The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia.

PURPOSE/BACKGROUND: The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined. METHODS/PROCEDURES: Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals. FINDINGS/RESULTS: Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (µ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (µ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (ß = 0.424, P < 0.001) and Personal and Social Performance scale (ß = 0.272, P = 0.006), were statistically significant predictors of drug attitude. IMPLICATIONS/CONCLUSIONS: Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.

Using the Work Behaviour Inventory and Work Environment Impact Scale to measure employment sustainability for people with severe mental illness in a vocational rehabilitation program.

OBJECTIVE: People with severe mental illness often have difficulty sustaining employment. Work Behaviour Inventory and Work Environment Impact Scale are vocational assessments used by occupational therapists to evaluate the facilitators and barriers of work performance and work environment respectively. These factors may have an impact on job tenure and can inform occupational therapy practice. METHODS: This study analysed retrospective data of 85 clients who attended a 3-month Employment Internship Program from August 2016 to August 2017. Scores from Work Behaviour Inventory and Work Environment Impact Scale were analysed for associations with job tenure. Repeated measures were used to determine significant changes in Work Behaviour Inventory composite scores across the 3 months. RESULTS: One-month Work Behaviour Inventory composite scores, three Work Behaviour Inventory domains (cooperativeness, work habits, work quality), and three Work Environment Impact Scale domains (time demands, supervisor interaction, architecture) were significantly associated with job tenure. Significant differences in mean job tenure were also found between participants of different internship status. However, these factors did not predict job tenure in regression analysis. There were significant improvements in Work behaviour Inventory composite scores from the first to third month. CONCLUSIONS: Work behaviours such as cooperativeness, work habits, and work quality as well as work characteristics such as time demands, supervisor interaction, and workplace architecture may play a role in influencing job tenure. Occupational therapists may consider such factors and provide more targeted interventions to effectively sustain employment.

Using the CHIME Personal Recovery Framework to Evaluate the Validity of the MHRM-10 in Individuals with Psychosis.

The recovery movement has revealed that outcomes which focuses on just symptoms and functioning may not be holistic and that consumer-rated outcomes may contribute to a more holistic and person-centric care model. However, a brief and effective measure is required in clinical settings; hence, the aim of the current study is to evaluate the psychometric properties of the briefest personal recovery measure- Mental Health Recovery Measure-10 items, using the CHIME (Connectedness, Hope and optimism about the future, Identity, Meaning in life, Empowerment) personal recovery framework. 64 outpatients with schizophrenia or schizoaffective disorder were assessed at two time points, 2 weeks apart. Data collected included sociodemographic information, MHRM-10, Psychological factors related to the CHIME framework, in respective order: RYFF subscale positive relations with others; Herth Hope Index (HHI); Internalized Stigma of Mental Illness (ISMI) and RYFF subscale self-acceptance; World Health Organization Quality of Life- BRIEF (WHOQOL-BREF); Empowerment, and Clinical factors- symptoms as measured by Positive and Negative Syndrome Scale, functioning (PSP) and depressive symptoms (CDSS). MHRM-10 demonstrated convergent validity with CHIME personal recovery psychological factors (all ρ > 0.5). MHRM-10 had excellent internal consistency (Cronbach's alpha = 0.904) and adequate test-retest reliability (ρ = 0.742, p < 0.001). Initial factor structure analysis revealed a one factor structure. The MHRM-10 is a valid instrument for use and can serve as a tool to facilitate a more collaborative and person-centric model of care for individuals with psychosis.

Defining Occupational Competence and Occupational Identity in the Context of Recovery in Schizophrenia.

IMPORTANCE: The Occupational Self Assessment (OSA) measures two constructs from the Model of Human Occupation: occupational competence and occupational identity. In the field of mental health, the recovery movement has sparked discussions about what constitutes personal, clinical, and functional recovery. However, how occupation-based terminologies are related to the recovery framework is unclear. OBJECTIVE: To elucidate how domains of recovery and psychological constructs are related to the OSA's constructs of occupational competence and occupational identity in order to inform occupational therapy practice in the recovery arena. DESIGN: Cross-sectional study. SETTING: Outpatient mental health unit. PARTICIPANTS: Sixty-six community-dwelling adults with schizophrenia recruited through convenience sampling. OUTCOMES AND MEASURES: Participants completed the OSA and clinical, functional, and personal recovery assessments. They also completed five scales that measured psychological constructs of recovery such as hope, resilience, empowerment, internalized stigma, and subjective well-being. Participants also identified up to four OSA items that were priorities for change. Tests of association and multiple regression analyses were conducted to identify predictors of occupational competence and occupational identity. RESULTS: Personal recovery predicted occupational competence, whereas depressive symptoms and hope predicted occupational identity. Functional and clinical recovery did not predict occupational competence. The top three OSA priorities for change were performance items: "managing my finances," "concentrating on my tasks," and "taking care of myself." CONCLUSIONS AND RELEVANCE: Occupational therapy interventions should not be limited to functional improvement. Instead, they should account for clients' affective states and seek to instill recovery-oriented psychological states such as hope and efficacy. WHAT THIS ARTICLE ADDS: Occupational competence is achieved by enhancing personal states of self-efficacy in fulfilling valued occupations rather than through functional improvement. The top three occupations prioritized for change were performance tasks that were observable by service users and immediate caregivers. Empowering clients to partake in these everyday performance tasks such as finance management, concentrating on tasks, and self-care may pave the way to enhancing occupational competence and identity.

An Asian study on clinical and psychological factors associated with personal recovery in people with psychosis.

BACKGROUND: Despite the rising recognition of personal recovery, there is a lack of research on personal recovery in individuals with psychosis in Singapore. This study aims to evaluate the psychometric properties of the QPR-15 using the CHIME personal recovery framework and to examine its associations with clinical recovery factors. METHODS: Sixty-six stable outpatients were recruited and assessed at two time points approximately 2 weeks apart. Convergent validity was examined through Spearman correlations with scores on CHIME-related psychological factors: connectedness (Ryff subscale- positive relations with others), hope (Herth Hope Index- abbreviated), identity (Ryff subscale- self-acceptance, Internalized Stigma of Mental Illness- Brief), meaning (World Health Organization Quality of Life Assessment-Brief Form), empowerment (Empowerment Scale). Pearson's correlation was used to examine the test-retest reliability, while Cronbach's alpha was used to examine internal consistency. The initial factor structure was evaluated via principal component analysis, Velicer's minimum average partial (MAP) criteria, parallel analysis, and a scree plot. Spearman correlations and hierarchical multiple linear regression (controlling for age and gender) were employed to examine the association of clinical (symptoms and functioning) and psychological factors with the QPR-15. RESULTS: The QPR-15 demonstrated convergent validity with all CHIME-related psychological factors (rs ranged from 0.472 to 0.687). Internal consistency was excellent (Cronbach's alpha = 0.934), and test-retest reliability was adequate (r = 0.708). Initial factor structure evaluations revealed a one-factor model. Correlations of clinical factors with the QPR-15 were mostly low (rs ranged from - 0.105 to - 0.544) but significant, except for depressive symptoms (CDSS: rs = - 0.529 to - 0.544), while correlations were moderate for psychological factors. Clinical factors significantly explained 28.3-31.8% of the variance of the QPR-15. Adding psychological factors significantly increased the model variance at baseline (∆ adjusted R2 = 0.369, F change < 0.001) and at time point 2 (∆ adjusted R2 = 0.208, F change < 0.001). CONCLUSION: Our results provide preliminary evidence that the QPR-15 has adequate psychometric properties in Singapore and encompasses the CHIME personal recovery framework. In addition, our results suggest that clinical recovery and personal recovery are not substitutes for each other but rather are complementary, thereby promoting a more holistic evaluation of recovery in people with psychosis. Implications are discussed.

Factors Associated with Changes in Community Ability and Recovery After Psychiatric Rehabilitation: A Retrospective Study.

One of the key goals of psychiatric rehabilitation is to return individuals with mental illnesses back into the community via restoration of the necessary skills. This retrospective study seeks to evaluate the factors associated with improvement in community functioning after a period of outpatient rehabilitation. 223 individuals enrolled into three broad rehabilitation groups-clinical, vocational and creative therapies/individual sessions-were included in this study. The Multnomah Community Ability Scale (MCAS) and Milestones of Recovery Scale (MORS) were used to evaluate each individual before and after the rehabilitation programme. Across all three groups, there were significant improvements in MCAS scores and MORS ratings. In multivariate models, clinical rehabilitation group was superior to creative therapies/individual sessions in predicting MORS change. The study also revealed a close relationship between recovery gains and improvement in community ability.

The effects of cognitive remediation on functional outcomes among people with schizophrenia: a randomised controlled study.

OBJECTIVE: Cognitive remediation is an intervention to overcome cognitive deficits through drills and use of strategies. Previous studies have reported positive effects for cognitive remediation on neurocognition, but researchers' allegiance effects are not always adequately controlled. Furthermore, its efficacy amongst the Asian population has not been established. Hence, this study aimed to determine if cognitive remediation would have positive effects on neurocognition and functioning within an English-speaking Asian population, when compared against the effects of a credible and balanced control provided by therapists blinded to the study hypothesis. METHOD: A total of 70 participants with schizophrenia who attended vocational training or day rehabilitation programmes were randomised to receive a 60-hour programme of either cognitive remediation or physical exercise. Neurocognition and functional outcomes were measured at baseline, upon completion of treatment, 6 months after treatment and 1 year after treatment. RESULTS: Participants who received cognitive remediation had significantly greater improvement in all neurocognitive domains. Furthermore, the cognitive remediation group achieved greater attainment of vocational or independent living skills and better functional outcomes at post-intervention and at the end of the 1-year follow-up. CONCLUSIONS: When compared against a credible intervention such as physical exercise, cognitive remediation was able to show significant positive effects on both neurocognition and functional outcomes among the Asian population of schizophrenia patients.

The use of virtual reality and augmented reality in psychosocial rehabilitation for adults with neurodevelopmental disorders: A systematic review.

Objectives: Virtual reality and augmented reality have been used in psychosocial rehabilitation for adults with neurodevelopmental disorders in recent years, to provide functional training in a scaffolded and appealing manner. This systematic review attempted to evaluate (1) how virtual reality or augmented reality technology was deployed, when used as an intervention for adults with neurodevelopmental disorders; and (2) how virtual or augmented reality-assisted psychosocial rehabilitation programs impacted on the functional domains of community living, employment and social participation. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was adopted and a search of publications between June 2012 and June 2022 was carried out. The target groups were adults with schizophrenia/schizoaffective disorders, autism spectrum disorder, intellectual disabilities and attention deficit hyperactivity disorder. Interventions that targeted at least one functional domain were included. Results: The database search generated 1,267 records and 38 studies met the inclusion criteria. Three studies utilized augmented reality while the rest utilized virtual reality. The virtual scenarios were displayed in various ways, such as head-mounted displays, computer screens, mobile devices and cave rooms. A few studies also used features such as speech recognition, eye tracking and motion-capture device to provide real-time feedback to participants during rehabilitation. Eleven studies reported interventions that addressed community living, 15 studies addressed vocational skills and nine studies trained participants in social skills or social cognition. Three studies sought to improve quality of life using virtual scenarios to expose participants to various situations. Majority of these studies reported preliminary promising results, with improvement in the functional domains addressed. However, several studies had small sample sizes and many single-arm pretest-posttest studies were assessed to be of serious or critical risk of bias. Conclusion: Virtual reality and augmented reality are deployed in various ways to augment psychosocial rehabilitation for adults with neurodevelopmental disorders. Most interventions target skills training or strategy learning in the areas of community living, work and social participation. Preliminary positive findings of their effects on functional performance were reported. Larger and robust studies using ecologically valid outcome measures will be needed to establish their effects on real-world functional outcomes. Systematic review registration: identifier: CRD42022335443.

Identifying psychiatric manifestations in schizophrenia and depression from audio-visual behavioural indicators through a machine-learning approach.

Schizophrenia (SCZ) and depression (MDD) are two chronic mental disorders that seriously affect the quality of life of millions of people worldwide. We aim to develop machine-learning methods with objective linguistic, speech, facial, and motor behavioral cues to reliably predict the severity of psychopathology or cognitive function, and distinguish diagnosis groups. We collected and analyzed the speech, facial expressions, and body movement recordings of 228 participants (103 SCZ, 50 MDD, and 75 healthy controls) from two separate studies. We created an ensemble machine-learning pipeline and achieved a balanced accuracy of 75.3% for classifying the total score of negative symptoms, 75.6% for the composite score of cognitive deficits, and 73.6% for the total score of general psychiatric symptoms in the mixed sample containing all three diagnostic groups. The proposed system is also able to differentiate between MDD and SCZ with a balanced accuracy of 84.7% and differentiate patients with SCZ or MDD from healthy controls with a balanced accuracy of 82.3%. These results suggest that machine-learning models leveraging audio-visual characteristics can help diagnose, assess, and monitor patients with schizophrenia and depression.

A gamified augmented reality vocational training program for adults with intellectual and developmental disabilities: A pilot study on acceptability and effectiveness.

Objectives: The Augmented Reality Games to Enhance Vocational Ability of Patients (REAP) was an augmented reality vocational training program that provided skills training in the context of a psychiatric rehabilitation program. It was implemented over 10 weeks and consisted of gamified augmented reality café training scenarios and bridging group activities to facilitate transfer of learning to the work context. This pilot study aimed to explore the acceptability and effectiveness of the REAP program when carried out with adults with intellectual and developmental disabilities attending work therapy. Its objectives were: (1) to obtain feedback from participants and trainers on their experiences and acceptability of the REAP program and (2) to measure changes in vocational and cognitive skills of participants in the REAP program. Materials and methods: This was a pretest-posttest mixed methods study. 15 adults with intellectual and developmental disabilities attending work therapy in a non-profit organization participated in the REAP program and their vocational trainers were involved in assisting in this program. Feasibility Evaluation Checklist (FEC) and the Neurobehavioral Cognitive Status Exam (Cognistat) were administered at baseline, post-training and eight weeks after training. The participants and their trainers also provided user feedback via semi-structured interviews. Results: Majority of the participants and trainers found the REAP program to be useful and interesting. They also found that the augmented reality games were user-friendly and provided a unique opportunity to acquire new skills. Participants who engaged in this program showed a significant improvement in vocational skills and aspects of cognitive skills, which were maintained eight weeks after training. Conclusion: The gamified augmented reality vocational training was feasible and accepted by both adults with intellectual and developmental disabilities and their trainers. When integrated with bridging sessions to facilitate transfer of learning to existing work therapy, participants on the REAP program showed significant improvements in vocational skills and aspects of cognitive skills. Future experimental studies with larger sample size could provide stronger evidence on its effectiveness in improving vocational outcomes.

Comparative study of emotion recognition and theory of mind between major depressive disorder and schizophrenia.

BACKGROUND: Social cognition as a transdiagnostic construct between major depressive disorder (MDD) and schizophrenia (SCZ) is not well understood. This may be attributed to the variability of social cognitive measures indexing the same construct. This study aims to compare emotion recognition and theory of mind domains, known to be impaired in SCZ, between MDD and SCZ. METHODS: Three groups of participants (NTotal = 150) were enrolled in this study: MDD (n = 51), SCZ (n = 50) and healthy controls (HC; n = 49). Emotion recognition was assessed on the Bell Lysaker Emotion Recognition Task (BLERT) and Penn Emotion Recognition Task (ER40); theory of mind was measured on The Awareness of Social Inference Test (TASIT). Mixed ANCOVAs were utilised to compare social cognitive performance across the groups. RESULTS: SCZ performed poorer in all 3 social cognition tasks compared to both MDD and HC. No statistically significant difference in social cognitive performance was observed between MDD and HC. CONCLUSIONS: This study serves as an effort towards employing the same standardised social cognitive measures for direct comparison of performance patterns across diagnostic groups. Future work is needed to extend this in larger samples of different illness severity and diagnostic categories.

Predicting Real-World Functioning in Schizophrenia: The Relative Contributions of Neurocognition, Functional Capacity, and Negative Symptoms.

Neurocognition and functional capacity are commonly reported predictors of real-world functioning in schizophrenia. However, the additional impact of negative symptoms, specifically its subdomains, i.e., diminished expression (DE) and avolition-apathy (AA), on real-world functioning remains unclear. The current study assessed 58 individuals with schizophrenia. Neurocognition was assessed with the Brief Assessment of Cognition in Schizophrenia, functional capacity with the UCSD Performance-based Skills Assessment (UPSA-B), and negative symptoms with the Negative Symptom Assessment-16. Real-world functioning was assessed with the Multnomah Community Ability Scale (MCAS) with employment status as an additional objective outcome. Hierarchical regressions and sequential logistic regressions were used to examine the associations between the variables of interest. The results show that global negative symptoms contribute substantial additional variance in predicting MCAS and employment status above and beyond the variance accounted for by neurocognition and functional capacity. In addition, both AA and DE predict the MCAS after controlling for cognition and functional capacity. Only AA accounts for additional variance in employment status beyond that by UPSA-B. In summary, negative symptoms contribute substantial additional variance in predicting both real-world functioning and employment outcomes after accounting for neurocognition and functional capacity. Our findings emphasize both DE and AA as important treatment targets in functional recovery for people with schizophrenia.

Plasticity of DNA methylation, functional brain connectivity and efficiency in cognitive remediation for schizophrenia.

Cognitive remediation (CR) is predicated on principles of neuroplasticity, but the actual molecular and neurocircuitry changes underlying cognitive change in individuals with impaired neuroplastic processes is poorly understood. The present study examined epigenetic-neurocircuitry-behavioral outcome measures in schizophrenia, before and after participating in a CR program that targeted higher-order cognitive functions. Outcome measures included DNA methylation of genes central to synaptic plasticity (CpG sites of Reelin promoter and BDNF promoter) from buccal swabs, resting-state functional brain connectivity and topological network efficiency, and global scores of a cognitive battery from 35 inpatients in a rehabilitative ward (18 CR, 17 non-CR) with similar premorbid IQ to 15 healthy controls. Baseline group differences between healthy controls and schizophrenia, group-by-time effects of CR in schizophrenia, and associations between the outcome measures were tested. Baseline functional connectivity abnormalities within the frontal, fronto-temporal and fronto-parietal regions, and trending decreases in global efficiency, but not DNA methylation, were found in schizophrenia; the frontal and fronto-temporal connectivity, and global efficiency correlated with global cognitive performance across all individuals. Notably, CR resulted in differential changes in Reelin promoter CpG methylation levels, altered within-frontal and fronto-temporal functional connectivity, increasing global efficiency and improving cognitive performance in schizophrenia, when compared to non-CR. In the CR inpatients, positive associations between the micro to macro measures: Reelin methylation changes, higher global efficiency and improving global cognitive performance were found. Present findings provide a neurobiological insight into potential CR-led epigenetics-neurocircuitry modifications driving cognitive plasticity.

Hybrid transitional-supported employment using social enterprise: a retrospective study.

OBJECTIVE: This brief report examines the implementation of a hybrid transitional-supported employment program using a social enterprise model to improve work skills and work behavior of people with psychiatric disabilities. METHODS: The subjects of this study included 25 consumers enrolled in a social enterprise café training program between May 2006 and December 2007. Work behavior assessments and supported employment tenure were retrospectively analyzed. RESULTS: All training participants who completed the 20-month training program demonstrated significant improvement in work behavior before leaving the transitional training at the café. Individuals who completed the transitional training at the café went on to sustain competitive employment for an average of 44 weeks. CONCLUSION: The social enterprise model is deemed helpful in assisting people with psychiatric disabilities to improve their employment outcomes.

Profile of cognitive problems in schizophrenia and implications for vocational functioning.

AIM: This literature review attempts to profile specific areas of cognition that have shown unique and consistent evidence of dysfunction among people with schizophrenia. In addition, their impact on vocational functioning is illustrated, so as to highlight the importance of managing these cognitive difficulties in vocational rehabilitation. METHODS: Literature search was carried out on seven key cognitive domains identified by the National Institute of Mental Health in the USA. Their impact on vocational function was also reviewed. RESULTS: It is found that attention, declarative and working memory, reasoning, problem-solving and social cognition are areas of impairment that have great impact on vocational functioning. Attention and memory problems affect learning of new work tasks. Executive function is particularly crucial in determining supported and open employment outcomes, as executive dysfunction cannot be easily compensated. Lastly, social cognition plays a major role in determining the success of workplace social exchanges. CONCLUSION: Occupational therapists need to have a good understanding of the profile of cognitive problems among people with schizophrenia, in order to tailor our intervention according to their cognitive strengths and difficulties. Several cognitive remediation strategies and programs have been designed specifically for people with mental illness. Equipping ourselves with skills in conducting such programs will augment our expertise in vocational rehabilitation.

Non-verbal speech cues as objective measures for negative symptoms in patients with schizophrenia.

Negative symptoms in schizophrenia are associated with significant burden and possess little to no robust treatments in clinical practice today. One key obstacle impeding the development of better treatment methods is the lack of an objective measure. Since negative symptoms almost always adversely affect speech production in patients, speech dysfunction have been considered as a viable objective measure. However, researchers have mostly focused on the verbal aspects of speech, with scant attention to the non-verbal cues in speech. In this paper, we have explored non-verbal speech cues as objective measures of negative symptoms of schizophrenia. We collected an interview corpus of 54 subjects with schizophrenia and 26 healthy controls. In order to validate the non-verbal speech cues, we computed the correlation between these cues and the NSA-16 ratings assigned by expert clinicians. Significant correlations were obtained between these non-verbal speech cues and certain NSA indicators. For instance, the correlation between Turn Duration and Restricted Speech is -0.5, Response time and NSA Communication is 0.4, therefore indicating that poor communication is reflected in the objective measures, thus validating our claims. Moreover, certain NSA indices can be classified into observable and non-observable classes from the non-verbal speech cues by means of supervised classification methods. In particular the accuracy for Restricted speech quantity and Prolonged response time are 80% and 70% respectively. We were also able to classify healthy and patients using non-verbal speech features with 81.3% accuracy.

Automated Verbal and Non-verbal Speech Analysis of Interviews of Individuals with Schizophrenia and Depression.

Schizophrenia and depression are the two most common mental disorders associated with negative symptoms that contribute to poor functioning and quality of life for millions of patients globally. This study is part of a larger research project. The overall aim of the project is to develop an automated objective pipeline that aids clinical diagnosis and provides more insights into symptoms of mental illnesses. In our previous work, we have analyzed non-verbal cues and linguistic cues of individuals with schizophrenia. In this study, we extend our work to include participants with depression. Powered by natural language processing techniques, we extract verbal features, both dictionary-based and vector-based, from participants' interviews that were automatically transcribed. We also extracted conversational, phonatory, articulatory and prosodic features from the interviews to understand the conversational and acoustic characteristics of schizophrenia and depression. Combining these features, we applied ensemble learning with leave-one-out cross-validation to classify healthy controls, schizophrenic and depressive patients, achieving an accuracy of 69%-75% in paired classification. From those same features, we also predict the subjective Negative Symptoms Assessment 16 scores of patients with schizophrenia or depression, yielding an accuracy of 90.5% for NSA2 but lower accuracy for other NSA indices. Our analysis also revealed significant linguistic and non-verbal differences that are potentially symptomatic of schizophrenia and depression respectively.

Social cognitive interventions for people with schizophrenia: A systematic review.

Social cognition is the mental process which underpins social interactions. Increasingly, it has been recognized to be impaired in people with schizophrenia, resulting in functional problems. Correspondingly, the past ten years have seen huge developments in the study of interventions to ameliorate social cognitive deficits among people with schizophrenia. In the present review, we systematically reviewed published studies on social cognitive interventions from 2005 to 2015. Of the 61 studies included in this review, 20 were on broad-based social cognitive interventions, which incorporated neurocognitive training, specialized learning technique or virtual reality social skills training. On the other hand, 31 studies on targeted interventions either focused on specific social cognitive domains, or a range of domains. Improvements in emotion processing and theory of mind were often reported, while social perception and attributional style were less frequently measured. Both broad-based and targeted interventions achieved gains in social functioning, albeit inconsistently. Lastly, nine studies on the use of oxytocin and one study on transcranial direct current stimulation reported positive preliminary results in higher-order cognition and facial affect recognition respectively. This review revealed that a wide range of social cognitive interventions is currently available and most have shown some promise in improving social cognition outcomes. However, there is a need to use a common battery of measurements for better comparisons across interventions. Future research should examine combination therapies and the sustainability of gains beyond the intervention period.

Montreal Cognitive Assessment as a screening instrument for cognitive impairments in schizophrenia.

BACKGROUND: Cognitive impairment is one of the core features of schizophrenia. For its evaluation, current clinical practice relies on detailed neuropsychological batteries which require trained testers and considerable amount of time to administer. Therefore, a brief and reliable screening tool for identification of overall cognitive impairment prior to a detailed comprehensive neurocognitive assessment is needed in a busy clinical setting. This study evaluates the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairments in schizophrenia and its relationship with functional outcome and demographic characters. METHODS: The MoCA, the Brief Assessment of Cognition in Schizophrenia (BACS), and the Brief UCSD Performance-based Skills Assessment (UPSA-B) were administered to 64 patients with schizophrenia. Mild and severe cognitive impairments were defined as BACS Z-score (calculated with the age and gender adjustments using previously published local norm data) of one or two standard deviations below the mean, respectively. RESULTS: The results showed that the MoCA was significantly correlated with BACS (r=.61, p<.001) and sensitive to detect both mild (AUC=0.82, p<.001) and severe (AUC=0.81, p<.001) cognitive impairments in schizophrenia. The MoCA was significantly correlated with UPSA-B score (r=.51, p<.001), and accounted for significant additional variance in UPSA-B score beyond the BACS. CONCLUSION: These findings indicate that MoCA is a useful bedside cognitive screening instrument for people with schizophrenia.