Study of positive and negative feedback sensitivity in psychosis using the Wisconsin Card Sorting Test.

BACKGROUND: Schizophrenia involves marked motivational and learning deficits that may reflect abnormalities in reward processing. The purpose of this study was to examine positive and negative feedback sensitivity in schizophrenia using computational modeling derived from the Wisconsin Card Sorting Test (WCST). We also aimed to explore feedback sensitivity in a sample with bipolar disorder. METHODS: Eighty-three individuals with schizophrenia and 27 with bipolar disorder were included. Demographic, clinical and cognitive outcomes, together with the WCST, were considered in both samples. Computational modeling was performed using the R syntax to calculate 3 parameters based on trial-by-trial execution on the WCST: reward sensitivity (R), punishment sensitivity (P), and choice consistency (D). The associations between outcome variables and the parameters were investigated. RESULTS: Positive and negative sensitivity showed deficits, but P parameter was clearly diminished in schizophrenia. Cognitive variables, age, and symptoms were associated with R, P, and D parameters in schizophrenia. The sample with bipolar disorder would show cognitive deficits and feedback abnormalities to a lesser extent than individuals with schizophrenia. CONCLUSION: Negative feedback sensitivity demonstrated greater deficit in both samples. Idiosyncratic cognitive requirements in the WCST might introduce confusion when supposing model-free reinforcement learning. Negative symptoms of schizophrenia were related to lower feedback sensitivity and less goal-directed patterns of choice.

Development and validation of the Self-Stigma Questionnaire (SSQ) for people with schizophrenia and its relation to social functioning.

Self-stigma specifically in people with schizophrenia has been little studied. The aims of the present study were to validate a new instrument for the assessment of self-stigma (SSQ) and to assess the relationship between self-stigma and social functioning in people with schizophrenia. A sample of 76 people with schizophrenia was assessed at two moments in time with the SSQ, the PDD (stigma), two scales of social functioning (LSP, SFS), and a scale of general functioning (GAF). The results indicated that SSQ presented good psychometric properties, with Cronbach's alpha ranging between 0.75 and 0.901. The stability of the instrument was between 0.836 and 0.402. Three factors were found in the factor analysis (social discrimination, perceived capabilities, concealment of the disease), explaining 62.66% of the total variance. A relationship was found between self-stigma and social functioning in people with schizophrenia, especially in relation to social contact. In conclusion, the SSQ seems to be a valid and reliable questionnaire for the assessment of self-stigma in people with schizophrenia, and interventions should be designed to cope with self-stigma in order to improve the social functioning of people who suffer schizophrenia.

Spanish adaptation of the Beck Cognitive Insight Scale (BCIS) for schizophrenia.

INTRODUCTION: The Beck Cognitive Insight Scale has been designed to evaluate the cognitive insight capacity, that is to say, the practice of self-reflectiveness as a meta-cognitive mechanism for examining and analysing the disorder's symptoms, it also permits a continuous re-evaluation of inadequate interpretations. METHODOLOGY: The aim of this study is to examine the psychometric properties, the dimensional structure and the internal validity of the Spanish version of Beck's Cognitive Scale of Insight (BCIS). In this paper we also analyse its relation with the Positive and Negative Symptoms Scale (PANSS). The Cognitive Insight Scale was translated and adapted to Spanish with 129 in- and out-schizophrenic patients. RESULTS: Principal component analysis showed a two-factor structure that was similar to the original one, recognizable as self-reflectiveness (R) and self-certainty (C) with similar reliability as the American version. Self-reflectiveness and the R-C index correlated with loss of insight of the PANSS scale. In general, BCIS showed significant associations with the PANSS subscales. Out patients scored self-reflectiveness and R-C index signicantly higher than in-patients and lower in self-certainty. CONCLUSION: Psychometric properties obtained with the adapted Spanish version of BCIS guarantee the adequate evaluation of cognitive insight.

Adaptation and validation of the quality-of-life scale: Satisfaction with Life Domains Scale by Baker and Intagliata.

OBJECTIVES: There are few quality-of-life instruments specifically for schizophrenia; thus, the objective of our study is to adapt and validate the Satisfaction with Life Domains Scale (SLDS) by Baker and Intagliata. METHOD: This is a validation study in which the subjects were evaluated on 2 occasions (24-48 hours). The sample is composed of people with schizophrenia from 18 to 65 years old and who were seen in one of the following centers: Sant Joan de Déu-SSM, Hospital Clínic, Hospital de Mataró and Hospital Pere Mata. The SLDS was administered, along with Positive and Negative Syndrome Scale, the Clinical General Impression for Schizophrenia, Global Assessment of Function, Disability Assessment Scale--short version, Beck Cognitive Insight, and the Strauss and Carpenter Prognostic Scale. The Cronbach alpha test was carried out, and the intraclass correlation coefficient was used to assess test-retest reliability, along with Pearson correlations for discriminating validity. RESULTS: The intraclass correlation coefficients oscillated between 0.51 and 0.83. The SLDS did correlate with any of the other instruments with the exception of the Positive and Negative Syndrome Scale general subscale and the Strauss and Carpenter prognostic scale. CONCLUSIONS: The Spanish version of the SLDS was shown to be valid and reliable and provides a fast and specific measure for schizophrenia.

Decision-making impairment on the Iowa Gambling Task after endovascular coiling or neurosurgical clipping for ruptured anterior communicating artery aneurysm.

OBJECTIVE: To investigate decision-making deficits after anterior communicating artery aneurysm (ACoA) rupture and to compare the effects of two treatments. METHOD: The sample included 40 patients with subarachnoid hemorrhage secondary to ruptured ACoA with a favorable neurological outcome and a control group of 31 subjects matched by age, sex, and years of education. Twenty patients had surgical interventions (clipping) and 20 had received endovascular treatment. Decision-making was assessed by the Iowa Gambling Task (IGT). We used the Expectancy Valence model to examine the different components associated with the IGT. RESULTS: ACoA patients performed significantly worse on the IGT than controls, we observed poorly performance on IGT in 70% of the patients. Comparing the groups according to type of intervention, we found that clipped patients performed significantly worse than controls on the IGT, whereas coiled patients did not differ significantly from controls or clipped patients; however, coiled patients performed worse than controls on the last block of the task. Patients with frontal lesions selected significantly more cards from the disadvantageous deck. IGT performance correlated with other tests of executive functions such as the perseverative errors and non perseverative errors of Wisconsin Card Sorting Tests, and verbal fluency test, but not with working memory tests. According to the Expectancy Valence model, patients with frontal lesions showed a greater tendency to focus on recent outcomes and ignore or rapidly discount past outcomes, and tended to have a more erratic response pattern. CONCLUSIONS: Our results suggest that patients with subarachnoid hemorrhage secondary to ruptured ACoA have deficits in decision-making under ambiguity. The main cause of this deficit is the presence of frontal lesions. Moreover, clipped patients, but not coiled patients, showed deficits in taking decisions in comparison with controls. Our results suggest that the IGT may help to identify neuropsychological sequelae in these patients.

Adaptation and validation of the Spanish version of the Strauss and Carpenter Prognostic Scale for Schizophrenia.

INTRODUCTION: The aim of this study was to validate the Spanish version of the Strauss and Carpenter Prognostic Scale for Schizophrenia (Strauss and Carpenter, 1977). METHOD: We performed a multicenter, longitudinal, descriptive study. Forward and backtranslation of the original scale was performed. The sample was composed of persons diagnosed with schizophrenia aged between 18 and 65 years. We calculated interrater reliability, construct validity according to the Global Assessment Scale (GAS), Satisfaction with Life Domains Scale (SLDS), the Global Clinical Impression-Schizophrenia (GCI) scale, The World Health. Organization Short Disability Assessment Schedule (WHO-DAS) and the Positive and Negative Syndrome Scale (PANSS), and predictive validity at the 1-year follow-up using three criterion measures of the GCI, WHO-DAS and GAS scales. RESULTS: The internal consistency coefficient (Cronbach's alpha) was 0.70. The intraclass correlation coefficient ranged from 0.54 to 0.99, except for item 5 (resources for the current treatment), which was -0.13. The correlation between the distinct scales (measuring construct validity) was significant, with a p-value of < 0.01, except for the SLDS, which showed a higher p-value (p<0.05). The Strauss-Carpenter score correlated with all three scores at 1 year (GCI, GAS and WHO-DAS) with an alpha of less than 0.01, showing good predictive validity. CONCLUSIONS: The Spanish adaptation of the Strauss and Carpenter prognostic scale is reliable and valid and allows a more severe disease course to be predicted.