Apathy Is Associated With Ventral Striatum Volume in Schizophrenia Spectrum Disorder.

Apathy is prevalent in schizophrenia, but its etiology has received little investigation. The ventral striatum (VS), a key brain region involved in motivated behavior, has been implicated in studies of apathy. We therefore evaluated whether apathy is associated with volume of the VS on MRI in 23 patients with schizophrenia using voxel-based morphometry. Results indicated that greater self-reported apathy severity was associated with smaller volume of the right VS even when controlling for age, gender, depression, and total gray matter volume. The finding suggests that apathy is related to abnormality of brain circuitry subserving motivated behavior in patients with schizophrenia.

Interference Resolution in Emotional Working Memory as a Function of Alexithymia.

Although alexithymia is recognized as a set of traitlike deficits in emotion processing, research suggests there are concomitant cognitive issues as well, including what appears to be an unusual pattern of enhanced working memory (WM) despite broader executive dysfunction. It is unknown whether this enhancement includes the executive elements of WM and whether executive control of WM in alexithymia differs for emotional and neutral stimuli. This study examined how alexithymia moderates patterns of interference resolution in WM with valenced and nonvalenced stimuli. Participants (N = 93) completed the Toronto Alexithymia Scale and a recency probes WM task containing positive, negative, and neutral stimuli, with some trials containing proactive interference from previous trials. The reaction time difference between interference and noninterference trials indexed degree of interference resolution. Toronto Alexithymia Scale score moderated a within-subject effect such that, when valenced probes were used, there was less proactive interference in the positive relative to negative valence condition; this valence-based interference discrepancy was significant for a subset of highly alexithymic participants. Alexithymia did not moderate proactive interference to negative or neutral stimuli or accuracy of responses. These results suggest that, although alexithymia does not influence executive control in WM for nonemotional items, alexithymic people demonstrate an idiosyncratic response to positive stimuli that might indicate blunted reactivity.

The Relation of Alexithymic Traits to Affective Theory of Mind.

Little research has focused on the contributors to adult theory of mind (ToM) even though there is reason to suspect individual differences in performance in neurotypical samples. Alexithymia, a term that references an impaired ability to attend to and verbally label emotions via ongoing introspection, is a useful construct through which to explore how socially relevant dimensions of emotion processing enable ToM. As 1 study has explored alexithymia vis-à-vis cognitive ToM, this study examined the relationships between facets of alexithymia and affective ToM while controlling for the potential confounds of empathy, verbal ability, and negative affect. A nonclinical sample of adults (N = 86) completed the Toronto Alexithymia Scale, the Reading the Mind in the Eyes Test, the Mehrabian and Epstein Scale of Emotional Empathy, the Profile of Mood States, and the Wechsler Abbreviated Scale of Intelligence. Hierarchical regression analysis showed that externally oriented thinking contributed unique variance to affective ToM, confirming an inverse relationship between alexithymia and affective ToM but highlighting the need to parse alexithymia into discrete facets when exploring its relevance to social cognition.

Urinary brain-derived neurotrophic factor as a biomarker of executive functioning.

BACKGROUND/AIMS: Neurotrophins such as brain-derived neurotrophic factor (BDNF) are vital for neuronal survival and adaptive plasticity. With high BDNF gene expression in the prefrontal cortex, BDNF is a potential regulatory factor for building and maintaining cognitive reserves. Recent studies suggest that individual differences in executive functioning, a broad cognitive domain reliant upon frontal lobe structure and function, are governed in part by variance in BDNF polymorphisms. However, as neurogenetic data are not necessarily indicative of in vivo neurochemistry, this study examines the relationship between executive functioning and the neurotransmitter by measuring peripheral BDNF levels. METHODS: Fifty-two healthy young adults completed a battery of standardized executive function tests. BDNF levels, adjusted for creatinine, were quantified with enzyme-linked immunosorbent assay of urine samples taken at the time of testing. RESULTS: BDNF concentration was positively associated with cognitive flexibility but had no relationship with working memory, abstract reasoning/planning, self-monitoring/response inhibition, or fluency. CONCLUSIONS: These results individuate cognitive flexibility as the specific facet of executive functioning associated with in vivo BDNF levels. This study also validates urinary BDNF as a peripheral biomarker of cognition in healthy adults.

Vitamin D and long-term memory in multiple sclerosis.

BACKGROUND AND OBJECTIVE: Memory disturbance is a frequent cognitive complaint by patients with multiple sclerosis (MS). Recent dementia research suggests a beneficial role for vitamin D in long-term memory functioning. While data suggest ameliorative effects of vitamin D for the physical impairments of MS, it is unknown whether vitamin D can benefit the cognitive sequelae. We examined the relationship between serum levels of vitamin D and performance on verbal and nonverbal tests of long-term memory in patients with MS. METHODS: A sample of 35 adults with relapsing-remitting MS completed cognitive testing and a vitamin D serum (25[OH]D) assay. Memory assessment used clinically established neuropsychological tests with multiple testing formats to determine whether vitamin D level was associated with memory during conditions of varying retrieval demands. Intellectual functioning and mood were also assessed to control for potential confounds. RESULTS: Vitamin D level was positively associated with performance on immediate and delayed recall trials of the Rey Complex Figure Test, effects that held after controlling for intelligence and disease duration. Vitamin D level was not associated with mood, intelligence, or verbal memory performance on the California Verbal Learning Test, Second Edition. CONCLUSIONS: Higher vitamin D level was associated with better nonverbal long-term memory performance in MS, particularly in conditions when no aid was given to help retrieval. These results supplement the literature on the neuroprotective effects of vitamin D and suggest that vitamin D is a worthwhile adjunct treatment for MS.

Lack of relationship between psychological denial and unawareness of illness in schizophrenia-spectrum disorders.

Numerous theories have been proposed to explain the unawareness of illness that is commonly seen in schizophrenia-spectrum disorders, including the theory that unawareness is the result of a psychological denial mechanism used to mitigate the emotional consequences of having a psychiatric illness. The present study was an attempt to determine whether increased denial (in the form of self-deception) is associated with impaired awareness, consistent with the denial theory. Participants included 40 patients with schizophrenia-spectrum disorders and 25 healthy comparison participants. Patients' levels of awareness and symptom attribution were assessed through interview, and all participants completed self-report questionnaires measuring mood symptoms as well as their use of self-deception. Awareness of negative symptoms was associated with increased depression. However, self-deception was not significantly correlated with awareness measures. When patients were divided on the basis of their awareness and attribution scores, no group differences emerged regarding use of self-deception. The patient group and the healthy comparison group did not differ in their use of self-deception. The current results do not support the psychological denial theory of unawareness of illness in schizophrenia-spectrum disorders.

Apathy and the processing of novelty in schizophrenia.

Apathy is a common negative symptom in schizophrenia that has been associated with poor medication compliance and treatment outcome. Recent studies in neurological patients have observed an association between apathy and reduced attention to novel stimuli. We evaluated whether patients with schizophrenia demonstrate a similar relationship. Participants included 20 patients with schizophrenia and 20 healthy comparison subjects matched for age, sex, handedness, and parental education. A self-paced visual novelty task was presented which assessed the duration that participants looked at frequent standard stimuli, infrequent target stimuli, and novel stimuli. Attention to novelty was defined as the duration of viewing novel relative to standard stimuli. Apathy was assessed with the Marin Apathy Evaluation Scale. Results revealed significantly greater self- and informant-reported apathy, slower reaction time to target stimuli, and longer viewing times to the stimuli, but not reduced attention to the novel stimuli, in the patient group. Although greater self-report of apathy was associated with longer viewing times for all stimuli in the patient group, this was accounted for by depressed mood. The present findings indicate that schizophrenia is associated with slowed information processing, but do not support the hypothesis that apathy in schizophrenia is associated with abnormal processing of novelty.

Specificity of emotion-related effects on attentional processing in schizotypy.

OBJECTIVES: In the schizophrenia spectrum, cognitive functions such as perception, language, and attention have been shown to be adversely influenced by negative affect. The present study addressed three issues of specificity and one issue of mechanism regarding affect-related attentional disruption in schizotypy: (1) Is attentional disturbance from negative affective stimuli specific to positive (PS) but not negative schizotypy (NS)? (2) Do positive affective stimuli also foster attentional disturbance? (3) Are anxiety and depression differentially related to PS and NS? (4) Whatever the degree of specificity in these relationships, does anxiety mediate the relationship between schizotypy and attentional disturbance? METHODS: Nonpatient participants (N=162) provided responses on scales of schizotypy, anxiety, and depression and performed an emotional Stroop task, judging the ink color of positive, neutral, and negative words. RESULTS: PS but not NS was associated with poorer attentional performance. This attentional disturbance was specific to negative words. PS was associated with anxiety and depression, whereas NS was associated only with depression. Finally, anxiety and depression did not fully mediate the relationship between PS and attentional interference related to negative affective stimuli. CONCLUSIONS: Findings of attentional disturbance in the presence of negative affective stimuli, particularly in positive schizotypy, have substantial theoretical implications. They provide a path by which the interplay of cognitive and affective phenomena could lead to the formation, maintenance, and exacerbation of positive symptoms, including delusions and hallucinations. Findings from this study also underscore the importance of examining the differential contribution of comorbid anxiety and depression to cognitive and affective function in the schizophrenia spectrum.

Functional magnetic resonance imaging of executive control in bipolar disorder.

Bipolar disorder has been associated with dysfunction of executive control processes. Using functional magnetic resonance imaging, we examined brain activation during a counting Stroop task in 11 healthy adults and 11 patients with bipolar I disorder. Results revealed greater activation for the healthy than bipolar disorder group in distributed brain regions that included the right inferior and medial frontal gyri. With the exception of one area within the left posterior cingulate gyrus that was correlated with mania severity, regional activations where group differences were observed were not associated with mood symptoms in the patient group. These findings add to the growing body of evidence implicating neural circuitry subserving executive control in bipolar disorder.

Executive Function and Emotion Regulation Strategy Use in Adolescents.

Development of emotion regulation strategy use involves a transition from reliance on suppression during childhood to greater use of reappraisal in adolescence and adulthood-a transition that parallels developmental changes in executive functions. We evaluated the relationship between emotion regulation strategy use and executive functioning in the everyday life of 70 typically developing adolescents who completed the Emotion Regulation Questionnaire for Youth and the Behavior Rating Inventory of Executive Function-Self-Report. Results indicated that greater reliance on reappraisal was associated with better executive functions, while reliance on suppression was related to poorer executive functions. Findings suggest that adolescents who rely on reappraisal may have more cognitive resources to help them remain attentive and well regulated in their daily lives. On the other hand, if better executive functions facilitate the use of reappraisal, adolescents' ability to regulate their emotions could potentially be enhanced via supports for executive functions.

Neural mechanisms of affective interference in schizotypy.

Negatively valenced stimuli foster cognitive impairment in schizotypy and schizophrenia. To identify relevant brain mechanisms, the authors had 16 positive-schizotypy and 16 control participants perform an emotional Stroop task, judging the ink color of negative and neutral words during functional magnetic resonance imaging (fMRI) of regional brain activity. Schizotypy individuals showed increased right and decreased left activity in dorsolateral prefrontal cortex, indicating a deficit in maintenance of attentional set in the presence of negative emotional distractors. They also showed abnormal activity in ventral limbic areas, including decreased activity in nucleus accumbens and increased activity in hippocampus and amygdala, a circuit involved in the integration of cognitive and affective processes. These results indicate that aspects of emotion-cognition processes and the brain mechanisms that implement them are similar in schizotypy and schizophrenia.

Emotion-modulated performance and activity in left dorsolateral prefrontal cortex.

Functional MRI (fMRI) was used to examine the relationship between processing of pleasant and unpleasant stimuli and activity in prefrontal cortex. Twenty volunteers identified the colors in which pleasant, neutral, and unpleasant words were printed. Pleasant words prompted more activity bilaterally in dorsolateral prefrontal cortex (DLPFC) than did unpleasant words. In addition, pleasant words prompted more activity in left than in right DLPFC. Response speed to pleasant words was correlated with DLPFC activity. These data directly link positive affect, enhanced performance, and prefrontal activity, providing some of the first fMRI evidence supporting models of emotional valence and frontal brain asymmetry based on electroencephalography (EEG).

The unique relationship between fear of cognitive dyscontrol and self-reports of problematic drinking.

Research has established positive associations between anxiety sensitivity (AS) and problematic drinking in clinical samples. The present study confirmed this relationship in a nonclinical sample (N=162) and investigated which AS dimension best predicts self-reports of problematic drinking. Only one AS facet, fear of cognitive dyscontrol (FCC), was associated with symptoms of alcohol dependence, severity of drinking problems, and alcohol-related expectations of global, positive changes, sexual enhancement, and tension reduction. The possible role of depression in these relationships was also evaluated. A series of hierarchical regressions revealed that, when trait anxiety, anxious arousal, and anxious apprehension were statistically removed, depression did not contribute significant variance beyond the effects of FMC and other anxiety measures. Results suggest that FCC is uniquely associated with self-reports of problematic drinking behaviors and attitudes. Implications for tension-reduction models of alcohol are discussed.

The clinical basis of orthorexia nervosa: emerging perspectives.

Orthorexia nervosa describes a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Although prompted by a desire to achieve optimum health, orthorexia may lead to nutritional deficiencies, medical complications, and poor quality of life. Despite its being a distinct behavioral pattern that is frequently observed by clinicians, orthorexia has received very little empirical attention and is not yet formally recognized as a psychiatric disorder. In this review, we synthesize existing research to identify what is known about the symptoms, prevalence, neuropsychological profile, and treatment of orthorexia. An examination of diagnostic boundaries reveals important points of symptom overlap between orthorexia and anorexia nervosa, obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), somatic symptom disorder, illness anxiety disorder, and psychotic spectrum disorders. Neuropsychological data suggest that orthorexic symptoms are independently associated with key facets of executive dysfunction for which some of these conditions already overlap. Discussion of cognitive weaknesses in set-shifting, external attention, and working memory highlights the value of continued research to identify intermediate, transdiagnostic endophenotypes for insight into the neuropathogenesis of orthorexia. An evaluation of current orthorexia measures indicates a need for further psychometric development to ensure that subsequent research has access to reliable and valid assessment tools. Optimized assessment will not only permit a clearer understanding of prevalence rates, psychosocial risk factors, and comorbid psychopathology but will also be needed to index intervention effectiveness. Though the field lacks data on therapeutic outcomes, current best practices suggest that orthorexia can successfully be treated with a combination of cognitive-behavioral therapy, psychoeducation, and medication.

Urinary BDNF-to-creatinine ratio is associated with aerobic fitness.

Circulating levels of brain-derived neurotrophic factor (BDNF) are known to be affected by aerobic exercise. As the previous research focus in humans has been to examine peripheral BDNF levels through blood, serum, and platelet assay, the present study investigated the association between basal urinary BDNF concentration and indices of aerobic fitness in a sample of young adults (n=52). Aerobic fitness was evaluated with self-report of exercise habits and heart rate (HR) assessment during a sub-maximal Step Test. BDNF concentration was determined by enzyme-linked immunosorbent assay and adjusted for creatinine. Results indicated that the basal BDNFlog/creatinine ratio was positively associated with greater frequency of exercise and, during aerobic challenge, a quicker rise in HR upon exercise, lower peak HR during exercise, and lower HR during the recovery period, each indicative of enhanced fitness. These results highlight the utility of urine capture as a non-invasive technique to assess for exercise-mediated changes in peripheral BDNF.

Basal salivary oxytocin level predicts extra- but not intra-personal dimensions of emotional intelligence.

A wealth of literature suggests that oxytocin is an important mediator of social cognition, but much of the research to date has relied on pharmaceutical administration methods that can raise oxytocin to artificially high levels. The present study builds upon previous work by examining whether basal oxytocin level predicts intra- and extra-personal (i.e., self- and other-focused) elements of emotional intelligence (EI), independent of shared variance with current mood. The sample included 71 healthy young adults (46 women). Assessment measures included the Mayer-Salovey-Caruso Emotional Intelligence Test Version 2.0 (MSCEIT), the Trait Meta-Mood Scale, and the Profile of Mood States. Peripheral oxytocin levels were examined with enzyme-linked immunosorbent assay from saliva after solid phase extraction. Oxytocin level was unrelated to TMMS scores but was positively associated with performance in the Experiential EI domain of the MSCEIT. However, total mood disturbance was positively related to MSCEIT scores. Hierarchical regression analysis indicated that oxytocin level added unique variance to the prediction of MSCEIT performance beyond that of current mood. These results confirm an association between endogenous levels of oxytocin in healthy adults and a subset of EI abilities, including extra-personal emotion recognition and the channeling of emotions to enhance social proficiency.

Specificity of meta-emotion effects on moral decision-making.

A recently proposed dual process theory of moral decision-making posits that utilitarian reasoning (approving of harmful actions that maximize good consequences) is the result of cognitive control of emotion. This suggests that deficits in emotional awareness will contribute to increased utilitarianism. The present study explored the relative contributions of the different facets of alexithymia and the closely related constructs of emotional intelligence and mood awareness to utilitarian decision making. Participants (N = 86) completed the Toronto Alexithymia Scale, Trait Meta Mood Scale, the Mood Awareness Scale, and a series of high-conflict, personal moral dilemmas validated by Greene et al. (2008). A brief neuropsychological battery was also administered to assess the possible confounds of verbal reasoning and abstract thinking ability. Principal components analysis revealed two latent factors-clarity of emotion and attention to emotion-which cut across all three meta-emotion instruments. Of these, low clarity of emotion-reflecting difficulty in reasoning thoughtfully about one's emotions-predicted utilitarian outcomes and provided unique variance beyond that of verbal and abstract reasoning abilities. Results are discussed in the context of individual differences in emotion regulation.

Regional gray matter correlates of perceived emotional intelligence.

Coping with stressful life events requires a degree of skill in the ability to attend to, comprehend, label, communicate and regulate emotions. Individuals vary in the extent to which these skills are developed, with the term 'alexithymia' often applied in the clinical and personality literature to those individuals most compromised in these skills. Although a frontal lobe model of alexithymia is emerging, it is unclear whether such a model satisfactorily reflects brain-related patterns associated with perceived emotional intelligence at the facet level. To determine whether these trait meta-mood facets (ability to attend to, have clarity of and repair emotions) have unique gray matter volume correlates, a voxel-based morphometry study was conducted in 30 healthy adults using the Trait Meta Mood Scale while co-varying for potentially confounding sociodemographic variables. Poorer Attention to Emotion was associated with lower gray matter volume in clusters distributed primarily throughout the frontal lobe, with peak correlation in the left medial frontal gyrus. Poorer Mood Repair was related to lower gray matter volume in three clusters in frontal and inferior parietal areas, with peak correlation in the left anterior cingulate. No significant volumetric correlations emerged for the Clarity of Emotion facet. We discuss the localization of these areas in the context of cortical circuits known to be involved in processes of self-reflection and cognitive control.