Impact of emotion dysregulation and cognitive insight on psychotic and depressive symptoms during the early course of schizophrenia spectrum disorders.

OBJECTIVE: Emotion dysregulation is relevant to the aetiology of schizophrenia spectrum disorders (SSD). While most studies have focused on the chronic phase of SSD, little is known about the effects of emotion dysregulation and associated cognitive risk factors during the early phase of the illness, with negative implications for early intervention. The purpose of this study is to examine the impact of maladaptive cognitive emotion regulation strategies, global emotion dysregulation, and cognitive insight on psychotic and comorbid depressive symptoms in patients with early SSD. METHOD: Participants included 150 newly diagnosed outpatients with SSD who were seeking treatment at the Early Psychosis Intervention Program. All participants completed the Cognitive Emotion Regulation Questionnaire, Difficulties with Emotion Regulation Scale, and Beck Cognitive Insight Scale. Severity of psychotic and depressive symptoms were rated on the Brief Psychiatric Rating Scale. RESULTS: Multivariate regression adjusting for gender and psychiatric comorbidity revealed that global emotion dysregulation was associated with more severe positive and depressive symptoms. Further moderation analyses revealed a significant interaction between global emotion dysregulation and cognitive insight (self-certainty) on depression such that for patients with high self-certainty, greater global emotion dysregulation was associated with increased severity of depressive symptoms. There was no interaction between global emotion dysregulation and cognitive insight on positive symptoms. CONCLUSIONS: Our findings provide preliminary support for the associations between emotion dysregulation and psychopathology in early SSD. Further research is needed to examine the transdiagnostic role of emotion dysregulation in the aetiology and treatment of a wider range of psychotic disorders.

Psychiatrists' opinion towards medication discontinuation in remitted first-episode psychosis: A multi-site study of the Asian Network for Early Psychosis.

AIM: The study investigated psychiatrists' views towards the issue of medication discontinuation for patients in remission from first-episode psychosis in four countries (Hong Kong, Korea, Singapore and Japan) that are part of the Asian Network for Early Psychosis, focusing on whether the views of these countries differ with one another. METHODS: A questionnaire was distributed to psychiatrists for completion. The questionnaire contained three sections: direct questions probing at views on medication discontinuation, case vignettes to assess applied decision-making and a checklist of criteria psychiatrists may view as necessary for the patient to satisfy before discontinuation. Total of 484 psychiatrists (97 from Hong Kong, 88 from Korea, 64 from Singapore and 233 from Japan) completed the questionnaire. RESULTS: We found that (a) Asian psychiatrists believed that 1% to 19% of remitted patients can discontinue medication, an estimation that was lower than Western psychiatrists; (b) in agreement with clinical guidelines, Asian psychiatrists believed that patients should remain on medication for at least 1 to 2 years following the absence of psychotic symptoms; (c) "Absence of any relapsing episode following first episode" was considered the most important criterion when making a decision; and (d) there were significant differences in clinicians' perceptions across the four countries: for instance, Korean psychiatrists were more conservative with the duration of antipsychotics maintenance, while Singaporean psychiatrists were more open-minded towards clinical trials. CONCLUSIONS: Culture and social norms appear to determine the relative importance of factors that psychiatrists might consider during the decision-making process, thereby producing variations in the views held in different countries.