rather than reasoning biases in the formation and maintenance of delusional beliefs. It is suggested that a reasoning abnormality is involved, which may coexist with perceptual abnormalities.
Article
Full-text available
A variety of rules have been suggested for determining the sample size required to produce a stable solution when performing a factor or component analysis. The most popular rules suggest that sample size be determined as a function of the number of variables. These rules, however, lack both empirical support and a theoretical rationale. We used a Monte Carlo procedure to systematically vary sample size, number of variables, number of components, and component saturation (i.e., the magnitude of the correlation between the observed variables and the components) in order to examine the conditions under which a sample component pattern becomes stable relative to the population pattern. We compared patterns by means of a single summary statistic, g–2, and by means of direct pattern comparisons using the kappa statistic. Results indicated that, contrary to the popular rules, samples size as a function of the number of variables was not an important factor in determining stability. Component saturation and absolute sample size were the most important factors. To a lesser degree, the number of variables per component was also important, with variables per component producing more stable results. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
Cognitive deficits are a fundamental feature of the psychopathology of schizophrenia. Yet the effect of treatment on this dimension of the illness has been unclear. Atypical antipsychotic medications have been reported to reduce the neurocognitive impairment associated with schizophrenia. However, studies of the pattern and degree of cognitive improvement with these compounds have been methodologically limited and have produced variable results, and few findings have been replicated. To clarify our understanding of the effects of atypical antipsychotic drugs on neurocognitive deficits in patients with schizophrenia, we have (1) reported on newly established standards for research design in studies of treatment effects on cognitive function in schizophrenia, (2) reviewed the literature on this topic and determined the extent to which 15 studies on the effect of atypical antipsychotics met these standards, (3) performed a meta-analysis of the 15 studies, which suggested general cognitive enhancement with atypical antipsychotics, and (4) described the pharmacological profile of these agents and considered the pharmacological basis for their effects on neurocognition. Finally, we suggest directions for the development of new therapeutic strategies.
Article
Full-text available
The Internet can be an effective medium for the posting, exchange, and collection of information in psychology-related research and data. The relative ease and inexpensiveness of creating and maintaining Web-based applications, associated with the simplicity of use via the graphic-user interface format of form-based surveys, can establish a new research frontier for the social and behavioral sciences. To explore the possible use of Internet tools in psychological research, this study compared Web-based assessment techniques with traditional paper-based methods of different measures of Internet attitudes and behaviors in an Italian sample. The collected data were analyzed to identify both differences between the two samples and in the psychometric characteristics of the questionnaires. Even if we found significant differences between the two samples in the Internet attitudes and behaviors, no relevant differences were found in the psychometric properties of the different questionnaires. This result, similar to the ones previously obtained in Web-based assessments of personality constructs, is even more interesting given the lack of control on the characteristics of the online sample. These finding suggests that, if sampling control and validity assessment is provided, Internet-based questionnaires can be a suitable alternative to more traditional paper-based measures.
Article
Full-text available
Introduction With the introduction of newer atypical antipsychotic agents, a question emerged, concerning their use as complementary pharmacotherapy or even as monotherapy in mental disorders other than psychosis. Material and method MEDLINE was searched with the combination of each one of the key words: risperidone, olanzapine and quetiapine with key words that refered to every DSM-IV diagnosis other than schizophrenia and other psychotic disorders, bipolar disorder and dementia and memory disorders. All papers were scored on the basis of the JADAD index. Results The search returned 483 papers. The selection process restricted the sample to 59 papers concerning Risperidone, 37 concerning Olanzapine and 4 concerning Quetiapine (100 in total). Ten papers (7 concerning Risperidone and 3 concerning Olanzapine) had JADAD index above 2. Data suggest that further research would be of value concerning the use of risperidone in the treatment of refractory OCD, Pervasive Developmental disorder, stuttering and Tourette's syndrome, and the use of olanzapine for the treatment of refractory depression and borderline personality disorder. Discussion Data on the off-label usefulness of newer atypical antipsychotics are limited, but positive cues suggest that further research may provide with sufficient hard data to warrant the use of these agents in a broad spectrum of psychiatric disorders, either as monotherapy, or as an augmentation strategy.
Article
The phenomenon of subjective response to antipsychotic medications in schizophrenia was reviewed, focusing on validity, measurement, implications for clinical outcome and quality of life. Recommendations were made on improvements in research approaches to important factors that may contribute to the genesis of this phenomenon. Clinicians should pay attention to the subjective complaints of their patients about medications and not ignore them as unreliable. Researchers should not dismiss research into subjective experiences as non-scientific, because it provides valuable information on recognizing psychopathology and for improving the management of patients.
Article
Introduction: Reasoning biases such as jumping to conclusions (JTC) and overconfidence in errors have been well replicated in patients with delusions. However, their relation to dopaminergic activity, central to pathophysiologic models of psychosis, has not yet been investigated. This study aimed to examine the effects of a dopaminergic agonist (L-dopa) and a dopaminergic antagonist (haloperidol) on the JTC bias and overconfidence in errors after single-dose administration in healthy individuals. Methods: The study used a randomized, double-blind, placebo-controlled, 3-way crossover design. Participants were 36 healthy individuals aged 18-36 years. The variables of interest were draws to decision and probability threshold to decision on a computerized variant of the beads task and the number of high-confident incorrect responses on a visual memory task. Results: There were no significant effects of substance on draws to decision and probability threshold to decision. A significant effect emerged for high-confident incorrect responses in the memory task; pairwise comparisons indicated a significant reduction of the number of high-confident incorrect responses after administration of haloperidol vs l-dopa and placebo. Conclusions: This is the first study to investigate the direct effects of dopaminergic drugs on reasoning biases. The JTC bias and overconfidence in errors showed a differential pattern of dopaminergic modulation, suggesting that they represent different facets of reasoning abnormalities that interact with each other to produce delusions in susceptible individuals.
Article
Approximately one third of schizophrenic patients treated with neuroleptic drugs experience unpleasant subjective responses, that are collectively known as neuroleptic dysphoria. Experimental research in animals indicates that drug induced dopaminergic blockade in mesolimbic circuits, especially the nucleus accumbens, leads to impaired pleasure responsivity and dysphoria. The present study tested this putative mechanism in drug-free schizophrenic patients (n = 12), through inducing dysphoric responses with alphamethyl paratyrosine (AMPT) and simultaneously quantifying their baseline striatal dopmine (D2) function with 123IBZM-SPECT imaging. Results showed a wide variability in the occurrence and severity of dysphoric responses, clearly distinguishing a dysphoric group from non-dysphoric responders. Severity of dysphoric responses, measured by standardized rating scales, correlated inversely with changes in D2 receptor binding ratios (r = +0.82, p < .01). These results support the notion that striatal dopaminergic activity is not uniformly elevated in all schizophrenic patients, and the sub-group of individuals with lower baseline dopamine function are at an increased risk for dysphoric responses during antipsychotic therapy with dopaminergic blocking drugs.
Article
Internet-based questionnaires (e-questionnaires) have become widely used in psychopathology research, but there is currently little evidence on their reliability as compared with pen-and-paper equivalents. Data from separate samples of young adults completing e-questionnaires on hallucination-proneness (N = 751) and persecutory ideation (N = 183) were compared with data from pen-and-paper versions of the same questionnaires completed by a third, unrelated sample (N = 188). There was no effect of modality of presentation on mean scores on these questionnaires. Multi-group confirmatory factor analysis indicated mode invariance of factor structure for the persecutory ideation questionnaire. Internal reliability of both questionnaire formats was satisfactory. We conclude that the administration of traditional measures of psychopathology via e-questionnaire is a reliable method of data collection.
Article
Although antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium-effect size range and at least 50% of patients discontinue