Range adaptive value representations in schizophrenia and major depression.

Anhedonia and amotivation are core symptoms of schizophrenia (SCZ) and major depressive disorder (MDD). Reward processing involves constructing and contrasting the representations for expected value (EV) and outcome value (OV) of a given stimulus, a phenomenon termed range adaptation. Impaired range adaptation can lead to anhedonia and amotivation. This study aimed to examine range adaptation in SCZ patients and MDD patients. Fifty SCZ, 46 MDD patients and 56 controls completed the Effort-based Pleasure Experience Task to measure EV and OV adaptation. SCZ and MDD patients showed altered range adaptation, albeit in different patterns. SCZ patients exhibited over-adaptation to OV and reduced adaptation to EV. By contrast, MDD patients exhibited diminished OV adaptation but intact EV adaptation. Both OV and EV adaptation were correlated with anhedonia and amotivation in SCZ and MDD. Taken together, our findings suggest that range adaptation is altered in both SCZ and MDD patients. Associations of OV and EV adaptation with anhedonia and amotivation were consistently found in SCZ and MDD patients. Impaired range adaptation in SCZ and MDD patients may be putative neural mechanisms and potential intervention targets for anhedonia and amotivation.

Psychometric Properties of the Caregiver Strain Questionnaire in a Chinese Sample of Caregivers of Children with Autism Spectrum Disorder.

The Caregiver Strain Questionnaire assesses the three dimensions of caregiver strain, namely the objective, subjective externalized and subjective internalized strain. It was validated among caregivers of children with Autism Spectrum Disorder (ASD) in the United States and Mainland China with promising psychometric properties.This study aimed to develop and validate the Chinese (traditional script) version of the Caregiver Strain Questionnaire (C-CGSQ) among 198 caregivers of children with ASD in Hong Kong. The C-CGSQ showed excellent internal consistency (α = 0.958) and test-retest reliability (Spearman's r = 0.966). Concurrent, convergent, divergent validity and a three-factor structure (consistent with previous studies) were established. The C-CGSQ demonstrated promising psychometric properties in measuring caregiver strain among caregivers of Chinese ASD children in Hong Kong.

Emotional subtypes in patients with depression: A cluster analysis.

Major depressive disorder (MDD) is associated with deficits in emotion experience, expression and regulation. Whilst emotion regulation deficits prolong MDD, emotion expression influences symptomatic presentations, and anticipatory pleasure deficits predict recurrence risk. Profiling MDD patients from an emotion componential perspective can characterize subtypes with different clinical and functional outcomes. This study aimed to investigate emotional subtypes of MDD. A two-stage cluster analysis applied to 150 MDD patients. Clustering variables included emotion experience measured by Temporal Experience of Pleasure Scale, emotion expression measured by Toronto Alexithymia Scale, and emotion regulation measured by Emotion Regulation Questionnaire. We validated the resultant clusters by comparing their symptoms and functioning with that of 50 controls. Cluster 1 (n = 50) exhibited intact emotion experience and expression yet adopted reappraisal rather than suppression strategy, whereas Cluster 2 (n = 66) exhibited generalized emotional deficits. Cluster 3 (n = 34) exhibited emotion expression deficits and adopted both reappraisal and suppression strategies. On validation, Cluster 2 exhibited the worst, but Cluster 1 exhibited the least symptoms and social functioning impairments. Cluster 3 was intermediate among the two other subtypes. Our findings support the existence of different emotional subtypes in MDD patients, and have clinical and theoretical implications for developing future specific treatments for MDD.

Latent structure of self-report negative symptoms in patients with schizophrenia: A preliminary study.

INTRODUCTION: Negative symptoms are associated with poor outcomes and functioning. Latent structure of negative symptoms is important for identifying potential intervention targets for novel treatments. Self-report instruments have been developed to measure negative symptoms. Previous findings on latent structure of negative symptoms are inconsistently and mainly rely on clinician-rated instruments. METHOD: We aimed to explore the latent structure of the Self-Evaluation of Negative Symptoms Scale (SNS) in 204 clinically-stable outpatients with schizophrenia. Confirmatory factor analysis (CFA) was used to compare the competing models (i.e., one-factor, two-factor and five-factor models), and estimated goodness-of-fit indexes. Other clinician-rated scales for psychopathology and medication side-effects were also collected. RESULTS: The CFA found the five-factor model performing best, with a comparative fit index (CFI) of > 0.95, a Tucker Lewis Index (TLI) of > 0.95, and a root mean square error of approximation (RMSEA) of < 0.06. The robust chi-square difference test for the weighted least squares with mean and variance adjusted estimation (WLSMV) also indicated a significant better fit for the five-factor model. DISCUSSION: Our preliminary findings support a five-factor latent structure of self-report negative symptoms in schizophrenia patients. Further research in this area should utilize multiple clinician-rated and self-report measures, and recruit large and homogeneous samples with schizophrenia.

Staging of Dementia Severity With the Hong Kong Version of the Montreal Cognitive Assessment (HK-MoCA)'s.

BACKGROUND: The Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) has been used to screen for dementia, but it has not been validated to delineate the stages of Alzheimer disease (AD). This study aimed to determine the cut-off score ranges for mild, moderate, and severe AD. METHODS: The HK-MoCA score was matched against the Clinical Dementia Rating on 155 patients with AD. Investigators performing the HK-MoCA and Clinical Dementia Rating were blinded to each other. Receiver-operating characteristic analysis was used to determine the cut-off scores between different stages of AD (mild, moderate, and severe stage). A secondary analysis with adjustments for age and education received were also performed. RESULT: The cut-off score in HK-MoCA was ≤4 for those with severe AD (sensitivity 84.4%, specificity 91.9%, area under curve=0.92, P<0.001) and 5 to 9 for those with moderate AD (sensitivity 86.3%, specificity of 93.3%, area under curve=0.953, P<0.001). With adjustments for age and education, the cut-off score for moderate AD was adjusted to 5 to 8, whereas the cut-off score for severe AD remained unchanged. CONCLUSIONS: The severity of AD could be delineated using the HK-MoCA for the Cantonese-speaking population in Hong Kong, and the effect of education on the cut-off score needs further investigation.

Clinical risk model to predict 28-day unplanned readmission via the accident and emergency department after discharge from acute psychiatric units for patients with psychotic spectrum disorders.

BACKGROUND: Unplanned readmissions rates are an important indicator of the quality of care provided in a psychiatric unit. However, there is no validated risk model to predict this outcome in patients with psychotic spectrum disorders. AIMS: This paper aims to establish a clinical risk prediction model to predict 28-day unplanned readmission via the accident and emergency department after discharge from acute psychiatric units for patients with psychotic spectrum disorders. METHOD: Adult patients with psychotic spectrum disorders discharged within a 5-year period from all psychiatric units in Hong Kong were included in this study. Information on the socioeconomic background, past medical and psychiatric history, current discharge episode and Health of the Nation Outcome Scales (HoNOS) scores were used in a logistic regression to derive the risk model and the predictive variables. The sample was randomly split into two to derive (n = 10 219) and validate (n = 10 643) the model. RESULTS: The rate of unplanned readmission was 7.09%. The risk factors for unplanned readmission include higher number of previous admissions, comorbid substance misuse, history of violence and a score of one or more in the discharge HoNOS overactivity or aggression item. Protective factors include older age, prescribing clozapine, living with family and relatives after discharge and imposition of conditional discharge. The model had moderate discriminative power with a c-statistic of 0.705 and 0.684 on the derivation and validation data-set. CONCLUSIONS: The risk of readmission for each patient can be identified and adjustments in the treatment for those with a high risk may be implemented to prevent this undesirable outcome.

Meta-analysis of neuropsychological measures of executive functioning in children and adolescents with high-functioning autism spectrum disorder.

Existing literature on the profile of executive dysfunction in autism spectrum disorder showed inconsistent results. Age, comorbid attention-deficit/hyperactivity disorder (ADHD) and cognitive abilities appeared to play a role in confounding the picture. Previous meta-analyses have focused on a few components of executive functions. This meta-analysis attempted to delineate the profile of deficit in several components of executive functioning in children and adolescents with high-functioning autism spectrum disorder (HFASD). Ninety-eight English published case-control studies comparing children and adolescents with HFASD with typically developing controls using well-known neuropsychological measures to assess executive functions were included. Results showed that children and adolescents with HFASD were moderately impaired in verbal working memory (g = 0.67), spatial working memory (g = 0.58), flexibility (g = 0.59), planning (g = 0.62), and generativity (g = 0.60) except for inhibition (g = 0.41). Subgroup analysis showed that impairments were still significant for flexibility (g = 0.57-0.61), generativity (g = 0.52-0.68), and working memory (g = 0.49-0.56) in a sample of autism spectrum disorder (ASD) subjects without comorbid ADHD or when the cognitive abilities of the ASD group and the control group were comparable. This meta-analysis confirmed the presence of executive dysfunction in children and adolescents with HFASD. These deficits are not solely accounted for by the effect of comorbid ADHD and the general cognitive abilities. Our results support the executive dysfunction hypothesis and contribute to the clinical understanding and possible development of interventions to alleviate these deficits in children and adolescents with HFASD. Autism Res 2017, 10: 911-939. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.