Specific facial emotion recognition deficits across the course of psychosis: A comparison of individuals with low-risk, high-risk, first-episode psychosis and multi-episode schizophrenia-spectrum disorders.

Our study aimed to explore the recognition of specific emotions across the course of psychosis. A visual task representing the six basic emotions was used to assess facial emotion recognition (FER) in 204 healthy controls classified into 152 low-risk (LR) and 52 high-risk for psychosis (HR), following a psychometric risk approach; and 100 patients: 44 with first-episode psychosis (FEP) and 56 with multi-episode schizophrenia-spectrum disorders (MES). First, we performed a MANCOVA to compare the four conditions. Next, we conducted a logistic regression to explore whether specific FER deficits predicted the presence of psychosis. Finally, we investigated the relationships of FER with psychosis-like experiences (PLEs) and psychotic symptoms. Global FER, anger and fear recognition were impaired in HR, FEP and MES. No differences between HR and FEP appeared. Moreover, fear and anger correctly classified 83% of individuals into LR or psychosis. FER was associated with PLEs and psychotic symptoms. Concluding, FER is early impaired in HR individuals and increases along the psychosis continuum. However, fear recognition is similarly impaired throughout the illness, suggesting a possible vulnerability marker. Furthermore, deficits in anger and fear recognition predicted the presence of psychosis. Therefore, we suggest that FER may be essential in detecting psychosis risk.

Self-reported cognitive biases in psychosis: Validation of the Davos Assessment of Cognitive Biases Scale (DACOBS) in a Spanish sample of psychotic patients and healthy controls.

Cognitive biases have been demonstrated to be important in developing and maintaining psychosis. However, self-report measures for everyday clinical practice have been developed only recently. We aimed to study one of these instruments for assessing cognitive biases: the Davos Assessment of Cognitive Biases Scale (DACOBS). In a Spanish sample of 84 patients diagnosed with schizophrenia-spectrum disorders and 152 healthy controls, we examined a) the factor structure using Confirmatory Factor Analysis (CFA) to test the original one-, three- and seven-factor solutions, b) the reliability (Cronbach's alpha), c) the discriminative power (Multivariate Analysis of Covariance - MANCOVA) and d) the relationships of cognitive biases with positive psychotic-like experiences (PPLEs) in healthy individuals and with psychotic symptoms in schizophrenia-spectrum patients. The CFA revealed that the seven-factor solution achieved the best fit. The DACOBS overall scale (Cronbach's alpha = .92) and subscales obtained good internal consistencies. MANCOVA, controlling for age and education, demonstrated that all subscales differentiated between healthy controls and psychotic patients (Wilks' Lambda = 0.87; F7, 226 = 4.70; p < .000; partial eta squared = 0.13). In addition, the DACOBS showed high correlations with PPLEs (controls) and moderate correlations with positive and general symptoms (patients), demonstrating its predictive validity. Concluding, the DACOBS proved to be a psychometrically suitable instrument for assessing cognitive biases in psychosis and adequately differentiated between patients and healthy individuals within the Spanish population. Norm scores are provided.

Do all people with schizophrenia receive the same benefit from different family intervention programs?

The study evaluated baseline characteristics that could be used to predict the outcome of family intervention in schizophrenia and focussed on identifying the subgroups of patients who were more likely to respond to one therapeutic modality than another. We conducted a controlled trial in which participants were assigned at random to either a Behavioral Family Intervention Group or a Relatives' Group. Patients in one catchment area, having suffered one psychotic relapse within the previous year and living with their families, were assessed by an independent evaluator at baseline and 12 months later. Some clinical and family factors such as the duration of illness, number of hospital admissions and relatives' level of psychological distress can predict the differential outcome of either type of family intervention modality. The results suggested that the short-term illness group requires more intensive and personal intervention, while the long-term illness group needs more continuous support. Our results should be confirmed in a larger sample before clinical recommendations can be made.