Sensory processing, neurocognition, and social cognition in schizophrenia: towards a cohesive cognitive model.

Schizophrenia research has identified deficits in neurocognition, social cognition, and sensory processing. Because a cohesive model of "disturbed cognitive machinery" is currently lacking, we built a conceptual model to integrate neurocognition, social cognition, and sensory processing. In a cross-sectional study, the cognitive performance of participants was measured. In accordance with the Schedules for Clinical Assessment in Neuropsychiatry, the participants were assigned to either the schizophrenia group or the non-schizophrenic psychosis group. Exclusion criteria included substance abuse, serious somatic/neurological illness, and perceptual handicap. The male/female ratio, educational level, and handedness did not differ significantly between the groups. The data were analyzed using structural equation modeling. Based upon the results of all possible pairwise models correlating neurocognition, social cognition, and sensory processing, three omnibus models were analyzed. A statistical analysis of a pairwise model-fit (χ(2), CFI, and RMSEA statistics) revealed poor interrelatedness between sensory processing and neurocognition in schizophrenia patients compared with healthy control participants. The omnibus model that predicted disintegration between sensory processing and neurocognition was statistically confirmed as superior for the schizophrenia group (χ(2)(53) of 56.62, p=0.341, RMSEA=0.04, CFI=0.95). In healthy participants, the model predicting maximal interrelatedness between sensory processing/neurocognition and neurocognition/social cognition gave the best fit (χ(2)(52) of 53.74, p=0.408, RMSEA=0.03, CFI=0.97). The performance of the patients with non-schizophrenic psychosis fell between the schizophrenia patients and control participants. These findings suggest increasing separation between sensory processing and neurocognition along the continuum from mental health to schizophrenia. Our results support a conceptual model that posits disintegration between sensory processing of social stimuli and neurocognitive processing.

[Behavioural standard or coercive measure? Some considerations regarding the special issue on ROM]. / ROM: gedragsnorm of dwangmaatregel? Overwegingen bij het themanummer over routine outcome monitoring.

BACKGROUND: The cost of mental health care has possibly risen more than costs in other sectors of health care in the Netherlands. In an attempt to control the rising costs, new policies have been implemented that include the introduction of selective financial penalties for those in need of mental health care as well as the start of performance-based mental health care reimbursement. In order to achieve the latter goal, a nation-wide large-scale data collection was introduced based on clinical routine outcome monitoring (ROM) data, with a view to using these data for benchmarking. AIM: Closer inspection of the benchmarking efforts in terms of scientific validity. METHOD: Qualitative review and analysis. RESULTS: Analysis shows that the type of ROM data that is collected in the Netherlands is valid for tracking the outcomes of individual patients, but unsuitable for performance comparisons between institutions for reasons of case-mix, instrument-mix, bias and lack of sensitivity. CONCLUSION: Attempts to introduce benchmarking based on rom will probably have a negative impact on the practice of mental health care in the Netherlands. More input from mental health professionals and scientists is required in order to identify more rational and efficient ways of spending scarce resources.

Modality-specific attention and multisensory integration of emotions in schizophrenia: reduced regulatory effects.

BACKGROUND: Deficits in emotion perception are a well-established phenomenon in schizophrenic patients and studies have typically used unimodal emotion tasks, presenting either emotional faces or emotional vocalizations. We introduced bimodal emotion conditions in two previous studies in order to study the process of multisensory integration of visible and audible emotion cues. We now build on our earlier work and address the regulatory effects of selective attention mechanisms on the ability to integrate emotion cues stemming from multisensory channels. METHODS: We added a neutral secondary distractor condition to the original bimodal paradigm in order to investigate modality-specific selective attention mechanisms. We compared schizophrenic patients (n=50) to non-schizophrenic psychotic patients (n=46), as well as to healthy controls (n=50). A trained psychiatrist used the Schedules of Clinical Assessment in Neuropsychiatry (SCAN 2.1) to diagnose the patients. RESULTS: As expected, in healthy controls, and to a lesser extent in non-schizophrenic psychotic patients, modality-specific attention attenuated multisensory integration of emotional faces and vocalizations. Conversely, in schizophrenic patients, auditory and visual distractor conditions yielded unaffected and even exaggerated multisensory integration. CONCLUSIONS: These results suggest that schizophrenics, as compared to healthy controls and non-schizophrenic psychotic patients, have modality-specific attention deficits when attempting to integrate information regarding emotions that stem from multichannel sources. Various explanations for our findings, as well as their possible consequences, are discussed.

Audiovisual emotion recognition in schizophrenia: reduced integration of facial and vocal affect.

Since Kraepelin called dementia praecox what we nowadays call schizophrenia, cognitive dysfunction has been regarded as central to its psychopathological profile. Disturbed experience and integration of emotions are, both intuitively and experimentally, likely to be intermediates between basic, non-social cognitive disturbances and functional outcome in schizophrenia. While a number of studies have consistently proven that, as part of social cognition, recognition of emotional faces and voices is disturbed in schizophrenics, studies on multisensory integration of facial and vocal affect are rare. We investigated audiovisual integration of emotional faces and voices in three groups: schizophrenic patients, non-schizophrenic psychosis patients and mentally healthy controls, all diagnosed by means of the Schedules of Clinical Assessment in Neuropsychiatry (SCAN 2.1). We found diminished crossmodal influence of emotional faces on emotional voice categorization in schizophrenics, but not in non-schizophrenia psychosis patients. Results are discussed in the perspective of recent theories on multisensory integration.

[Quality of life measurement in child-psychiatry]. / Meten van kwaliteit van leven in de kinderpsychiatrie.

BACKGROUND: Quality of life (QoL) has become an important outcome measure in health care, including in child psychiatry. AIM: To formulate assessment criteria with regard to instruments that are designed to measure QoL in children. METHOD: Literature search, using five key electronic databases. results When selecting an instrument, one has to consider the following aspects: its validity and reliability, the relative dimensions of QoL, its suitability for use with both the child and its parents and its cross-cultural applicability. A number of instruments were found to meet these criteria. CONCLUSION: The Child Quality of Life Questionnaire, the Revidierter Kinder Lebensqualit"atsfragebogen, the tno-azl Children's Quality of Life questionnaire, the Pediatric Quality of Life Inventory, the Child Health Questionnaire and in particular the kidscreen show to be suitable instruments for assessing QoL in children.

Relationships between social functioning and quality of life in a population of Dutch adult psychiatric outpatients.

BACKGROUND: The relationship between social functioning and QOL in psychiatric patients has not been explicitly investigated before. AIMS: To investigate the relationship between social functioning and QOL in a population of psychiatric outpatients (N = 410) with a broad spectrum of psychiatric disorders. METHOD: Social functioning was assessed with the Groningen Social Behavior Questionnaire-100 (GSBQ-100) and the Global Assessment of Functioning (GAF) scale. QOL was measured with the WHO Quality of Life Assessment Instrument (WHOQOL-100). RESULTS: The study population experienced a wide range of problems concerning all aspects of social functioning. The numbers of problems were significantly higher compared with healthy controls and (partly) also compared with a norm group of psychiatric outpatients. Almost all scales of the GSBQ-100 were negatively correlated with all QOL aspects, whereas the GAF score correlated positively with all QOL aspects. In general, participants with problems on aspects of social functioning had lower QOL scores than those without such problems, even after a correction for the presence of psychopathology according to DSM-IV classification. CONCLUSION: In addition to the presence of psychopathology, social functioning is significantly related to QOL. Therefore, it should be considered more systematically in psychiatric assessment, treatment and program evaluation.

Mental health in The Netherlands.

The Netherlands borders the North Sea and is located between Belgium and Germany. Its total area is about 41 500 km2, nearly 34 000 km2 of which is land area. The country consists mostly of coastal lowland and land reclaimed from the sea (polders). An extensive system of dykes and dams protects nearly one-half of the total area from being flooded.

Relationships between demographic variables and quality of life in a population of Dutch adult psychiatric outpatients.

BACKGROUND: Examinations of the role of demographic characteristics in quality of life (QOL) in psychiatric samples are not new. However, serious limitations of previous research have been that (1) QOL was not assessed according to current recommendations, (2) assessment of QOL was often hampered by a substantial overlap in content between symptoms and QOL measures, and (3) the majority of the study samples had quite specific characteristics hampering the generalizability of results, as a result of which clinical implications of the results remained unclear. The aim of the present study was to investigate explicitly the relationships between demographics and QOL in a sample reflecting the general population of psychiatric outpatients, QOL being assessed in a comprehensive, culturally sensitive, and subjective way, paying attention to the relative importance of its various facets. The main hypothesis was that these relationships would be rather weak. METHOD: From a population of 533 adult Dutch psychiatric outpatients, 495 participants completed the World Health Organization Quality of Life (WHOQOL)-Bref for assessing QOL. Furthermore, several demographic characteristics were recorded. RESULTS: Statistically significant correlations were found between partner relationship, habitual status, work, and sick leave and the WHOQOL-Bref domains social relationships and environment. Psychological health was associated to partner relationship, educational level, and sick leave. The total amount of QOL variance explained by demographics was rather low. CONCLUSION: Amongst factors determining QOL, demographic characteristics are relatively unimportant. Therefore, paying attention to demographics during psychiatric treatment will probably have little effect on improvement of QOL.

Psychiatric disorders in a Dutch Health Area: a repeated cross-sectional survey.

BACKGROUND: Decades of psychiatric epidemiology have shown a wide variation in prevalence rates, but a consistent relationship between psychiatric disorder and sociodemographic variables. In this repeated cross-sectional survey, the prevalence of psychiatric disorders and their distribution in the general population of the same area was assessed in 1983 and 1997. METHODS: With an interval of 14 years, 2 two-phase studies of psychiatric prevalence were carried out among the inhabitants of a Dutch Health Area (Nijmegen). In phase 1, a random sample of persons answered the General Health Questionnaire (GHQ-30). In phase 2, the respondents were interviewed using a clinical semi-structured interview. Only phase 1 data will be reported here. RESULTS: The mean overall GHQ-score changed significantly from 3.1 (+/-1.0) in 1983 to 4.6 (+/-1.8) in 1997. On a bivariate level, higher score rates were found consistently in the age categories > or = 50 years, among divorced persons, the lower educational levels, the unemployed/chronically ill and in the urban areas. On a multivariate level (second order effect), however, the variance explained by these sociodemographic variables doubled, revealing the importance of complex interactions. LIMITATIONS: Our aim to ensure identical designs in 1983 and 1997 could not completely be achieved. CONCLUSIONS: In the course of time, psychiatric prevalence increased in all sociodemographic categories, despite the improved socioeconomic conditions in the survey population as a whole. The increasing complexity of life apparently takes its toll, even of the socially best equipped.

Psychometric properties of the schedules for clinical assessment in neuropsychiatry (SCAN-2.1).

BACKGROUND: The Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the successor of the ninth version of the Present State Examination (PSE-9), is one of the latest instruments developed by the World Health Organisation for the assessment of psychiatric disorders. So far, the psychometric properties have only been established for certain sections of the instrument. The present study is the first to test the psychometric properties of SCAN-2.1 for most of the disorders covered by the SCAN, and was carried out prior to a survey conducted in the Nijmegen Health Area (the Netherlands). METHODS: Interviewers were psychology graduates with little clinical experience. Two designs were used. In one design, pairs of independent live interviews with the same respondent were compared (test-retest situation). In the other, ten videotaped interviews by experts were rated by each of the interviewers (standardized situation), and the outcomes were compared with those of the other interviewers as well as with a reference score. RESULTS: In the test-retest situation the kappa coefficient for diagnostic caseness was qualified as substantial (0.62) and for diagnostic categories and diagnostic groups as moderate to good (0.24 to 0.64). In the standardized situation using videotaped interviews by experts, sensitivity as well as specificity proved to be substantial to almost perfect. The agreement per interviewer with regard to the reference diagnoses ranged from 87% (diagnostic group) to 94% (diagnostic caseness). Agreement on the syndrome level (without duration and interference criteria of DSM-IV) was excellent. CONCLUSIONS: Although the instrument is traditionally used by experienced clinicians, this study shows that less experienced (but well trained) interviewers can apply SCAN reliably. Special attention should be paid to the items without explicit interview questions, as they tend to be more sensitive to neglect than the items with interview questions.

Antidepressieve onderhoudsbehandeling na elektroconvulsieve therapie Een overzicht van de recente literatuur en een enquête onder de Nederlandse ECT-centra.

The different forms of antidepressive continuation therapy, used in the Netherlands, to prevent relapse after electroconvulsive therapy, were examined by sending a questionaire to all ECT centers. Common practice is in agreement with the results of current research. However, recent studies suggest that pharmacological continuation therapy is less usefull to prevent relapse when pharmacotherapeutic resistance has been proven in the past. In these cases ECT-continuation therapy might bring a solution. On the effect of ECT-continuation therapy are few valid research results available.

[Standardized behavior assessment plays a minor role in arriving at indications for admission to a psychogeriatric nursing home]. / Gestandaardiseerde gedragsbeoordeling speelt een betrekkelijk geringe rol bij de indicatiestelling voor opname in een psychogeratrisch verpleeghuis.

To investigate the role which standardised, patient related data play in indicated admission to a psychogeriatric nursing home, we compared the data of 120 indicated with those of 68 not-indicated patients. High scores on subscales 'helplessness' and 'inactivity' of the Dutch version of the Stockton Geriatric Rating Scale were the best predictors of indicated admission to a certain extent (21.6%). Furthermore a history of cardiac diseases and the state of being unmarried increased the probability of indicated admission to a small degree. Only a limited percentage of the variance in the decision of the indication committee could be explained. The limited availability of data which are collected in a standardised way, especially data concerning the caregiving system and the absence of valid and reliable instruments for the investigation of indicated admission are the most probable causes of this fact.

The structure of common psychiatric symptoms: how many dimensions of neurosis?

In order to replicate and elaborate the two-dimensional model of depression and anxiety underlying the structure of common psychiatric symptoms proposed by Goldberg et al. (1987), we carried out latent trait analyses on PSE symptom data of the original Manchester study and two recent Dutch studies. We used the same analytical strategy as Goldberg et al. to facilitate comparison with the earlier work. It was found that a more comprehensive set of common psychiatric symptoms caused an extra, third dimension to emerge, so that the earlier anxiety dimension became split between a specific anxiety axis characterized by situational and phobic anxiety and avoidance, and a non-specific anxiety axis characterized by free-floating anxiety, various symptoms relating to tension, irritability and restlessness. It is argued that three dimensions are sufficient to account for the covariance between common psychiatric symptoms. A fairly consistent correlation between the non-specific anxiety and the depression dimension was found across sites, as well as independence of the specific anxiety dimension from the other two dimensions. Furthermore, the depression dimension was robust with similar symptom profiles across samples, but there appeared to be local differences in the structure of anxiety symptoms.

How normal are anxiety and fear?

In practice or in research, psychiatrists should confine their work to abnormal or pathological phenomena. To distinguish normality from abnormality, psychiatrists (often implicitly) test people's behaviour against the following criteria: suffering, loss of autonomy and unreality. The positive aspects of anxiety/fear will be discussed: in how far the phenomenon induces pleasure, enhances autonomy or is justified. This approach to the reality aspect is through an ethological focus on a specific form of fear--the fear of strangers in young children. The prevalence of abnormal fear and anxiety in similar populations is shown to be dependent on the way in which (ab)normality is operationalised. A qualitative individual-oriented approach yields considerably less anxiety than a quantitative group-oriented approach. In practice a careful assessment of (ab)normality will help the psychiatrist to treat normal anxiety in an efficient and abnormal anxiety in an effective manner.

Epidemiological aspects of psychiatric disorder in a Dutch health area.

A two-phase study of psychiatric prevalence has been carried out among the inhabitants (aged 18-64) of a Dutch health area (Nijmegen). In phase 1, a random sample of 3232 persons answered the GHQ-30 (response rate: 75%). In phase 2, 486 of the respondents were interviewed with the full PSE within two weeks. The relationship of PSE-'caseness' (ID greater than or equal to 5) and GHQ score was expressed in a logistic regression model, the parameters of which showed strong agreement with the Canberra results, for all socio-demographic variables examined, except for urbanization. By means of the logistic model the point-prevalence of PSE cases was calculated at 7.3% (range 5.5%-9.2%). Prevalence did not differ significantly in men and women. Higher case rates were found in the age category of 55-59 years, among divorced and widowed persons, the lower educational and occupational levels, the unemployed, chronically ill and unable to work, and with city people. This study adds further evidence to a growing body of epidemiological data suggesting similar rates and patterns of psychiatric disorder in populations in industrialized countries.