Neurophysiological evidence of motor preparation in inner speech and the effect of content predictability.

Self-generated overt actions are preceded by a slow negativity as measured by electroencephalogram, which has been associated with motor preparation. Recent studies have shown that this neural activity is modulated by the predictability of action outcomes. It is unclear whether inner speech is also preceded by a motor-related negativity and influenced by the same factor. In three experiments, we compared the contingent negative variation elicited in a cue paradigm in an active vs. passive condition. In Experiment 1, participants produced an inner phoneme, at which an audible phoneme whose identity was unpredictable was concurrently presented. We found that while passive listening elicited a late contingent negative variation, inner speech production generated a more negative late contingent negative variation. In Experiment 2, the same pattern of results was found when participants were instead asked to overtly vocalize the phoneme. In Experiment 3, the identity of the audible phoneme was made predictable by establishing probabilistic expectations. We observed a smaller late contingent negative variation in the inner speech condition when the identity of the audible phoneme was predictable, but not in the passive condition. These findings suggest that inner speech is associated with motor preparatory activity that may also represent the predicted action-effects of covert actions.

A pilot study on the effectiveness of low-intensity cognitive behavioural therapy (LiCBT) for common mental disorders in Hong Kong.

BACKGROUND: To cope with the rising demand for psychological treatment, evidence-based low-intensity cognitive behavioural therapy (LiCBT) delivered by trained para-professionals was introduced internationally. AIMS: This pilot study aimed at examining the effectiveness of LiCBT in Hong Kong. METHOD: This study was of an uncontrolled pre- and post-treatment design, testing LiCBT at a local community mental health centre in Hong Kong. Two hundred and eighty-five Chinese adult help-seekers to the centre attended two or more sessions of LiCBT delivered by trained para-professionals. These participants also rated their depression and anxiety on the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Scale-7 (GAD-7), respectively, at pre- and post-treatment. RESULTS: Comparison of the pre- and post-treatment PHQ-9 and GAD-7 scores of 285 participants indicated significant improvements in depression and anxiety with large effect sizes (depression: d = 0.87; anxiety: d = 0.95). For those participants reaching the clinical level of either depression and/or anxiety at pre-treatment (n = 229, 80.4%), they reported even larger effect sizes (depression: d = 1.00; anxiety: d = 1.15). The recovery rate was 55.9% with a reliable improvement rate of 63.9%. An average of 5.6 sessions was offered to the participants with each session spanning a mean of 42 minutes. The baseline clinical conditions and participants' educational level were predictive of post-treatment recovery. CONCLUSIONS: The results supported the effectiveness and cost-efficiency of LiCBT for depression and anxiety at a Hong Kong community mental health centre. The effect sizes and the recovery and reliable improvement rates achieved were comparable to those reported from countries such as the UK and Australia.

A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic.

STUDY OBJECTIVES: The lifestyles change of children and adolescents during the COVID-19 pandemic due to antipandemic measures can affect their sleep health. Existing studies have used convenient samples and focused on the initial months of the pandemic, leaving a knowledge gap on changes in young people's sleep patterns under the "new normal" under COVID-19. METHODS: As part of a territory-wide epidemiological study in Hong Kong, this cross-sectional study recruited primary and secondary school students by stratified random sampling. Sleep parameters were collected using the structured diagnostic interview for sleep patterns and disorders. We investigated the pandemic's effects on sleep parameters by comparing data of participants recruited pre-COVID and those recruited during COVID using multivariate regression, adjusting for age, sex, household income, seasonality, and presence of mental disorders, and the moderators and mediators of the effects. RESULTS: Between September 1, 2019 and June 2, 2021, 791 primary and 442 secondary school students were recruited and analyzed. Primary school and secondary school participants assessed before COVID had a longer sleep latency on school days (95% confidence interval [CI] = 1.0-5.2 minutes, adjusted P-value = .010; and 95% CI= 3.9-13.0 minutes, adjusted P-value = .004, respectively) and nonschool days (95% CI = 1.7-7.2 minutes, adjusted P-value = .005; 95% CI = 3.4-13.7 minutes, adjusted P-value = .014, respectively). Low household income was a moderator for later bedtime (adjusted P-value = .032) and later sleep onset (adjusted P-value = .043) during nonschool days among secondary school students. CONCLUSIONS: Changes associated with COVID have a widespread and enduring effect on the sleep health of school-aged students in Hong Kong. Household income plays a role in adolescent sleep health resilience, and the impact of antiepidemic measures on the health gaps of the youth should be considered. CITATION: Chau SWH, Hussain S, Chan SSM, et al. A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(4):749-757.

Longitudinal bifactor modeling of anxiety, depression and schizotypy - The role of rumination as a shared mechanism.

A bifactor model with a general (p) factor reflecting shared variance and specific factors reflecting additional variance in individual symptoms has been introduced to explain common co-occurrence among anxiety, depression and schizotypy. However, longitudinal evidence is lacking and the validity of bifactor modeling is debatable. The current study aimed to examine the presence of the p factor together with specific factors in accounting for relationships between anxiety, depression and schizotypy both cross-sectionally and longitudinally, and to investigate the relationship between these factors and rumination. A validated sample of university students were surveyed on levels of anxiety, depression, schizotypy and rumination at baseline (N = 2291), one year (N = 1833) and two years (N = 1656). Models were estimated using exploratory structural equation modeling (ESEM) and compared at each time point. Longitudinal invariance of the best-fitting model was examined and all potential within- and between-factor stability pathways were tested in an SEM framework. A bifactor model with a p factor and four specific factors (representing residual information of composite anxiety and depression, cognitive-perceptual, interpersonal and disorganized schizotypy respectively) consistently outperformed a correlated-factors model. The bifactor structure appeared longitudinally stable. Within-factor stabilities were moderate, and between-factor pathways reflected a few significant interactions, mostly involving the p factor. Rumination was independently associated with p and four specific factors at each time point. Therefore, there is a p factor accounting for concurrent and sequential co-occurrence of anxiety, depression and schizotypy. Rumination explained partly the p and specific factors. Transdiagnostic interventions should target rumination.

Altered cortico-striatal functional connectivity in people with high levels of schizotypy: A longitudinal resting-state study.

PURPOSE OF THE RESEARCH: Cortico-striatal functional connectivity has been implicated in the neuropathology of schizophrenia. However, the longitudinal relationship between the cortico-striatal connectivity and schizotypy remains unknown. We examined the resting-state fMRI connectivity in 27 individuals with a high level of schizotypy and 20 individuals with a low level of schizotypy at baseline and 18 months later. Correlations between changes in cortico-striatal connectivity and changes in schizotypy scores over time were examined. PRINCIPAL RESULTS: We found both increased and decreased cortico-striatal connectivity in individuals with a high level of schizotypy at baseline. Over time, these individuals showed improvement in both the negative and positive schizotypal domains. Changes in striatal-insula connectivity were positively correlated with changes in positive schizotypy from baseline to follow-up. MAJOR CONCLUSIONS: Our results suggested impaired cortico-striatal connectivity in individuals with a high level of schizotypy. The dysconnectivity mainly involves the dorsal striatum. The connectivity between the dorsal striatum and the insula may be a putative marker for temporal changes in positive schizotypy.

Cognitive Impairment In Treatment-Naïve Bipolar II and Unipolar Depression.

Cognition dysfunction may reflect trait characteristics of bipolarity but cognitive effects of medications have confounded previous comparisons of cognitive function between bipolar II and unipolar depression, which are distinct clinical disorders with some overlaps. Therefore, we examined the executive function (WCST), attention, cognitive speed (TMT-A) and memory (CAVLT, WMS-Visual reproduction) of 20 treatment-naïve bipolar II patients (BPII), 35 treatment-naïve unipolar depressed (UD) patients, and 35 age/sex/education matched healthy controls. The subjects were young (aged 18-35), and had no history of psychosis or substance use, currently depressed and meeting either RDC criteria for Bipolar II Disorder or DSM-IV-TR criteria for Major Depressive Disorder. The patients were moderately depressed (MADRS) and anxious(HAM-A), on average within 3.44 years of illness onset. Sociodemographic data and IQ were similar between the groups. UD patients had significantly slower cognitive speed and cognitive flexibility (WCST perseverative error). BPII depressed patients showed relatively intact cognitive function. Verbal memory (CAVLT List A total) correlated with illness chronicity only in BPII depression, but not UD. In conclusion, young and treatment-naïve BPII depressed patients differed from unipolar depression by a relatively intact cognitive profile and a chronicity-cognitive correlation that suggested a stronger resemblance to Bipolar I Disorder than Unipolar Depression.

Association between Ambient Temperatures and Mental Disorder Hospitalizations in a Subtropical City: A Time-Series Study of Hong Kong Special Administrative Region.

Background: Mental disorders have been found to be positively associated with temperature in cool to cold climatic regions but the association in warmer regions is unclear. This study presented the short-term association between temperatures and mental disorder hospitalizations in a subtropical city with a mean annual temperature over 21 °C. Methods: Using Poisson-generalized additive models and distributed-lagged nonlinear models, daily mental disorder hospitalizations between 2002 and 2011 in Hong Kong were regressed on daily mean temperature, relative humidity, and air pollutants, adjusted for seasonal trend, long-term trend, day-of-week, and holiday. Analyses were stratified by disease class, gender and age-group. Results: 44,600 admissions were included in the analysis. Temperature was positively associated with overall mental-disorder hospitalizations (cumulative relative risk at 28 °C vs. 19.4 °C (interquartile range, lag 0-2 days) = 1.09 (95% confidence interval 1.03, 1.15)), with the strongest effect among the elderly (≥75 years old). Transient mental disorders due to conditions classified elsewhere and episodic mood disorders also showed strong positive associations with temperature. Conclusion: This study found a positive temperature-mental-disorder admissions association in a warm subtropical region and the association was most prominent among older people. With the dual effect of global warming and an aging population, targeted strategies should be designed to lower the disease burden.

Trajectories of schizotypy and their emotional and social functioning: An 18-month follow-up study.

Schizotypy is a set of personality traits that convey liability to develop schizophrenia. Studying schizotypy in healthy individuals may facilitate the understanding of the psychopathological processes underlying schizophrenia. The present study aimed to examine the developmental trajectories of schizotypy over time using a longitudinal study design. The Chapman Scales for Psychosis Proneness were administered to 1541 college students at baseline, and subsequently at six-monthly intervals up to 18months. Latent class growth analysis was conducted to track the different trajectories. In addition, self-reported scales were used to measure idea of reference, emotional experiences and expression, stress and coping, as well as social functioning. We identified four latent classes with distinct trajectories: "nonschizotypy" group (LC1), "stable high schizotypy" group (LC3), "high reactive schizotypy" group (LC2) and "low reactive schizotypy" group (LC4). These findings suggest that there may be distinct developmental trajectories for schizotypy. Two groups may be of particular interest: the "stable high schizotypy" group that displayed the worst clinical and functioning outcomes on almost all measures and the "high reactive schizotypy" group characterized by a relatively rapid decline in functioning.