A randomized controlled pilot study of cognitive behavioral social skills training for older patients with schizophrenia.
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Aged↗
Biomedical subjects
E Granholm
Publications and source records attributed to E Granholm.
Ethical issues in psychosocial interventions research involving controls.
Psychiatric research is of critical importance in improving the care of persons with mental illness. Yet it may also raise difficult ethical issues. This article explores those issues in the context of a particular kind of research: psychosocial intervention research with control groups. We discuss 4 broad categories of ethical issues: consent, confidentiality, boundary violations, and risk-benefit issues. We believe that, despite the potential difficulties, psychosocial intervention research is vital and can be accomplished in an ethical manner. Further discussion and research into these issues are warranted.
Behavioral Research↗
Pupillary and reaction time measures of sustained processing of negative information in depression.
BACKGROUND: Disruptions of emotional information processing (i.e., attention to, memory for, and interpretation of emotional information) have been implicated in the onset and maintenance of depression. The research presented here investigated cognitive and psychophysiological features of a particularly promising correlate of depression: sustained processing of negative information 4--5 sec after an emotional stimulus. METHODS: Pupil dilation data and reaction times were collected from 24 unmedicated depressed and 25 nondepressed adults in response to emotional processing tasks (lexical decision and valence identification) that employed idiosyncratically generated personally relevant and normed stimuli. Pupil dilation was used to index sustained cognitive processing devoted to stimuli. RESULTS: Consistent with predictions, depressed individuals were especially slow to name the emotionality of positive information, and displayed greater sustained processing (pupil dilation) than nondepressed individuals when their attention was directed toward emotional aspects of information. Contrary to predictions, depressed participants did not dilate more to negative than positive stimuli, compared to nondepressed participants. CONCLUSIONS: These data suggest depressed individuals may not initially attend to emotional aspects of information but may continue to process them seconds after they have reacted to the information.
Adult↗
Pupillary responses and processing resources on the visual backward masking task.
Task-evoked pupillary responses were recorded during a visual backward masking task as an index of resource allocation. Increased pupillary dilation indicates increased allocation of processing resources to the task. Consistent with numerous studies, detection accuracy increased with longer interstimulus intervals and approximated no-mask accuracy in the 300-ms condition. Pupillary dilation responses were significantly greater during task performance (cognitive load) than during a passive stimulus viewing condition (no-load) and were significantly greater in the 300-ms condition than the no-mask condition. Consistent with models of early visual information processing, the results suggest that the mask demanded extra processing resources when it followed the target by more than 100 ms. Pupillography methods may be useful in evaluating the contribution and timing of resource-demanding processes during early visual information processing.
Adult↗
Differentiation of deception using pupillary responses as an index of cognitive processing.
The deception literature has predominantly focused on detection of guilty individuals using electrodermal measures. Little research has examined other psychophysiological measures or the mechanisms underlying deception. Therefore, the present study examined pupillary responses in a differentiation-of-deception paradigm. Twenty-four undergraduate participants answered the same questions twice, once truthfully and once deceptively, while pupillary responses were recorded. Questions were based on recently learned (episodic) information from scenarios or on general (semantic) knowledge from long-term memory. Task-evoked pupil dilation was significantly greater when participants confabulated responses than when they told the truth for both episodic and semantic memory questions. Previous research has demonstrated that pupil size increases with increased cognitive processing load. The present study suggested that generating deceptive recall was associated with increased pupil size and required greater cognitive processing than truthful recall.
Adult↗
Accelerated age-related decline in processing resources in schizophrenia: evidence from pupillary responses recorded during the span of apprehension task.
Cognitive impairment in schizophrenia may be related to reduced availability of information-processing resources (resource limitations hypothesis). An abnormally accelerated age-related decline in processing resource availability may also occur in older patients with schizophrenia (neurodegeneration hypothesis). To test these hypotheses, pupillary responses were recorded as an index of processing resource availability during performance of the span of apprehension (SOA) task in 33 middle-aged and older patients with schizophrenia and 37 age-comparable nonpsychiatric participants. Consistent with the resource-limitations hypothesis, the patients with schizophrenia showed impaired detection accuracy and abnormally small pupillary responses (reduced resource allocation) only in the higher processing load SOA conditions. This pattern of results suggests that the patients depleted their available processing resources at lower processing loads than the nonpsychiatric participants. Consistent with the neurodegeneration hypothesis, cross-sectional analyses showed abnormally accelerated rates of age-related decline in SOA performance and pupillary responses in the patients with schizophrenia relative to age-comparable normal participants.
Age Factors↗
Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in a mental health clinic sample.
OBJECTIVE: To examine the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) and to identify the implications of this structure for its clinical use. METHOD: The AUDIT was administered to mental health clinic outpatients (N = 197; 86% men) at high risk for alcohol-use disorders. Confirmatory and exploratory factor analyses were used to determine the underlying factor structure of the AUDIT for this high-risk population. RESULTS: Confirmatory analyses indicated that the a priori three- and one-factor solutions did not fit the observed data. The exploratory analyses supported a two-factor solution that included level of alcohol consumption and drinking problems, with both factors explaining substantial variance in AUDIT scores. These findings contrast the original three-factor design of the AUDIT and the conventional use of the AUDIT as a one-factor screening device with a single cutoff score. CONCLUSIONS: Other screening methods that incorporate this two-factor model may be important for mental health patient populations. Replication of these findings among other mental health samples is needed.
Adolescent↗
Neurocognitive functioning of adolescents: effects of protracted alcohol use.
BACKGROUND: The present study examined associations between alcohol involvement in early to middle adolescence and neuropsychological (NP) functioning. METHODS: Alcohol-dependent adolescents (n = 33) with over 100 lifetime alcohol episodes and without dependence on other substances were recruited from alcohol/drug abuse treatment facilities. Comparison (n = 24) adolescents had no histories of alcohol or drug problems and were matched to alcohol-dependent participants on age (15 to 16 years), gender, socioeconomic status, education, and family history of alcohol dependence. NP tests and psychosocial measures were administered to alcohol-dependent participants following 3 weeks of detoxification. RESULTS: Alcohol-dependent and comparison adolescents demonstrated significant differences on several NP scores. Protracted alcohol use was associated with poorer performance on verbal and nonverbal retention in the context of intact learning and recognition discriminability. Recent alcohol withdrawal among adolescents was associated with poor visuospatial functioning, whereas lifetime alcohol withdrawal was associated with poorer retrieval of verbal and nonverbal information. CONCLUSIONS: Deficits in retrieval of verbal and nonverbal information and in visuospatial functioning were evident in youths with histories of heavy drinking during early and middle adolescence.
Adolescent↗
Development of an integrated cognitive-behavioral and social skills training intervention for older patients with schizophrenia.
There is considerable evidence that psychosocial treatments benefit younger adults with schizophrenia. However, no studies have been undertaken of such interventions for older patients with schizophrenia. This report describes the development of a novel integrated treatment combining cognitive-behavioral therapy (CBT) and social skills training (SST). This intervention is designed to address the needs of older patients with schizophrenia by challenging beliefs common in this population that interfere with treatment and by providing repetitive practice of behaviors to improve retention and skill development. The authors provide two case reports and pilot data suggesting benefits of this approach.
Adult↗
Brain activation and pupil response during covert performance of the Stroop Color Word task.
Patterns of brain activation associated with covert performance of the Stroop Color-Word task were studied in young, healthy, adult volunteers using blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI). Comparisons of the incongruous Stroop condition were made with both color naming and word reading baselines. Areas of the left and right anterior cingulate, the right precuneus, and the left pars opercularis displayed larger BOLD signal responses during the incongruous Stroop condition than during baseline conditions. Activation of BOLD signals in these areas was highly repeatable. In a second experiment, pupil diameter was used to assess cognitive load in 7 individuals studied during overt and covert performance of both Stroop and color naming conditions. Cognitive load was similar in overt and covert response conditions. Results from the BOLD study indicate that brain regions participating in selective visual attention and in the selection of motor programs involved in speech were activated more by the Stroop task than by the baseline tasks. The neural substrate involved in the resolution of the perceptual and motor conflicts elicited by the Stroop Color-Word task does not appear to be a single brain region. Rather, a network of brain regions is implicated, with separate regions within this system supporting distinct functions.
Adult↗
Computerized and traditional stroop task dysfunction in HIV-1 infection.
Controlled processing, response inhibition, and set adoption were examined in 51 HIV-1 infected participants and 21 uninfected controls who were administered a vocal reaction time (RT) version of the Stroop task (Stroop-RT; J. R. Stroop, 1935) as well as the traditional 100 item paper-and-pencil version. Response set expectancies on the Stroop-RT were manipulated by presenting 50% of trials in homogenous blocks and randomly varying the stimulus type during the remaining trials. As hypothesized, HIV seropositive (HIV+) participants were significantly slower than HIV seronegative controls on both versions of the Stroop. Significant interference effects were apparent on the paper-and-pencil version of the Stroop, but were not as prominent on the Stroop-RT. The HIV+ participants did profit from the blocking manipulation on the Stroop-RT, suggesting that set adoption is retained in HIV infection. These data suggest that HIV infection may result in deficient response inhibition, possibly secondary to frontostriatal dysfunction and dopaminergic alterations.
Adult↗
The role of neurocognitive abilities in coping with adolescent relapse to alcohol and drug use.
OBJECTIVE: Neurocognitive abilities are hypothesized to influence coping with temptations to relapse to alcohol and drug use. In particular, a moderator model was proposed whereby neurocognitive abilities moderate the influence of coping strategies on treatment outcome. METHOD: Participants (N = 79) were consecutive admissions to inpatient alcohol and drug treatment centers in the San Diego, California. area, (age range = 14 to 18 years; 41% female). Treatment programs were abstinence focused, with an average inpatient stay of 5 weeks. Participants met DSM-III-R lifetime criteria for alcohol abuse or dependence and abuse or dependence of at least one other substance. Follow-up assessments were conducted 1 and 2 years following discharge, including a battery of neuropsychological tests, coping questionnaire, and detailed assessment of alcohol and other drug involvement. RESULTS: The interaction between general intelligence and coping diversity significantly predicted alcohol and drug use 1 year later (F = 10.71, 1/72 df, p <.005, R2 change =.08), even when controlling for current use. Attention-coping and problem solving-coping interactions also significantly predicted outcome, but not above the intelligence-coping interaction. CONCLUSIONS: Teens with poor neurocognitive abilities used little or no alcohol and drugs if good coping skills were evidenced, but used more alcohol and drugs if their coping skills were poor. This association between coping skills and outcome did not exist for teens with better neurocognitive abilities. Clinically, teens with poorer neurocognitive skills may maximally benefit from coping skills training programs, and neuropsychological evaluations may be particularly helpful in addressing these individual needs in treatment.
Adaptation, Psychological↗
Positive and negative schizotypal symptoms relate to different aspects of crossover reaction time task performance.
Although the expressions of both positive and negative symptoms in schizophrenia spectrum illnesses can each occur with varying degrees of severity, researchers have often dichotomized patients as generally positive or negative subtypes. Studies of schizophrenia and schizotypal personality disorder (SPD) have not typically controlled for the severity of the other symptom types when examining the relationship between positive and negative symptom subtypes and cognitive impairment. The present study investigated the relationship between the severity of both symptom types and reaction time crossover task performance in SPD in groups made equivalent on the severity of the other type of symptom. Fifty-eight out of 458 undergraduates were screened into one of four groups (high negative-high positive, low negative-low positive, high negative-low positive or low negative-high positive) by the Schizotypal Personality Questionnaire and assessed with the reaction time crossover task. The results indicated that negative schizotypal symptoms were associated with the early crossover pattern, while positive schizotypal symptoms related to longer overall reaction time. Therefore, different cognitive mechanisms involved in crossover task performance appeared to be associated with different symptom subtypes.
Adult↗
Pupillary responses evoked during verbal fluency tasks indicate semantic network dysfunction in schizophrenia.
Pupillary responses, which index task controlled processing load, were recorded during semantic and phonemic fluency tasks to examine controlled search and automatic semantic network deficits in patients with schizophrenia. Word retrieval was more impaired on semantic than on phonemic fluency, but only during the first 15 seconds of trials. Pupillary dilation was greater on phonemic than on semantic fluency in nonpsychiatric participants but was greater on semantic than on phonemic fluency in the patients, during the first 15 seconds of trials. Thus, early in semantic fluency trials, patients with schizophrenia showed poorer word retrieval and abnormally high demand for frontal lobe controlled search processes, suggesting impairments in the temporal lobe automatic semantic memory processes that normally facilitate word retrieval.
Adult↗
Substance-Induced Psychosis.
Intoxication and withdrawal from a variety of central nervous system depressants and stimulants may induce hallucinations or delusions, which, when unaccompanied by insight, are the hallmarks of psychosis. A substance-induced psychosis may, in many instances, present as an organic psychosis or as an independent mental disorder (eg, schizophrenia), complicating diagnostic efforts. Ramifications of a misdiagnosed psychotic illness are potentially long-lasting and harmful to a patient. It is, therefore, crucial that health care providers be aware of the complex relationship between substance abuse, psychotic symptoms, and independent psychotic disorders. This report addresses substance-induced psychosis, by describing those psychotic symptoms most commonly associated with the abuse of specific drugs and alcohol, detailing useful diagnostic techniques and outlining treatment recommendations.
Journal Article↗
Effects of schizophrenia and aging on pupillographic measures of working memory.
The amount of cognitive resources used to perform a task can be indexed as changes in pupil size. In a previous study, we examined pupillary response measures of slave store and central executive cognitive resources during a working memory task and found abnormally reduced utilization of these resources in schizophrenia. In the present study, multiple regression analyses were performed to examine the independent and combined effects of aging and schizophrenia on pupillary response and recall measures in a larger sample of community-dwelling schizophrenia patients. Schizophrenia was associated with a significant decline in working memory capacity, and an additional moderate decline was associated with aging, but these two factors did not interact. Baseline pupil size was significantly correlated with symptom severity, independent of medication. However, pupillary responses evoked by the working memory task and recall scores were not related to symptom severity. Results were consistent with an additive, rather than a synergistic, relationship between aging and schizophrenia, and suggested that working memory impairment in noninstitutionalized outpatients with schizophrenia may remain stable across symptom status and across the life span.
Adult↗
Pupillary responses index overload of working memory resources in schizophrenia.
The authors examined the hypothesis that schizophrenia patients have reduced availability of working memory resources by using pupillary responses as an index of resource overload. Pupillary responses were recorded during a verbal working memory task (digit recall) in 24 schizophrenia patients and 32 normal controls. Pupil size increased with increased processing load (digit-span length) but changed little or declined when processing demands exceeded available resources (overload). The schizophrenia patients showed impaired digit recall and abnormally small pupillary responses during digit presentation only in the higher processing load conditions, but they showed abnormally small pupillary responses during digit retrieval in all processing load conditions. The results suggest reduced availability of slave store and central executive working memory resources in schizophrenia. This study serves as an example of how pupillography methods can be used to test current hypotheses regarding overload of cognitive capacities in schizophrenia patients.
Adult↗
Span of apprehension deficits in older outpatients with schizophrenia.
Performance on the span of apprehension task, a well-studied information processing task in schizophrenia research, was examined in 11 schizophrenia patients and 11 normal comparison participants, all over the age of 45 years. Subjects detected "T' and "F' targets in briefly-flashed arrays of 1, 6, and 12 letters on the span task. Consistent with previously reported findings in younger schizophrenia patients, the older patients detected significantly fewer targets in the larger (12-letter), but not smaller (1-, or 6-letter), arrays. The older schizophrenia patients also showed significantly slower reaction times in all array-size conditions. Neither age of onset nor duration of illness was significantly correlated with span task performance. The characteristic span of apprehension task deficit found in the older schizophrenia patients suggests that late-life schizophrenia shares a common cognitive impairment with childhood and young adulthood schizophrenia, and provides supportive evidence for a possible stable vulnerability trait deficit in schizophrenia that is independent of age of onset and duration of illness.
Age Factors↗