Parental age effects on odor sensitivity in healthy subjects and schizophrenia patients.

A schizophrenia phenotype for paternal and maternal age effects on illness risk could benefit etiological research. As odor sensitivity is associated with variability in symptoms and cognition in schizophrenia, we examined if it was related to parental ages in patients and healthy controls. We tested Leukocyte Telomere Length (LTL) as an explanatory factor, as LTL is associated with paternal age and schizophrenia risk. Seventy-five DSM-IV patients and 46 controls were assessed for detection of PEA, WAIS-III for cognition, and LTL, assessed by qPCR. In healthy controls, but not schizophrenia patients, decreasing sensitivity was monotonically related to advancing parental ages, particularly in sons. The relationships between parental aging and odor sensitivity differed significantly for patients and controls (Fisher's R to Z: χ(2) = 6.95, P = 0.009). The groups also differed in the association of odor sensitivity with cognition; lesser sensitivity robustly predicted cognitive impairments in patients (<0.001), but these were unassociated in controls. LTL was unrelated to odor sensitivity and did not explain the association of lesser sensitivity with cognitive deficits.Parental aging predicted less sensitive detection in healthy subjects but not in schizophrenia patients. In patients, decreased odor sensitivity strongly predicted cognitive deficits, whereas more sensitive acuity was associated with older parents. These data support separate risk pathways for schizophrenia. A parental age-related pathway may produce psychosis without impairing cognition and odor sensitivity. Diminished odor sensitivity may furthermore be useful as a biomarker for research and treatment studies in schizophrenia. © 2015 Wiley Periodicals, Inc.

Olfactory performance segregates effects of anhedonia and anxiety on social function in patients with schizophrenia.

BACKGROUND: Social dysfunction is common among individuals with schizophrenia. While often attributed to anhedonia, social dysfunction could also result from unrecognized anxiety. We examined the contributions of anhedonia and anxiety to social function using olfactory function to examine whether the domains had separate underpinnings. METHODS: We assessed anhedonia, anxiety and social function as well as olfactory function in well-characterized patients with schizophrenia or schizoaffective disorder and healthy controls. RESULTS: We included 56 patients and 37 controls in our study. Patients exhibited significantly higher levels of anhedonia and anxiety than controls, and the domains were highly correlated in patients. The combination of anhedonia and anxiety more strongly predicted social dysfunction than either measure alone. Smell identification was differentially related to the symptoms, with better performance predicting less anhedonia but more social fear in male patients. LIMITATIONS: The use of self-report measures precludes differentiation between recollected or recounted experience. Aside from smell identification and odour threshold, additional measures of olfaction may be considered for future studies. CONCLUSION: Anhedonia and anxiety were strongly correlated and both negatively impacted social function. The olfactory biomarker results support the conclusion that these domains are separate. Social function in patients with schizophrenia may improve with interventions for anxiety, even in the presence of marked negative symptoms.

Extending the validity of the Personality Assessment Inventory's (PAI) Level of Care Index (LOCI) in multiple psychiatric settings.

The purpose of this study was to extend the validity and clinical application of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in 2 independent psychiatric samples. In Study 1 (N = 201), the LOCI effectively differentiated level of care (inpatients from outpatients), and was also meaningfully associated with risk factors for psychiatric admission (e.g., suicidal ideation, self-harming behavior, previous psychiatric admission, etc.), even after controlling for other demographic variables (range of Cohen's ds = 0.57-1.00). Likewise, the LOCI also incremented other risk indicators (suicide and violence history) and relevant PAI indexes (i.e., Mean Clinical Elevation, and Suicide and Violence Potential) in predicting level of care, and explained an additional 6% to 12% of variance in the target variable. Diagnostic efficiency analyses indicated LOCI scores in the range of 15 to 18 optimize positive and negative predictive power, and classification rate. In Study 2 (N = 96), the LOCI was found to be significantly higher in those with a recent psychiatric admission within the past 6 months (d = 0.64), as compared to those without an admission. Similarly, those who were admitted for suicide risk had significantly higher mean LOCI scores as compared to those who did not (d = 0.70). The clinical implications of these findings and potential application of the LOCI are discussed.

Behavioral health symptoms associated with chronic traumatic encephalopathy: a critical review of the literature and recommendations for treatment and research.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative syndrome that has been linked to serious psychiatric symptoms, including depression, aggression, and suicidal behavior. This review critically examines the extant research on the behavioral manifestations of CTE and concludes that the paucity of longitudinal prospective studies on CTE, combined with a lack of research-accepted diagnostic criteria for identifying individuals who are considered at risk for CTE, makes it difficult to reliably establish a causal relationship between CTE and the onset of behavioral health problems. Selection and reporting bias and inconsistency in data collection methods are other concerns. To advance the field, there is a critical need for more empirical research on the behavioral manifestations of CTE. Recommendations and intervention models are also discussed.

Assessing the heterogeneity of aggressive behavior traits: exploratory and confirmatory analyses of the reactive and instrumental aggression Personality Assessment Inventory (PAI) scales.

The heterogeneity of violent behavior is often overlooked in risk assessment despite its importance in the management and treatment of psychiatric and forensic patients. In this study, items from the Personality Assessment Inventory (PAI) were first evaluated and rated by experts in terms of how well they assessed personality features associated with reactive and instrumental aggression. Exploratory principal component analyses (PCA) were then conducted on select items using a sample of psychiatric and forensic inpatients (n = 479) to examine the latent structure and construct validity of these reactive and instrumental aggression factors. Finally, a confirmatory factor analysis (CFA) was conducted on a separate sample of psychiatric inpatients (n = 503) to evaluate whether these factors yielded acceptable model fit. Overall, the exploratory and confirmatory analyses supported the existence of two latent PAI factor structures, which delineate personality traits related to reactive and instrumental aggression.

Olfaction and cognition in schizophrenia: sex matters.

Cognitive and olfactory deficits occur in schizophrenia, but little is known whether sex modifies these deficits. We examined the relationship between olfaction and cognition in 55 schizophrenia patients and 32 healthy controls. Patients and controls demonstrated significant differences performing cognitive tasks. In patients, sex modified all relationships of odor identification to cognition. Female patients showed significantly stronger trends than male patients correlating better smell identification with higher scores on intelligence, memory, and attention, whereas their correlations of odor identification with executive functioning contradicted those of male patients. Odor acuity significantly correlated with several cognitive measures, especially in male patients, in whom better acuity was generally associated with better cognition. Female patients again differed significantly from males; odor acuity correlations with cognitive measures were weaker, or contradicted, those of male patients. These findings indicate significant sex differences in olfactory processing in schizophrenia. Combining the sexes in research analyses may obscure important differences.

Schizophrenia comorbid with panic disorder: evidence for distinct cognitive profiles.

Patients with comorbid schizophrenia and panic symptoms share a distinct clinical presentation and biological characteristics, prompting some to propose panic psychosis as a separate subtype of schizophrenia. Less is known about these patients' neuropsychological profiles, knowledge of which may facilitate target-specific treatments and research into the etiopathophysiology for such cases. A total of 255 schizophrenia patients with panic disorder (n=39), non-panic anxiety disorder (n=51), or no anxiety disorder (n=165) were assessed with the Wechsler Adult Intelligence Scale-Revised, the Wisconsin Card Sorting Test, the Trail Making Test, the Controlled Oral Word Association Test, the Animal Naming subtest of the Boston Diagnostic Aphasia Examination, and the Wechsler Memory Scale-Revised. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale. Patients with panic disorder demonstrated a higher verbal IQ and better problem solving, set switching, delayed recall, attention, and verbal fluency as compared to schizophrenia patients without comorbid anxiety. The schizophrenia-panic group reported a higher level of dysthymia on stable medication. Our findings suggest that patients with schizophrenia and comorbid panic disorder exhibit distinct cognitive functioning when compared to other schizophrenia patients. These data offer further support for a definable panic-psychosis subtype and suggest new etiological pathways for future research.

Development and initial validation of a scale for detecting inconsistent responding on the personality assessment inventory-short form.

The goal of this investigation was the development of an inconsistency scale (ICN-SF) for the personality assessment inventory-short form (PAI-SF). In Study 1, 503 inpatient profiles were randomly assigned to a derivation or cross-validation sample. Ten correlated item pairs were identified using the derivation sample and placed on the ICN-SF. Psychometric properties of the ICN-SF total scores were comparable in the derivation and cross-validation samples. Total ICN-SF scores in both samples were significantly lower than scores obtained from computer-generated random samples. Diagnostic efficiency statistics are reported using multiple cut-off scores at various base rate estimates. ICN-SF scores greater than 8 reasonably balanced sensitivity and specificity rates. This cutoff correctly classified 92% of the random protocols and inaccurately classified 9% of the patient protocols in study 1. In study 2, PAI-SF scores from 627 forensic and civil inpatients produced similar results, effectively identifying cases with elevated scores on the full-form inconsistency scale. Overall the results of both studies suggest that the ICN-SF can aid examiners in assessing for inconsistent responding.

Multivoxel proton MR spectroscopy used to distinguish anterior cingulate metabolic abnormalities in patients with schizophrenia.

PURPOSE: To test the hypothesis that anterior cingulate cortex (ACC) subregions in patients with schizophrenia are metabolically different from those in healthy control subjects. MATERIALS AND METHODS: This institutional review board-approved study was HIPAA compliant, and all participants provided written informed consent. Twenty-two patients with schizophrenia (13 male, nine female; 39.4 years ± 10.6 [standard deviation]) and 11 age- and sex-matched control subjects (seven male, four female; 35.5 years ± 10.7) underwent magnetic resonance (MR) imaging and three-dimensional 3-T voxel proton MR spectroscopy to measure absolute rostral and caudal ACC N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) concentrations. Exact Mann-Whitney test was used to compare patient data with control data, paired-sample Wilcoxon signed rank test was used to compare subregions within groups, and receiver operating characteristic curve analysis was used to assess sensitivity and specificity in diagnosis of schizophrenia. RESULTS: There were no significant metabolic differences between patients and control subjects or between ACC subregions in control subjects. In patients, rostral ACC NAA and Cr concentrations were significantly lower than those in caudal ACC (6.2 mM ± 1.3 vs 7.1 mM ± 1.3, P < .01; 5.7 mmol/L ± 1.4 vs 6.3 mmol/L ± 1.6, P < .01; respectively); however, this did not hold true for Cho concentrations (1.7 mmol/L ± 0.5 vs 1.8 mmol/L ± 0.5). For individual differences between caudal and rostral measurements, only NAA in patients was different from that in control subjects (0.9 mmol/L ± 1.3 vs -0.1 mmol/L ± 0.5, P < .01), enabling prediction of schizophrenia with 68% sensitivity and 91% specificity, for a difference of more than 0.4. CONCLUSION: Significant differences between caudal and rostral NAA concentration are found in ACC of patients with schizophrenia but not in ACC of healthy control subjects, indicating that neuronal density or integrity differences between ACC subregions may be characteristic of the disease.

Emotional and neurobehavioural status in chronic pain patients.

OBJECTIVE: To investigate the emotional and neurobehavioural status of patients suffering from chronic pain. METHODS: Fifteen male patients with chronic lower back pain and 15 healthy control subjects were studied for approximately six months. Pain was measured using a visual analogue scale. The WHO Neurobehavioral Core Test Battery (NCTB) was used to assess neurobehavioural effects of environmental and occupational exposures. RESULTS: Visual analogue scale results demonstrated a modest range of reported pain (mean [± SD] 62.0 ± 10.8) in chronic pain patients, whereas control subjects reported no measurable pain. With the NCTB, it was found that scores of negative mood state, including anger-hostility, depression-dejection, fatigue-inertia and tension-anxiety in pain patients were significantly higher than scores in the control subjects. By contrast, scores of positive mood state (vigour-activity) in chronic pain patients were lower than those in the control group. The NCTB scores of the Santa Ana Dexterity and Pursuit Aiming II tests in chronic lower back pain patients were lower than those of the control group. Scores for other NCTB subtests, including the Digit Span, Benton Visual Retention and Digit Symbol tests, were not significantly different compared with controls. Assuntos Emoções , Transtornos das Habilidades Motoras/etiologia , Dor/complicações , Dor/psicologia , Tempo de Reação/fisiologia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Dor/diagnóstico , Medição da Dor , Estimulação Luminosa , Retenção Psicológica/fisiologia , Inquéritos e Questionários

Trauma centrality and PTSD in veterans returning from Iraq and Afghanistan.

Research has demonstrated that the extent to which an individual integrates a traumatic event into their identity ("trauma centrality") positively correlates with posttraumatic stress disorder (PTSD) symptom severity. No research to date has examined trauma centrality in individuals exposed to combat stress. This study investigated trauma centrality using the abridged Centrality of Event Scale (Berntsen & Rubin, 2006) among Operation Enduring Freedom/Operation Iraqi Freedom combat veterans (n = 46). Multiple regression analyses demonstrated that trauma centrality predicted PTSD symptoms. Trauma centrality and PTSD symptoms remained significantly correlated when controlling for depression in subgroups of veterans with or without probable PTSD. This study replicates and extends findings that placing trauma at the center of one's identity is associated with PTSD symptomatology.

Ineffective risk-reward learning in schizophrenia.

The underpinnings of poor decision-making in schizophrenia could reflect excessively risky or inhibited behaviors. This study employed the Balloon Analogue Risk Task (BART) to compare decision-making in schizophrenia cases to that of healthy controls. Individuals with schizophrenia performed significantly differently across three trials, failing to improve their performance as shown by the control group. In the control group, cognitive ability, measured with the Wechsler Adult Intelligence Scale (WAIS-III) showed that Perceptual Organization scores predicted Average Inflations per Trial, Total Balloon Pops, and Total Earnings. Although the schizophrenia cases failed to learn, group performance on the BART was not associated with cognitive ability, but regression analyses showed 41.4% of average inflations per trial were explained by Excitement, Delusions, Emotional Withdrawal, and Poor Rapport; total balloon pops were only explained by emotional withdrawal and Total Earnings were reduced by Delusions, Excitement and Poor Rapport. Only healthy participants demonstrated a relation between cognitive ability performance improvement across trials. Schizophrenia cases showed less risk-taking, and earned significantly less money overall. Identifying the determinants of poor decision-making could inform interventions and possible treatments to improve their function and perhaps be of relevance to public safety if decisions are overly risky.

In support of Bleuler: objective evidence for increased affective ambivalence in schizophrenia based upon evocative testing.

BACKGROUND: Ambivalence and anhedonia have long been identified as schizophrenic symptoms. However, ambivalence has rarely been studied, and in most evocative studies, schizophrenia participants are not anhedonic. Affective neurosciences posit two evaluative systems (one for Positivity and one for Negativity), the coactivation of which produces ambivalence, and point to two asymmetries in affective processing: Positivity Offset (which measures our capacity to explore the environment) and Negativity Bias (a measure of reactivity to intense threat). These characteristics have not received much attention in schizophrenia research. METHODS: Sixty-four individuals with schizophrenia and 32 non-patient control participants completed an evocative emotional task with pictures, sounds and words of various valences and intensities. Following each presentation, participants rated the level of pleasantness, unpleasantness, and arousal elicited by the stimulus. Finally, participants completed questionnaires on anhedonia, and practical life skills were assessed. RESULTS: Schizophrenia participants showed higher levels of ambivalence, greater arousal, greater Positivity Offset, and non-significantly different hedonic capacities and Negativity Bias. Ambivalence to positive stimuli significantly correlated with duration of illness, current level of psychopathology, anhedonia questionnaires and practical life skills. Schizophrenia patients with negative symptoms did not differ from patients without negative symptoms on computer tasks. CONCLUSIONS: Ambivalence is greater in schizophrenia, and can be understood as a de-differentiation of the activation of the two evaluative systems. Ambivalence to positive stimuli, which may reflect early-stage affective processing is associated with impairments in higher-level emotional processes and in everyday functioning. Future studies should clarify the status of anhedonia in schizophrenia.

A psychometric evaluation of the Personality Assessment Inventory - short form clinical scales in an inpatient psychiatric sample.

Few studies have assessed the psychometric properties of the Personality Assessment Inventory short-form (PAI-SF) clinical scales, and none have conducted these evaluations using participants from psychiatric inpatient units. The present study evaluated item-level tests of scaling assumptions of the PAI-SF using a large (N=503) clinical sample of participants who completed the PAI during their admission to a psychiatric inpatient unit. Internal consistency reliability was high across scales, and tests of item-scale convergence and discrimination generally confirmed hypothesized item groupings. Scale-level correlations supported unique variance being measured by each scale. Finally, agreement between the PAI short- and full-form scales was found to be high. The results are discussed with regards to scale interpretation.

Emotion antecedents in schizophrenia.

Emotion antecedents are defined as external or internal events that cause emotions in individuals. Their study brings us insight into individuals' emotion processing. Emotion antecedents have rarely been studied in schizophrenia. Thirty individuals with schizophrenia and 30 non-patient comparison subjects, matched by gender and age, related events when they felt extremely angry, disgusted, fearful, happy, sad and surprised. Each antecedent was summarized in a written sentence and 20 judges matched the antecedent with the correct emotion. The antecedents of individuals with schizophrenia were less frequently matched with their emotion than the antecedents of non-patient comparison subjects for all emotions. Moreover, error pattern analyses revealed distinct deficits for the emotion "fear". In the schizophrenia group, fear antecedents were more frequently judged as non-emotional, and non-fear antecedents were more often judged as fear antecedents when compared to the control group. A deficit in fear processing correlated with the Suspiciousness item on the Brief Psychiatric Rating Scale. Our results indicate differences in emotion processing in schizophrenia. Error pattern results are consistent with impairment in the appraisal of fear. Lower accuracy rates with schizophrenia subjects' antecedents may reflect lower emotion awareness for all emotions in schizophrenia. This study furthers the understanding of deficits in basic emotion processing in schizophrenia.

A new rating scale for negative symptoms: the Motor-Affective-Social Scale.

The commonly used rating scales for negative symptoms in schizophrenia have shown good reliability, but disagreement persists regarding both the content definition and the validity of several items. Instead, authors have recommended rating the specific behaviors that are defined as negative symptoms. To surmount these shortcomings, we developed a new rating scale for negative symptoms: the Motor-Affective-Social Scale (MASS). During a 5-minute structured interview, hand coverbal gestures, spontaneous smiles, voluntary smiling, and questions asked by the interviewer were counted and rated on 101 inpatients with a diagnosis of schizophrenia or schizoaffective disorder. Information on social behavior was obtained from nursing staff. The scale consisted of a total of eight items. The MASS showed high internal consistency (Cronbach alpha coefficient=0.81), inter-rater reliability, and test-retest reliability (intra-class correlation coefficient=0.81). Convergent validity analyses showed high correlations between MASS scores and scores on the Scale for the Assessment of Negative Symptom (SANS), and the negative symptoms subscale of the Positive and Negative Syndrome Scale (PANSS). The MASS showed excellent psychometric properties, practicality, and subject tolerability. Future research that includes the use of the MASS with other patient populations and that investigates the scale's sensitivity during clinical trials should be performed.

Alcohol use moderates the relationship between symptoms of mental illness and aggression.

Diagnosis of mental illness (MI) inconsistently predicts aggressive behavior although co-occurrence of substance use appears to increase the frequency of aggression in MI populations. We propose that alcohol use should moderate the relationship between mental disorders marked by deficits in self-control and aggression and victimization. In the present study, alcohol use, physical aggression perpetration, physical aggression victimization, injury and psychiatric symptoms were assessed in a sample of 297 substance use disorder patients (102 women; Mage = 38.9, SD = 20.2) recruited from a residential treatment facility. Negative binomial regression analyses examined the relationship of physical aggression, victimization, and injury over the previous 12 months to symptoms of bipolar mania, psychosis, posttraumatic stress disorder, antisocial personality disorder (ASPD), and daily volume of alcohol consumed. Consistent with past research relating MI to aggression, rates of victimization were higher than rates of perpetration. Results demonstrated that alcohol use moderated the relationship of manic symptoms of bipolar disorder to perpetration of aggression and causing injury to others. Three way-interactions between gender, alcohol use, and both psychotic and ASPD symptoms were related to victimization. The combination of heavy alcohol use and increased psychotic or ASPD symptoms was related to greater victimization for women but not for men. Women with more psychotic symptoms who were heavy drinkers were also more likely to report causing injury to another person. Results were generally consistent with the multiple-thresholds model of alcohol-related aggression; however, the moderating effects of alcohol use were dependent on gender and type MI. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Factor Structure of the Positive and Negative Syndrome Scale (PANSS) Differs by Sex.

Although the Positive and Negative Syndrome Scale (PANSS) is widely used in clinical research, factor analytic studies of the scale have been inconsistent and questions remain about the underlying factor structure of schizophrenia symptoms. The purpose of this study was to examine whether the factor structure of the PANSS differs in men and women with schizophrenia. Principal components analysis (PCA) with equamax rotation was used to examine the factor structure of the PANSS separately in 124 males and 74 females with schizophrenia-related psychoses. In males, a four-factor structure was identified: 1) Negative, 2) Cognitive, 3) Positive, and 4) Hostility. In females, a four-factor structure also emerged: 1) Negative, 2) Cognitive, 3) Positive, and 4) Depression. The most notable difference between the male and female PCAs was the presence of a depression factor in the females and a hostility factor in males. These results support sex differences in the factor structure of schizophrenia symptoms, which has important implications for clinical research.

Sex differences in hedonic judgement of odors in schizophrenia cases and healthy controls.

The neurocircuitries subserving affective and olfactory processes overlap, are sexually dimorphic, and show disruptions in schizophrenia, suggesting their intersection may be a window on the core process producing psychosis. This study investigated diagnostic and sex differences in hedonic judgments of odors and smell identification in 26 schizophrenia cases and 27 healthy controls. Associations between olfaction measures and psychiatric symptoms were also examined. Cases and controls had similar identification accuracy of unpleasant odors, but cases were significantly less accurate in naming pleasant odors. In cases, greater negative symptom severity was related to abnormal hedonic judgments; specifically, higher pleasantness ratings for unpleasant odors and higher unpleasantness ratings for pleasant odors. Greater positive symptom severity was associated with lower pleasantness ratings for neutral odors. Regarding sex differences, male cases and female controls rated pleasant odors as significantly more unpleasant than male controls. Correlations between depression severity and pleasantness ratings of neutral odors were in opposite directions in male and female cases. These results suggest that a normal sexual dimorphism in the circuitry for hedonic odor judgments may interact with schizophrenia pathology, supporting the utility of olfactory hedonics as a sex-specific biomarker of this pathology.

Effectively Assessing Treatment Needs in Incarcerated Seriously Mentally Ill Individuals: The Utility of the Personality Assessment Inventory-Level of Care Index.

Early identification of treatment needs in incarcerated individuals with serious mental illness has significant implications. Validated assessment instruments to guide treatment are lacking in correctional settings. Hierarchical linear modeling was used to examine the predictive validity of the Level of Care Index (LOCI) in 35 inmates admitted to a specialized treatment unit. The LOCI score was predictive of levels of depressogenic psychopathology and psychological well-being as well as changes in these constructs over time. These results validate the use of the LOCI in a correctional setting and demonstrate the utility of the LOCI to identify treatment trajectories.