Cognitive behaviour therapy for schizophrenia

Schizophrenia is one of the major and potentially severe mental illnesses. Even with best practices, there are limitations to the effectiveness of treatments that include medications for this disorder. Relapse rates are high and often those with the illness remain symptomatic and functionally impaired. All the evidence suggests that individuals with schizophrenia do best with a combination of pharmacological and psychosocial intervention. One psychosocial treatment that has received much attention is cognitive behaviour therapy (CBT). This brief review will address what we know about the use and effectiveness of CBT at all phases of schizophrenia and its strengths, weaknesses and its future

Cognitive Insight in Youth at Clinical High Risk of Psychosis

Introduction: Cognitive insight reflects one’s Self-Reflectiveness (recognition of dysfunctional reasoning, corrigibility) and Self-Certainty (overconfidence). In schizophrenia, lower Self-Reflectiveness and higher Self-Certainty has been associated with severity of symptoms and poor functioning. There is some evidence that lower Self-Reflectiveness and higher Self-Certainty are associated with attenuated symptoms in youth at clinical high risk (CHR) of psychosis. The present study evaluated in a CHR sample the relationship between cognitive insight and attenuated symptoms, current functioning, and evaluated change in cognitive insight at baseline and 1-month follow-up. Methods: Twenty-four individuals at CHR of psychosis completed the Beck Cognitive Insight Scale. Attenuated psychotic symptoms were assessed with the Scale of Prodromal Symptoms and functioning with the Global Functioning Social and Role scales. A subset of the sample completed the Calgary Depression Scale for Schizophrenia. Self-Reflectiveness, Self-Certainty, and Composite Index scores were correlated with clinical and functional variables. In addition, cognitive insight levels were compared at baseline and 1-month follow-up. Results: Trends were observed toward both increased attenuated perceptual abnormalities/hallucinations and higher Self-Reflectiveness, and increased avolition and increased Self-Reflectiveness. Cognitive insight did not significantly correlate with social or role functioning, or depression. Cognitive insight scores did not significantly differ between baseline and 1-month follow-up. Discussion: These findings provide little evidence for a relation between cognitive insight and clinical and functional variables in CHR, and suggest that cognitive insight remains stable over a 1-month time period in our sample. These data add to a growing body of literature on cognitive insight across the schizophrenia spectrum

Development and Usability Testing of SOMO, a Mobile-Based Application to Monitor Social Functioning for Youth at Clinical High-Risk for Psychosis

Background: Youth at clinical high-risk (CHR) for developing psychosis are characterized by long-standing social deficits and isolation compared to healthy youth. Because poor social functioning is predictive of transition to psychosis, it is important to monitor its fluctuations. Objective: To describe the development of a mobile application to monitor social functioning for CHR youth. Methods: App development was divided in two phases. In Phase 1, three focus groups with up to 10 CHR participants were conducted to discuss (i) content, (ii) graphic design, and (iii) user experience of the app. A working prototype was developed, debugged, and systematically tested by developers. In Phase 2, 13 participants evaluated the app through a usability testing for one week. Feedback was gathered through the 23-item Mobile Application Rating Scale user-version (uMARS). Focus groups and MARS’ qualitative data were audio-recorded, transcribed verbatim, and analyzed through an inductive approach. Results: The app was named SOMO and incorporated five features: 1) home screen; 2) goal setting; 3) 13 daily questions; 4) a calendar; and 5) feedback.  The application monitored number of daily in-person and online interactions, meaningfulness and time spent with each person, conflict and conflict resolution, activities performed, subjective perception of socialization, and loneliness. SOMO received a good overall score in the uMARS, with an excellent score in functionality; followed by good scores in information, aesthetics, and safety; and adequate scores for subjective quality, and engagement. Conclusion: Co-design with youth through focus groups provided effective feedback for developing SOMO, which demonstrated initial usability and acceptability

Depression, family interaction and family intervention in adolescents at clinical-high risk for psychosis.

AIM: The relationship between family behaviour and depression in adolescents at clinical high risk (CHR) for psychosis remains understudied despite high rates of depression in this population. This study examines the relationship between family problem-solving behaviours and depression in CHR adolescents and the impact of family interventions targeting subthreshold symptoms of psychosis on reducing symptoms of depression over 2-years. METHODS: Participants were a subset of the North American Prodrome Longitudinal Study who were randomized to 6-months of family focused therapy for individuals at CHR or family psychoeducational treatment. We evaluated the relationship between communication during family conflict discussion and adolescents symptoms of depression before treatment. At follow-up assessments the family treatment groups were compared on depression. Finally, we compared those in family treatment with matched controls. RESULTS: Adolescents constructive communication was associated with less severe symptoms of depression before treatment. Symptoms of depression improved for adolescents in both family treatment groups. However, there were no significant group by treatment interactions. When adolescents who participated in either type of family intervention were compared to CHR adolescent controls, symptoms of depression improved for adolescents in treatment and control groups, but there were no significant time by treatment interactions. CONCLUSIONS: The communication skills of CHR adolescents are related to both depression and their parents communication skills pre-treatment. However, reductions in depression over the course of the treatment trial cannot be attributed to family treatment. It is imperative to incorporate interventions that directly target depression into future family treatment studies

The Role of Cognition and Social Functioning as Predictors in the Transition to Psychosis for Youth With Attenuated Psychotic Symptoms

In the literature, there have been several attempts to develop prediction models for youth who are at clinical high risk (CHR) of developing psychosis. Although there are no specific clinical or demographic variables that seem to consistently predict the later transition to psychosis in those CHR youth, in addition to attenuated psychotic symptoms, the most commonly occuring predictors tend to be poor social functioning and certain cognitive tasks. Unfortunately, there has been little attempt to replicate alogorithms. A recently published article by Cornblatt et al suggested that, for individuals with attentuated psychotic symptoms (APS), disorganized communication, suspiciousness, verbal memory, and a decline in social functioning were the best predictors of later transition to psychosis (the RAP model). The purpose of this article was to first test the prediction model of Cornblatt et al with a new sample of individuals with APS from the PREDICT study. The RAP model was not the best fit for the PREDICT data. However, using other variables from PREDICT, it was demonstrated that unusual thought content, disorganized communication, baseline social functioning, verbal fluency, and memory, processing speed and age were predictors of later transition to psychosis in the PREDICT sample. Although the predictors were different in these 2 models, both supported that disorganized communication, poor social functioning, and verbal memory, were good candidates as predictors for later conversion to psychosis

Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis

Elevated rates of substance use (alcohol, tobacco, cannabis) have been reported in people at clinical high risk (CHR) of developing psychosis and there is some evidence that substance use may be higher in those who convert to a psychosis compared to non-converters. However little is known about the predictive value of substance use on risk of conversion to psychosis in those at CHR of psychosis. In the current study, 170 people at CHR of psychosis were assessed at baseline on severity of alcohol, tobacco and cannabis using the Alcohol and Drug Use Scale. Participants were recruited across three sites over a four year period as part of the Enhancing the Prospective Prediction of Psychosis (PREDICT) study. Predictors of conversion to psychosis were examined using Cox proportional hazards models. Results revealed that low use of alcohol, but neither cannabis use nor tobacco use at baseline contributed to the prediction of psychosis in the CHR sample. Prediction algorithms incorporating combinations of additional baseline variables known to be associated with psychotic conversion may result in increased predictive power compared with substance use alone

Genetic effects on gene expression across human tissues

Characterization of the molecular function of the human genome and its variation across individuals is essential for identifying the cellular mechanisms that underlie human genetic traits and diseases. The Genotype-Tissue Expression (GTEx) project aims to characterize variation in gene expression levels across individuals and diverse tissues of the human body, many of which are not easily accessible. Here we describe genetic effects on gene expression levels across 44 human tissues. We find that local genetic variation affects gene expression levels for the majority of genes, and we further identify inter-chromosomal genetic effects for 93 genes and 112 loci. On the basis of the identified genetic effects, we characterize patterns of tissue specificity, compare local and distal effects, and evaluate the functional properties of the genetic effects. We also demonstrate that multi-tissue, multi-individual data can be used to identify genes and pathways affected by human disease-associated variation, enabling a mechanistic interpretation of gene regulation and the genetic basis of disease.Postprint (published version

Patterns of premorbid functioning in individuals at clinical high risk of psychosis

In schizophrenia, four typical patterns of premorbid functioning have been observed: stable-good, stable-intermediate, poor-deteriorating and deteriorating. However, it is unknown whether similar patterns exist in those who are at clinical high risk (CHR) of psychosis. The aim of this study was to examine patterns of premorbid functioning in a large sample of individuals at CHR of psychosis and its association with symptoms, functioning, and conversion to psychosis. One-hundred sixty people at CHR of psychosis were assessed on premorbid functioning using the Premorbid Adjustment Scale. Poorer premorbid functioning was significantly correlated with worse negative symptom severity and lower social functioning. Cluster analysis was used to identify patterns of premorbid functioning. Results indicated three patterns of premorbid functioning in our CHR sample: stable-intermediate, stable-good, and deteriorating. The deteriorating group had more severe disorganization, worse negative symptoms and poorer social functioning than the other groups. Participants who made the conversion to psychosis had significantly poorer premorbid functioning during adolescence compared to those who did not convert. These results suggest that those at a clinical high risk for psychosis display similar patterns in premorbid functioning as have been observed in those with a psychotic illness and that poor premorbid functioning may be a predictor of psychosis

Theory of mind and social judgments in people at clinical high risk of psychosis

Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations