Naturalistic Study on the Effects of Electroconvulsive Therapy (ECT) on Depressive Symptoms.

OBJECTIVE: The effectiveness of ECT under naturalistic conditions has not been well-studied. The current study aimed to 1) characterize a naturalistic sample of ECT patients; and 2) examine the long-term outcomes of ECT on depressive symptoms (Beck Depression Inventory-II; BDI-II) and functional disability symptoms (WHO Disability Assessment Schedule 2.0) in this sample. METHODS: Participants were adults who received ECT for a major depressive episode at an ambulatory ECT clinic between September 2010 and November 2020. Clinical and cognitive assessments were completed at baseline (n = 100), mid-ECT (n = 94), 2-4 weeks post-ECT (n = 64), 6-months post-ECT (n = 34), and 12-months post-ECT (n = 19). RESULTS: At baseline, participants had severe levels of depressive symptoms (BDI-II: M = 41.0, SD = 9.4), and 62.9% screened positive for multiple psychiatric diagnoses on the MINI International Neuropsychiatric Interview. Depressive symptoms (F(4,49.1) = 49.92, P < 0.001) and disability symptoms (F(3,40.72) = 12.30, P < 0.001) improved significantly following ECT, and this was maintained at 12-months follow-up. Improvement in depressive symptoms trended towards significantly predicting reduction in disability symptoms from baseline to post-ECT, (F(1,56) = 3.67, P = 0.061). Although our clinical remission rate of 27% (BDI-II score ≤ 13 and ≥ 50% improvement) and overall response rate of 41.3% (≥50% improvement in BDI-II score) were lower than the rates reported in the extant RCT and community ECT literature, 36% of those treated with ECT were lost to follow-up and did not complete post-ECT rating scales. At baseline, remitters had significantly fewer psychiatric comorbidities, lower BDI-II scores, and lower disability symptoms than non-responders (P < 0.05). CONCLUSIONS: Participants were severely symptomatic and clinically complex. ECT was effective at reducing depressive symptoms and functional disability in this heterogeneous sample. Although a large amount of missing data may have distorted our calculated response/remission rates, it is also likely that clinical heterogeneity and severity contribute to lower-than-expected remission and response rates to ECT.

Preliminary Support for a Cognitive Remediation Intervention for Women During the Menopausal Transition: A Pilot Study.

Background: Menopause is associated with physical and emotional symptoms, and subjective cognitive concerns that are generally not borne out on objective cognitive measures. This discrepancy suggests that a psychological rather than biological mechanism likely mediates the cognitive concerns of women in menopause. The current study assessed the feasibility and effectiveness of a cognitive remediation intervention with the goal of reducing subjective perceptions of cognitive difficulty during the menopause. Methods: Twenty-seven menopausal women (M age = 53.74, SD = 4.14) completed a 5-week group-based intervention (with a post-group booster) consisting of 2-h weekly sessions. Participants completed pre- and post-intervention measures capturing subjective cognitive ability, mood, anxiety, stress, personality, and objective cognitive tests. The primary variable of interest was self-reported cognitive confidence measured by the Memory and Cognitive Confidence Scale (MACCS). Results: All but one MACCS subscale significantly decreased over the course of treatment (with lower scores associated with higher confidence) and effect sizes ranged from small to large (d = -0.39 to -0.91) with gains maintained at 1-month follow-up. Interestingly, no change in objective cognitive test performance was observed, indicating increases in subjective cognitive confidence in the absence of objective cognitive improvement. There was no change in mood, anxiety, or stress scores. Two-level HLM analyses revealed that those with higher baseline neuroticism, as measured by the NEO Personality Inventory, had smaller decreases in post-group MACCS High Standards subscale relative to those with lower baseline neuroticism (p = 0.027, d = -0.45). Those with higher baseline depression scores on the Depression Anxiety Stress Scale (DASS-21) had a smaller decrease in post-intervention MACCS Total Score relative to those with lower depression ratings. Conclusion: To our knowledge, this is the first feasibility study of its kind targeting perceptions of cognitive impairment during menopause. Although generally well-tolerated, recruitment and scheduling difficulties were flagged as challenges to engagement while a small sample size and lack of control group limit conclusions about efficacy. Providing current results could be replicated with enhanced methods, these results provide support that cognitive remediation is a feasible and credible treatment, and may improve quality of life for women in menopause. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03311880.

Comparability of the WCST and WCST-64 in the assessment of first-episode psychosis.

The Wisconsin Card Sorting Test (WCST) was designed as a measure of executive functioning and is commonly used in the assessment of psychiatric disorders. The original WCST, consisting of 128 cards, has been criticized as being too lengthy for patients experiencing significant distress. Consequently, a shortened version consisting of a single 64-card deck (WCST-64) was created. The purpose of this study was to examine the comparability of the WCST and WCST-64 in 99 patients with first-episode psychosis. Findings showed the WCST-64 yielded a mean T score for perseverative responses (PR) that was 4.08 points lower than the corresponding variable from the WCST, and the correlation between the variables was r = .65. The mean discrepancy was only 2.34 for nonperseverative error (NPE) T scores and the correlation was also stronger, r = .82. Nearly half the sample (44%) had a T score discrepancy between the respective PR indexes that was greater than 1 SD, whereas this discrepancy was observed in only 4% of the sample for NPE. Based on a cut point of < 40T to define impaired versus normal performance for PR, 80% of the sample received the same classification. These findings suggest that NPE scores may be comparable across both tests. Conversely, whereas the PR score from the WCST-64 and WCST can be used as a gross measure of impairment, this score should not be used interchangeably to characterize the severity of perseverative tendencies in first-episode patients on a case-by-case basis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Noise as a mechanism of anomalous face processing among persons with Schizophrenia.

There is substantial evidence that people with Schizophrenia (SCZ) have altered visual perception and cognition, including impaired face processing. However, the mechanism(s) underlying this observation are not yet known. Eye movement studies have found that people with SCZ do not direct their gaze to the most informative regions of the face (e.g., the eyes). This suggests that SCZ patients may be less able to extract the most relevant face information and therefore have decreased calculation efficiency. In addition, research with non-face stimuli indicates that SCZ is associated with increased levels of internal noise. Importantly, both calculation efficiency and internal noise have been shown to underpin face perception among healthy observers. Therefore, the current study applies noise masking to upright and inverted faces to determine if face processing deficits among those with SCZ are the result of changes in calculation efficiency, internal noise, or both. Consistent with previous results, SCZ participants exhibited higher contrast thresholds in order to identify masked target faces. However, higher thresholds were associated with increases in internal noise but unrelated to changes in calculation efficiency. These results suggest that SCZ-related face processing deficits are the result of a decreased noise-to-signal ratio. The source of increased processing noise among these patients is unclear, but may emanate from abnormal neural dynamics.

Grasping behavior in schizophrenia suggests selective impairment in the dorsal visual pathway.

This study frames anomalous functional brain organization in schizophrenia (SCZ) within an evolutionary model of brain development, the dual trends theory (DTT). The DTT argues that neural architecture develops along 2 separate pathways: the dorsal archicortical trend and the ventral paleocortical trend. The DTT dovetails with visual system organization, which is also composed of 2 independent pathways: a dorsal stream dedicated to visuomotor action and a ventral stream dedicated to perceptual processing. The present study examined the integrity of these pathways using a size-contrast visual illusion. Prior research has shown that, normally, perceptual estimations of object size are susceptible to visual illusions, whereas goal-directed actions are resistant. The authors hypothesized that, unlike control participants, SCZ patients' actions would be susceptible to the illusion, reflecting dorsal stream dysfunction. Here, 42 SCZ patients and 42 healthy controls grasped and estimated the size of target blocks in control and illusion conditions. During estimation, both groups were equally perturbed by the illusion; however, grasping movements of patients alone were influenced by the illusion. These results suggest disrupted dorsal brain circuitry in SCZ but relatively intact ventral circuitry.

Decomposing perseverative errors among undergraduates scoring high on the Schizotypal Personality Questionnaire.

Cognitive control (CC), the capacity to flexibly direct resources to a goal by selecting and integrating relevant contextual information, is impaired among persons with schizophrenia-spectrum disorders. CC is achieved, in part, through shifting one's cognitive set towards stimuli of task relevance. Set-shifting deficits typically result in perseverative errors, like those captured by the Wisconsin Card Sorting Test (WCST). However, a disadvantage of the WCST is that it confounds the potential sources of perseverative errors. The Dimensional Change Card Sorting Task (DCCS), in contrast, allows for the decomposition of perseverative errors by systematically varying the shape and/or color of stimuli across pre-switch, switch and post-switch trials. Using these techniques previous research has evaluated the separable contributions of negative priming, positive priming, and extra dimensional shifting to the production of perseverative errors. In the current study, college students scoring high on the Schizotypal Personality Questionnaire (High-SPQ; Raine, A., 1991. The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophr. Bull. 17 (4), 555-564.) and average scoring individuals (Ave-SPQ) were administered the DCCS to investigate schizotypal-related mechanisms underlying set-shifting abnormalities. Relative to Ave-SPQ, High-SPQ participants showed more perseverative responses that were restricted to the positive priming post-switch condition. Possible mechanisms of this impairment, including depletion of cognitive resources and differences in strategy commitment, are discussed.