Emotion deficits in schizophrenia: Timing matters.

The past two decades of research on emotional response in schizophrenia has demonstrated that people with schizophrenia do not have a marked deficit in reported emotional experience in the presence of emotionally evocative stimuli. However, the extent to which people with schizophrenia maintain their emotional state to guide future behavior remains a largely unexplored area of investigation. In the present study, we tested hypotheses about whether people with schizophrenia maintained their emotional state in the absence of emotionally evocative stimuli. In addition to reported emotional experience, we measured startle response magnitude both during the viewing and after the offset of emotional pictures to assess whether people with schizophrenia (n = 31) and without schizophrenia (n = 28) differ in their patterns of immediate response to emotional pictures and in their patterns of maintenance of these responses. Our findings indicated that people with and without schizophrenia did not differ in their self-report or startle response magnitude during presentation of emotional pictures. However, healthy controls maintained these responses after the stimuli were removed from view, but people with schizophrenia did not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of antipsychotic treatment on polysomnographic measures in schizophrenia: a replication and extension

OBJECTIVE: The authors sought to replicate and extend previous observations of improvement in some EEG sleep measures during the course of antipsychotic treatment in schizophrenia patients. METHOD: Fourteen medication-free patients with schizophrenia underwent 2 nights of sleep EEG monitoring before and after 3-4 weeks of treatment with clinically determined doses of haloperidol or thiothixene. RESULTS: Measures of sleep continuity improved consistently. REM latency increased, although five of 14 patients continued to exhibit short REM latencies (less than 60 minutes). Stage 3 sleep increased during neuroleptic treatment, while stage 4 sleep did not change. CONCLUSIONS: These data demonstrate partial improvement of some but not all EEG sleep measures in schizophrenic patients through the course of neuroleptic treatment. They suggest that shortened REM latency and disturbed sleep continuity might represent reversible state abnormalities, while reduced slow-wave sleep may represent a more persistent trait abnormality in schizophrenia.     

A new theory of schizophrenia.

Atheory of schizophrenia is presented by a patient on a closed ward of a VA hospital with a diagnosis of paranoid schizophrenia. "My view is that the schizophrenic has adopted semi-instinctive, insincere strategems in order to escape punishment, one of them being withdrawal from intimacy—which isolation causes a libidinal starvation resulting in an involuntary, neurotic-type outbreak of symptoms based on unconscious, pregenital (perverted libidinal) drives… . He is a terrified, conscience-stricken crook, who has repressed his interest in people, unavowedly insincere and uncooperative, struggling against unconscious sexual perversion." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using positive psychology with special mental health populations.

In our clinical practice, we have attempted to use a positive psychology approach in working with people with schizophrenia and youths with behavioral disorders. We present three clinical applications that use a positive psychology approach with these populations: group treatment with persons with schizophrenia; individual cognitive stimulation therapy with persons with schizophrenia; and computer-facilitated dialogue and therapy with persons with schizophrenia and adolescents with behavioral disorders. These three clinical applications using positive psychology are consistent with those traditional treatment goals that aim to increase clients' functioning and improve their quality of life. Given that many people with long-standing emotional "problems" have difficulties initiating change or internalizing feedback regarding their behavioral deficits, the therapeutic environment and clinical interactions need to focus equally on clients' strengths and skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploration of cerebellar-dependent associative learning in schizophrenia: Effects of varying and shifting interstimulus interval on eyeblink conditioning.

Eyeblink conditioning abnormalities have been reported in schizophrenia, but the extent to which these anomalies are evident across a range of delay intervals (i.e., interstimulus intervals; ISIs) is unknown. In addition, the effects of ISI shifts on learning are unknown, though such manipulations can be informative about the plasticity of cerebellar timing functions. Therefore, the primary purpose of the present study was to investigate the interactions between ISI manipulations and learning in schizophrenia. A standard delay eyeblink conditioning procedure with four different interstimulus intervals (ISIs; 250, 350, 550, 850 ms) was employed. Each eyeblink conditioning experiment was immediately followed by another with a different ISI, thus permitting the characterization of conditioned response (CR) learning at one ISI and the extent to which CRs could be generated at a different latency following an ISI shift. Collapsing across all conditions, the schizophrenia group (n = 55) had significantly fewer conditioned responses and longer onset latencies than age-matched controls (n = 55). Surprisingly, shifting to a new ISI had negligible effects on conditioned response rates in both groups. These findings contribute to evidence of robust eyeblink conditioning abnormalities in schizophrenia and suggest impaired cerebellar function, but underscore the need for more research to clarify the source of these abnormalities and their relationship to clinical manifestations of schizophrenia. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Implicit memory for spatial context in depression and schizophrenia.

Deficits in explicit spatial memory, as well as abnormalities of the hippocampus and neighboring medial temporal structures, have been documented in schizophrenia and depression. Recent evidence relying on the contextual cueing paradigm has shown that integrity of these structures is crucial not only for explicit memory but also for implicit spatial memory. Using this paradigm, the authors show that implicit memory for spatial context is severely impaired in clinically depressed patients but reaches a normal level in schizophrenia patients, although in these patients, acquisition is slower than in controls. By contrast, implicit memory for isolated locations and colors is normal in both schizophrenia and depressed patients. These findings suggest an implicit memory impairment specific to spatial context in depression. The implications for research on the differences between schizophrenia and depression in abnormalities of the hippocampal system and for research on the neural correlates of contextual cueing are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building up linguistic context in schizophrenia: Evidence from self-paced reading.

An impairment in the build-up and use of context has been proposed as a core feature of schizophrenia. The current study tested the hypothesis that schizophrenia patients show impairments in building up context within sentences because of abnormalities in combining semantic with syntactic information. Schizophrenia patients and healthy controls read and made acceptability judgments about sentences containing verbs that were semantically associated with individual preceding words but that violated either the meaning (animacy/semantic constraints) or the syntactic structure (morphosyntactic constraints) of their preceding contexts. To override these semantic associations and determine that such sentences are unacceptable, participants must integrate semantic with syntactic information. These sentences were compared with congruous and pragmatically/semantically violated sentences that imposed fewer semantic-syntactic integration demands. At sentence-final words and decisions, patients showed smaller reaction time differences than controls to animacy/semantically violated or morphosyntactically violated sentences relative to pragmatically/semantically violated or nonviolated sentences. The relative insensitivity to these violations in patients with schizophrenia may arise from impairments in combining semantic and syntactic information to build up sentence context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A revised psychoanalytic conception of schizophrenia: An interdisciplinary update.

The psychoanalytic conception and treatment of schizophrenia is in need of fundamental revision because of (a) refinements in nosology which have separated out the borderline and affective disorders with which it had formerly been confused; (b) the development of newer psychoanalytic schools; and (c) the impact of various aspects of neurobiological research, the putative outcome of which seems to confirm that many, if not most, schizophrenics begin with a hereditary and/or congenital vulnerability to life and are disadvantaged in how they experience life, not only emotionally, but also neuroperceptually, neurocognitively, and neurobehaviorally. This contribution seeks to put schizophrenia and psychoanalysis in an interdisciplinary perspective by assigning the concept of disorders of psychical meaningfulness to the neurotic portion of the schizophrenic personality and of psychical meaninglessness to the psychotic portion of the personality. Whereas all psychoanalytic schools traditionally employ models that address meaningfulness, I suggest the employment of a newer model to deal with schizophrenia as a "disorder of self-regulation" (of meaninglessness), the latter being the neurobiological contribution. To the former I should like also to append the concept of a "disorder of interactional regulation" as its interpersonal complement in the sense of psychosocial, object relations, and systems theory interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emergence of coherence over the course of decision making.

Previous research has indicated that decision making is accompanied by an increase in the coherence of assessments of the factors related to the decision alternatives. In the present study, the authors investigated whether this coherence shift is obtained before people commit to a decision, and whether it is obtained in the course of a number of other processing tasks. College students were presented with a complex legal case involving multiple conflicting arguments. Participants rated agreement with the individual arguments in isolation before seeing the case and after processing it under various initial sets, including playing the role of a judge assigned to decide the case. Coherence shifts were observed when participants were instructed to delay making the decision (Experiment 1), to memorize the case (Experiment 2), and to comprehend the case (Experiment 3). The findings support the hypothesis that a coherence-generating mechanism operates in a variety of processing tasks, including decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theory of Mind and Motion Perception in Schizophrenia.

This study investigated the relationship between theory of mind (ToM) deficits and visual perception in patients with schizophrenia (N=52; 17 remitted and unmedicated) compared with healthy controls (N=30). ToM was assessed with the Eyes Test, which asked participants to choose which of 4 words best described the mental state of a person whose eyes were depicted in a photograph. Visual perception was evaluated with form and motion coherence threshold measurements. Results revealed that patients with schizophrenia (both remitted and nonremitted) showed deficits on the Eyes Test and the motion coherence task. ToM dysfunctions were associated with higher motion coherence thresholds and more severe negative symptoms. This suggests that ToM deficits are related to motion perception dysfunctions, which indicates a possible role of motion-sensitive areas in the pathophysiology of schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrating emotional events in schizophrenia.

Research has indicated that schizophrenia patients report similar amounts of experienced emotion in response to emotional material compared with nonpatients. However, less is known about how schizophrenia patients describe and make sense of their emotional life events. We adopted a narrative approach to investigate schizophrenia patients' renderings of their emotional life experiences. In Study 1, patients' (n = 42) positive and negative narratives were similarly personal, tellable, engaged, and appropriate. However, negative narratives were less grammatically clear than positive narratives, and positive narratives were more likely to involve other people than negative narratives. In Study 2, emotional (positive and negative) narratives were less tellable and detached, yet more linear and social compared with neutral narratives for both schizophrenia patients (n = 24) and healthy controls (n = 19). However, patients' narratives about emotional life events were less appropriate to context and less linear, and patients' narratives, whether emotional or not, were less tellable and more detached compared with controls' narratives. Although schizophrenia patients are capable of recounting life events that trigger different emotions, the telling of these life events is fraught with difficulty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A learning theory approach to research in schizophrenia.

"An attempt has been made to view schizophrenia as a problem in learning theory. The research in conditioning, learning, and generalization in schizophrenia has been reviewed in these terms. It was found that this research supported such an interpretation. An explication of the causes of an acute schizophrenic break and the transition to chronicity was attempted." 79 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-related practice effects across longitudinal neuropsychological assessments in older people with schizophrenia.

Objective: The relationship between aging and practice effects on longitudinal neuropsychological assessments was investigated in middle-aged and older people with schizophrenia and healthy controls. Method: Older people with schizophrenia (n = 107; M age = 56.1) and age-comparable nonpsychiatric controls (n = 107; M age = 57.7) were scheduled to receive annual assessments on a comprehensive battery of neuropsychological tests for an average of 2.5 years (range 11 months to 4 years). Mixed-model analyses were used to separately examine the effects of practice and age on test performance. Results: Number of prior assessments (practice) was associated with significant performance improvement across assessments, whereas older age was associated with significant decline in performance. The groups did not differ significantly in extent of age-related cognitive decline, but a three-way interaction among group, age, and practice was found, such that greater age-related decline in practice effects were found for older people with schizophrenia relative to nonpsychiatric participants. Conclusions: This study did not find any evidence of neurodegenerative age-related decline in neuropsychological abilities in middle-aged and older people with schizophrenia, but older age was associated with diminished ability to benefit from repeated exposure to cognitive tasks in people with schizophrenia. Cognitive impairment in schizophrenia may combine with cognitive decline associated with normal aging to reduce practice effects in older patients. These findings have important implications for the design of studies examining the longitudinal trajectory of cognitive functioning across the life span of people with schizophrenia, as well as clinical trials that attempt to demonstrate cognitive enhancement in these individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antonovsky's sense of coherence: theoretical basis of psychoeducation in schizophrenia

Psychoeducational models have been found to be effective interventions for people with schizophrenia. However, a unifying theoretical basis for these models has not been articulated. This article explicates the sense of coherence theory developed by A. Antonovsky (1987) and demonstrates its utility as a framework for conceptualizing the basis for the effectiveness of psychoeducational programs.     

The Primacy of Cognition in Schizophrenia.

Cognitive tasks and concepts are used increasingly in schizophrenia science and treatment. Recent meta-analyses show that across a spectrum of research domains only cognitive measures distinguish a majority of schizophrenia patients from healthy people. Average effect sizes derived from common clinical tests of attention, memory, language, and reasoning are twice as large as those obtained in structural magnetic resonance imaging and positron emission tomography studies. Chronic stress, genes, brain disturbances, task structure, gender, and sociocultural background may all enhance the sensitivity of cognitive performance to schizophrenia. At the same time, disease heterogeneity and the presence of endophenotypes and subtypes within the patient population may place upper limits on the strength of any specific cognitive finding. Schizophrenia is a complex biobehavioral disorder that manifests itself primarily in cognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cortical Networks Generating Movement-Related EEG Rhythms in Alzheimer's Disease: An EEG Coherence Study.

Patients with mild Alzheimer's disease (AD) present with abnormally strong values of frontal and ipsilateral central sensorimotor rhythms. The authors tested 2 working hypotheses of the related electroencephalographic (EEG) coherence: disconnection, defined as a sign of a reduced coordination within the frontoparietal and interhemispheric networks, and cooperation, defined as a reflection of the reorganization of the brain sensorimotor networks. Results showed that, compared with healthy controls, patients with mild AD had an unreactive and abnormally low interhemispheric EEG coherence and an unreactive and abnormally high frontoparietal EEG coherence. These findings support the hypothesis of an impaired mechanism of sensorimotor cortical coupling (disconnection) in mild AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological impairment in patients with schizophrenia and evidence of hyponatremia and polydipsia.

Patients with schizophrenia and water imbalance may represent a subset of patients with distinct pathophysiological abnormalities and susceptibility to cognitive impairment. Specifically, patients with polydipsia and hyponatremia have been shown to have smaller anterior hippocampal volumes, which are also associated with various impairments in neuroendocrine function. To determine whether abnormalities in patients with water imbalance extend to the cognitive realm, the present study evaluated neuropsychological functioning in three groups of patients with schizophrenia: polydipsic hyponatremic, polydipsic normonatremic, and nonpolydipsic normonatremic. Participants were administered cognitive tests assessing intelligence, attention, learning/memory (verbal, nonverbal, emotional), and facial discrimination. Hyponatremic patients showed poorer overall neuropsychological functioning relative to all other patients, and polydipsic normonatremic patients performed intermediate to the other two groups. Results indicate that patients with schizophrenia and polydipsia, and particularly those with hyponatremia, show prominent cognitive deficits relative to patients without water imbalance. The clinical, neuroendocrine, and cognitive abnormalities in these patients may arise from pathology within the anterior hippocampus and associated prefrontal/limbic brain regions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Expressed emotion in families: Its significance for mental illness.

Reviews the book, Expressed emotion in families: Its significance for mental illness by Julian Leff and Christine Vaughn (1985). The authors, Leff & Vaughn, along with George Brown, the originator of the "expressed emotion" concept provide an opportunity to observe their minds at work. In presenting the origins and clinical, theoretical, and research developments focused on the initial observations that high levels of expressed emotions in the families of schizophrenic patients can be debilitating, the volume not only provides a wealth of significant information about schizophrenia and how research ideas are formulated, tested, refined, and retested but also provides significant insights into the thought processes--the intuitions, doubts, and confidences--of the researchers every step of the way. The book is a landmark study of the role of emotional attitudes and their expression by family members in the course and outcome of schizophrenia. From its British origins, the research has sparked heuristic cross-cultural replication and innovations. While the book should be essential reading for every family psychologist and psychotherapist, its main audience will probably be researchers interested in family processes and schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response-monitoring dysfunction in schizophrenia: An event-related brain potential study.

Error-monitoring abnormalities may underlie positive symptoms of schizophrenia. Response-synchronized event-related potentials during picture-word matching yielded error- and correct-response-related negativity (ERN, CRN) and positivity (Pe, Pc) and preresponse lateralized readiness potentials (LRP) from 18 schizophrenic patients and 18 controls. Both groups responded faster to matches than nonmatches, although patients were generally slower and made more errors to nonmatches. Compared with controls, patients, particularly with paranoid subtype, had smaller ERNs and larger CRNs, which were indistinguishable. LRPs showed evidence of more response conflict before errors than before correct responses in controls but not patients. Despite ERN/CRN abnormalities, post-error slowing and Pe were normal in patients, suggesting a dissociation of ERN and error awareness. Anterior cingulate and dorsolateral prefrontal cortical dysfunction in schizophrenia are implicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)