Anomalous self-experiences in cognition are negatively associated with neurocognitive functioning in schizophrenia.

INTRODUCTION: Anomalous self-experiences (ASEs) are disturbances in the subjective experience of the self and are common in people with schizophrenia. Theorists have suggested that ASEs may underlie the neurocognitive deficits that are also common in people with schizophrenia; however, few studies have empirically investigated the relationship between these variables. Thus, the current study aimed to determine whether self-reported ASEs, particularly disturbances in cognitive or mental experiences, are meaningfully related to neurocognitive performance in individuals with schizophrenia. METHODS: 48 individuals with schizophrenia and 34 healthy comparison participants completed the Inventory of Psychotic-Like Anomalous Experiences (IPASE), which is composed of five subscales including disturbances in cognition, and the MATRICS Consensus Cognitive Battery (MCCB). RESULTS: Participants with schizophrenia performed worse than controls on each MCCB domain and had higher ASE scores on the total IPASE and all five subscales. Only the IPASE-Cognition subscale was associated with cognitive performance. Specifically, IPASE-Cognition was negatively correlated with scores in attention, visual learning, reasoning, and working memory. CONCLUSIONS: These results suggest that self-reported subjective disturbances in cognition may be meaningfully associated with several objectively-measured domains of neurocognition. Severity of ASEs may therefore be an important consideration when analysing the extent of cognitive deficits in schizophrenia.

Verbal Learning and Memory Enhancement Strategies in Schizophrenia: A Randomized, Controlled Investigation.

OBJECTIVES: Verbal episodic memory is a key domain of impairment in people with schizophrenia with close ties to a variety of aspects of functioning and therapeutic treatment response. A randomized, blinded trial of two mnemonic strategies for verbal episodic memory deficits for people with schizophrenia was conducted. METHODS: Sixty-one people with schizophrenia were assigned to one of three experimental conditions: training in a mnemonic strategy that included both visualization and narrative structure (Story Method), a condition in which participants were trained to visualize words interacting with one another (Imagery), or a non-trained control condition in which participants received equivalent exposure to training word lists and other verbal memory assessments administered in the other two conditions, but without provision of any compensatory mnemonic strategy. Participants were assessed on improvements in recall of the word list used as part of training, as well as two, standardized verbal memory assessments which included stimuli not used as part of strategy training. RESULTS: The Story Method produced improvements on a trained word list that generalized to a non-trained, prose memory task at a 1-week follow-up. In contrast, provision of a mnemonic strategy of simple visualization of words produced little improvement on word recall of trained words or on measures of generalization relative to the performance of participants in the control condition. CONCLUSIONS: These findings support the inclusion of enriched mnemonic strategies consisting of both visualization and narrative structure in sustained and comprehensive programs of CR for enhancement of verbal episodic memory in schizophrenia. (JINS, 2017, 23, 352-357).

Randomized Laboratory Study of Single-Dose Cannabis, Dronabinol, and Placebo in Patients With Schizophrenia and Cannabis Use Disorder.

BACKGROUND AND HYPOTHESIS: Up to 43% of people with schizophrenia have a lifetime cannabis use disorder (CUD). Tetrahydrocannabinol (THC) has been shown to exacerbate psychosis in a dose-dependent manner, but little research has assessed its effects on schizophrenia and co-occurring CUD (SCZ-CUD). In this double-dummy, placebo-controlled trial (total n = 130), we hypothesized that a modest dose of THC would worsen cognitive function but not psychosis. STUDY DESIGN: Effects of single-dose oral THC (15 mg dronabinol) or smoked 3.5% THC cigarettes vs placebo in SCZ-CUD or CUD-only on positive and negative symptoms of schizophrenia (only for SCZ-CUD), cognition, and drug experiences assessed several hours after drug administration. SCZ-only and healthy control participants were also assessed. STUDY RESULTS: Drug liking was higher in THC groups vs placebo. Neither smoked THC nor oral dronabinol predicted positive or negative symptom subscale scores 2 and 5 h, respectively, after drug exposure in SCZ-CUD participants. The oral dronabinol SCZ-CUD group, but not smoked THC SCZ-CUD group, performed worse than placebo on verbal learning (B = -9.89; 95% CI: -16.06, -3.18; P = .004) and attention (B = -0.61; 95% CI: -1.00, -0.23; P = .002). Every 10-point increment in serum THC + THCC ng/ml was associated with increased negative symptoms (0.40 points; 95% CI: 0.15, 0.65; P = .001; subscale ranges 7-49) and trends were observed for worse positive symptoms and performance in verbal learning, delayed recall, and working memory. CONCLUSIONS: In people with SCZ-CUD, a modest single dose of oral THC was associated with worse cognitive functioning without symptom exacerbation several hours after administration, and a THC dose-response effect was seen for negative symptoms.

Form and content of attenuated psychotic symptoms in psychometrically assessed positive and negative schizotypy.

AIM: Greater attention is being paid to early detection and identification of individuals who are at high risk of developing psychosis. One area of interest is the particular content types of psychotic-like experiences (PLEs), which can be thought of as attenuated, non-clinical positive symptoms (eg, feeling perplexed by reality). Previous research has examined content of PLEs in clinical high-risk samples. The current study aimed to build upon these findings by analysing content in a psychometrically determined high-risk sample. METHODS: One hundred fifty-three undergraduates with scores greater than 1.96 SDs above the mean on a measure of schizotypy symptoms participated in a semi-structured interview for the assessment of prodromal syndromes. Each interview was transcribed verbatim and content of PLEs was rated according to the Content of Attenuated Positive Symptoms scale. RESULTS: Frequencies of content items in the psychometric high-risk sample were similar to those found in a clinical high-risk sample. Multiple regression analyses revealed that certain content items were more predictive of decreased global functioning and increased positive symptom severity. CONCLUSIONS: Content items that were associated with worse outcomes may be cause for greater concern if endorsed by individuals presenting for treatment. Future research should examine content of PLEs in a longitudinal design to determine whether particular items could predict subsequent conversion to a schizophrenia-spectrum disorder.

Perceptions of attenuated psychosis in a diverse sample of undergraduates.

AIM: Prior to the release of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, experts in the field of psychosis research considered including a psychosis high-risk syndrome-attenuated psychosis syndrome-as a formal diagnosis. Opponents argued that such a diagnosis may increase the risk of stigmatization of individuals whose symptoms often remit. Although previous research has examined provider perceptions of attenuated psychosis syndrome, little work has focused on lay perceptions. METHODS: A total of 455 college students read three vignettes, each depicting a character with a different level of psychotic disorder (attenuated psychosis syndrome, schizophrenia or no psychosis). Following each vignette, participants responded to questions assessing: (1) identification of the character as mentally ill, (2) stigmatizing attitudes and (3) beliefs regarding the helpfulness of potential treatments. RESULTS: Compared to a character with no psychosis, participants identified the attenuated psychosis syndrome character as more likely to be experiencing mental illness, but endorsed only slightly more stigmatizing attitudes. Participants tended to rate psychological types of treatment as more helpful than other types for an attenuated psychosis syndrome character. CONCLUSIONS: Non-expert undergraduates appear to view attenuated psychosis symptoms as indicative of mental illness, though not as severe as schizophrenia symptoms. The minimal level of stigma endorsement indicates that college students may not be especially likely to spontaneously stigmatize peers with attenuated psychosis syndrome.

Associations among domains of self-disturbance in schizophrenia.

Self-disturbances are increasingly recognized as important, possibly even central, features of schizophrenia. However, little is known about the associations among different manifestations of self-disturbances. The aims of the current study were threefold. We aimed to (1) replicate previous findings of increased self-disturbances in schizophrenia, (2) correlate manifestations of self-disturbances in schizophrenia across three domains, and (3) correlate self-disturbances with five symptoms domains of schizophrenia, including positive, negative, disorganized symptoms, excitement, and emotional distress. We examined three domains of self-experience, including somatosensation, anomalous self-experiences, and self-concept clarity. Participants included 48 individuals with schizophrenia and 36 non-psychiatric controls. The results of this study replicate previous findings of significantly higher levels of self-disturbances in people with schizophrenia. The results also indicate positive correlations between the domains of anomalous self-experiences and self-concept clarity, but not somatosensation, in individuals with schizophrenia. As well, anomalous self-experiences were positively correlated with positive symptoms, disorganized symptoms, and emotional distress and self-concept clarity was negatively correlated with disorganized symptoms and emotional distress.

The Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE): Development and validation.

Anomalous self-experiences (ASEs) are among the first symptoms to appear in the prodrome, predict the development of psychosis over and above clinical symptoms, and are common in people with schizophrenia. Although there are well-validated phenomenological interviews for assessing ASEs, there are no self-report measures. The current research describes 4 studies designed to develop and validate a new scale to assess ASEs: the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE). In Study 1, an overinclusive item pool was generated based on phenomenological descriptions of ASEs, and items were kept or discarded based on factor loadings in an exploratory factor analysis. Five factors were extracted including disturbances in Cognition, Consciousness, Self-Awareness and Presence, Somatization, and Transitivism/Demarcation. The 5-factor structure was confirmed in Study 2, and the scale showed measurement invariance between sexes. IPASE scores were correlated with self-report and task measures of self-processing including self-concept clarity, self-consciousness, and self-esteem as well as measures of psychotic-like experiences. In Study 3, people with positive schizotypy had higher IPASE scores than a negative schizotypy and comparison group. In Study 4, people with schizophrenia had higher IPASE scores than healthy controls. Overall, the IPASE displayed strong psychometric qualities and is a brief alternative to resource-intensive phenomenological interviews in clinical, at-risk, and general population samples. (PsycINFO Database Record

Anomalous Self-Experiences and positive symptoms are independently associated with emotion processing deficits in schizophrenia.

Social-cognitive models posit a role of Anomalous Self-Experiences (ASEs), disturbances in the subjective experience of the self, in the development and maintenance of psychosis. Theorists have suggested that ASEs may underlie the social-cognitive deficits that are common in people with schizophrenia. Positive symptoms, negative symptoms, and ASEs may interfere with the ability to perceive, use, understand, and manage emotions. In the current study, 45 people with schizophrenia and 28 healthy controls completed the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE), the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), and were rated on the Positive and Negative Syndrome Scale (PANSS). Participants with schizophrenia had higher IPASE scores and lower MSCEIT scores than the comparison group. In a series of simultaneous regressions, ASEs, but not positive or negative symptoms, were associated with Total MSCEIT scores and the Using Emotions branch score. In contrast, positive symptoms, but not ASEs or negative symptoms were associated with Perceiving and Managing Emotions branches. Both ASEs and positive symptoms independently contributed to Emotional Experiencing scores. The severity of negative symptoms was not associated with deficits in any MSCEIT scores. These results suggest unique roles for ASEs and positive symptoms in emotion processing deficits in people with schizophrenia.