Temporal self and reflected appraisals in euthymic and depressed individuals.

BACKGROUND: Temporal self-appraisal (TSA) theory, reflected appraisal theory, and their clinical applications have previously been explored as independent constructs. This study investigates how TSA corresponds to temporal reflected appraisal (TRA), and how the relationship between them differs in the presence of depression. METHODS: 273 adults (57 % female), recruited using Amazon Mechanical Turk, filled out a series of measures of mood and self-appraisal assessments (TSA and TRA versions of the Me/Not Me task). Repeated measures MANOVAs were used to assess between group differences. RESULTS: The TSA trajectory of depressed individuals replicated the 'V' shape found in previous research, whereas the TRA of depressed individuals did not decline from past to present. There was little difference between TSA and TRA "past" and "future" appraisals, though there was a significant difference in appraisal of the "present." Individuals with depression believe that others perceive them as doing much better currently than the way they view themselves. By contrast, euthymic individuals had no significant differences between the TSA and TRA appraisals of their present selves, indicating they think their self-perception matches how others view them. LIMITATIONS: We assessed depression using online self-reports. Cross-sectional data limits causality determination but suffices for studying mood-related self-perceptions over time. CONCLUSIONS: Temporal self-appraisal and temporal reflected appraisal have varying relationships among euthymic and depressed individuals. This more precise characterization of depressed individuals' identity can further aid clinicians in understanding the nature of identity development and treating identity disruption among depressed individuals.

Temporal Self, Psychopathology, and Adaptive Functioning Deficits: An Examination of Acute Psychiatric Patients.

Individuals with psychiatric illness have difficulty remembering specific events from their personal past and imagining their future. We examined psychotic psychiatric inpatients' sense of self-continuity over time, predicting that low levels of temporal continuity would predict increased psychopathology and lower functionality. Inpatients (n = 60) were compared with healthy controls (n = 60) on a validated measure of self-continuity, psychiatric symptoms, insight, and adaptive functioning capacity. Results revealed that patients had significant difficulty perceiving their past, present, and future selves as unified over time compared with controls. Within the inpatient group, deficits in present to future self-continuity was associated with patients' severity of positive, negative, and mood symptoms, degree of insight, and adaptive capacity. It may be the case that temporal self-unity provides a context for deriving reinforcement from daily life experiences in the moment and in anticipating the future as well as a worthwhile goal for treatment exploration.

Predictors of residency status in chronically institutionalized and community dwelling schizophrenia patients.

BACKGROUND: This cross-sectional study contrasted chronically hospitalized schizophrenia (SZ) spectrum disorder inpatients to SZ community dwelling patients on measures of psychopathology, social competence, neuropsychological performance and real-world functioning in order to discern factors predictive of patients' residency status and to characterize the contrasting ends of the SZ outcome continuum. METHOD: Subjects included 26 chronic SZ patients hospitalized continuously on average for 12.8 years, and 26 SZ patients with a history of at least 18 months tenure in community placement. RESULTS: A series of multivariate analyses revealed both chronically hospitalized and community dwelling patients were similar in terms of their real world functioning abilities such as work skills, interpersonal skills, self-care skills and community engagement. Chronic SZ inpatients' manifested more severe functional competency and neurocognitive deficits relative to outpatients. Additionally, chronic inpatients were discriminated from community dwelling outpatients by their symptom severity and commitment of more socially undesirable/antisocial type behaviors. CONCLUSIONS: Factors associated with chronic institutionalization are, in part, related to commission of antisocial type behaviors, as well as poor social and neurocognitive competences, and total symptom severity rather than deficits in everyday functional abilities.

Emotional awareness and delusions in schizophrenia and schizoaffective disorder.

BACKGROUND AND OBJECTIVES: Emotion plays a significant role in schizophrenia. Emotional awareness (i.e., attention to and clarity of emotions) is associated with a wide range of outcomes. Given that individuals with schizophrenia and schizoaffective disorder differ in the significance of their mood symptoms, the present research examined whether the association between emotional awareness and delusions differs for these two groups of patients. METHODS: Emotional awareness (i.e., attention to and clarity of emotions) was measured with self-report in a sample of 44 individuals diagnosed with either schizophrenia or schizoaffective disorder. Clinical ratings of delusions were made using the Scale for the Assessment of Positive Symptoms. RESULTS: For the sample as a whole, individuals with higher levels of attention to emotion tended to have more severe delusions. In addition, diagnostic group significantly moderated the relation between emotional clarity and delusions. LIMITATIONS: Conclusions regarding causality cannot be drawn due to the cross-sectional design. Replication is particularly important given the small sample sizes. CONCLUSIONS: The present research indicates that emotional awareness is associated with delusions. The results raise the possibility that the emotional factors that contribute to delusional beliefs among individuals with schizophrenia differ in at least some ways from the emotional factors that contribute to delusional beliefs among individuals with schizoaffective disorder.

Depression and cognitive deficits in geriatric schizophrenia.

OBJECTIVE: Past reports have found patients with comorbid depression and schizophrenia spectrum disorders exhibit greater deficits in memory and attention compared to schizophrenia spectrum disorder patients without depressive symptoms. However, in contrast to younger schizophrenia patients, the few past studies using cognitive screens to examine the relationship between depression and cognition in inpatient geriatric schizophrenia have found that depressive symptomatology was associated with relatively enhanced cognitive performance. In the current study we examined the relationship between depressive symptoms and cognitive deficits in geriatric schizophrenia spectrum disorder patients (n=71; mean age=63.7) on an acute psychiatric inpatient service. METHOD: Patients completed a battery of cognitive tests assessing memory, attention and global cognition. Symptom severity was assessed via the PANSS and Calgary Depression Scale for Schizophrenia. RESULTS: Results revealed that geriatric patients' depression severity predicted enhancement of their attentional and verbal memory performance. Patients' global cognitive functioning and adaptive functioning were not associated with their depression severity. CONCLUSION: Contrary to patterns typically seen in younger patients and non-patient groups, increasing depression severity is associated with enhancement of memory and attention in geriatric schizophrenia spectrum disorder patients. Also, diverging from younger samples, depression severity was unassociated with patients adaptive and global cognitive functioning.

Adaptive competence impairment and cognitive deficits in acutely ill schizophrenia patients residing in nursing homes.

OBJECTIVES: The loss of long-term inpatient psychiatric hospital beds over the years has caused schizophrenia patients of all ages to be increasingly placed in nursing home environments that were traditionally reserved for elderly patients. Consequently, many nongeriatric patients with chronic schizophrenia are now residing in nursing home settings. The objective of this article is to determine whether many of these nongeriatric patients are placed in nursing homes because of chronicity of illness and severity of impairment, or because of the limited alternative viable housing options. DESIGN: Multiple and stepwise regressions examined predictors of cognitive ability, adaptive competence, social skills and inpatient social and adaptive functioning, and clinical symptomatology. SETTING: Inpatient psychiatric unit in a general hospital. PARTICIPANTS: Fifty acutely ill geriatric and nongeriatric patients with schizophrenia who reside in nursing homes. MEASUREMENTS: Participants' clinical symptoms, cognitive ability, adaptive functioning, social skills, and inpatient social and adaptive functioning were assessed. RESULTS: Findings revealed that patients' cognitive impairment and age of admission to the nursing home, irrespective of patients' current age, were predictors of impaired adaptive competence. CONCLUSIONS: Examination of cognitive and adaptive deficits with assessment of symptom severity, independent of patients' current age, may aide in the determination of appropriate residential placements for individuals with schizophrenia.

Impact of traumatic and violent victimization experiences in individuals with schizophrenia and schizoaffective disorder.

Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients' symptomatology. We were also interested in determining whether SZ patients' pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients' autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients' symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.

Examination of clinical and cognitive insight in acute schizophrenia patients.

Lack of insight or awareness of illness is a hallmark feature of schizophrenic illness and has become an increasingly important area of investigation. Although clinical insight focuses on awareness of illness factors, the concept of cognitive insight focuses on the cognitive processes involved in correcting erroneous judgments and certainty about mistaken judgments. The present study was aimed at further investigating the clinical utility and the statistical coherence of the Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004) in acute schizoaffective and schizophrenia (SZ) patients. The present study examined the internal consistency of the scale, as well as its discriminative and predictive validity relative to a well-established traditional measure of clinical insight in a sample of 50 DSM-IV diagnosed SZ patients, presenting for acute inpatient treatment. The BCIS was found to be an internally consistent and a coherent measure of cognitive insight. The BCIS was unassociated with clinical insight, indicating the 2 constructs share little empirical overlap. Cognitive insight was found to be inversely associated with patients' severity of autistic preoccupation symptoms such that those individuals with more cognitive insight, exhibited fewer autistic/cognitive symptoms. Patients' clinical insight, however, was found to be inversely associated specifically with patients' severity of depression. Additionally, clinical insight was also found to be more impaired in patients residing in nursing home environments relative to their counterparts living in less restrictive settings when outside the hospital. Results are discussed in terms of the relationship between clinical and cognitive insight constructs to SZ symptom domains.

Beliefs about voices and aggressive behavior in inpatients in an acute psychiatric setting.

OBJECTIVE: To examine the relationship between the personal beliefs that patients with auditory hallucinations have concerning their voices and the incidence of aggression toward self, others, and objects on the inpatient ward. METHOD: Forty actively hallucinating adults were recruited from the psychiatric inpatient service at Bellevue Hospital Center in New York. The beliefs that subjects had about their voices were measured using the revised Beliefs About Voices Questionnaire, and symptom severity was measured using the Positive and Negative Syndrome Scale. Frequency and severity of aggressive acts were measured retroactively over a 2-week period using the retroactive Overt Aggression Scale-Modified. The study was conducted from August 2007 to December 2007. RESULTS: Analyses revealed that hallucinators' beliefs that their voices are omnipotent, malevolent, and unable to be resisted accounted for 34% of the variance in predicting aggression on the psychiatric inpatient service. Subsequent stepwise regression analysis determined that hallucinators' belief in the omnipotence of their voices accounted for 21% of variance in predicting aggressive episodes on the inpatient service. Additionally, hallucinators with the strongest conviction in the omnipotence of their voices engaged in almost 10 times more aggressive acts on the inpatient service compared to voice hearers without these convictions. CONCLUSIONS: Individuals who believe their hallucinated voices to be all-powerful, malevolent, and irresistible are significantly more likely to engage in aggressive acts on the inpatient service. Examining the beliefs that an individual has about his/her voices may be a useful addition to current aggression risk batteries utilized on acute psychiatric inpatients.

Effects of Δ-THC on Working Memory: Implications for Schizophrenia?

This article reviews the literature on the acute effects of Delta 9-tetrahydrocannabinol, the primary psychoactive component of marijuana, on working memory, and the implications for schizophrenia. Working memory deficits are a hallmark feature of schizophrenia, and have been implicated as an etiologic mechanism contributing to the onset of the disorder. Regular marijuana smokers may also exhibit subtle working memory impairment relative to healthy controls, and an association between marijuana abuse and subsequent development of schizophrenia, though controversial, has been reported in the literature. The causal role that marijuana plays in working memory impairment related to schizophrenia, however, remains unclear. Thus, this article specifically considers the acute effects of marijuana on working memory performance. The ecologic relevance and clinical significance of these findings will be examined, and directions for future research will be recommended.

Predictors of aggression on the psychiatric inpatient service: self-esteem, narcissism, and theory of mind deficits.

Aggressive behavior committed by inpatients has significant negative effects on patients, clinical staff, the therapeutic milieu, and inpatient community as whole. Past research examining nonpsychiatric patient groups has suggested that elevated self-esteem and narcissism levels as well as self-serving theory of mind (ToM) biases may be robust predictors of aggressive behavior. In the present study, we examined whether these constructs were useful in predicting aggressive acts committed by psychiatric inpatients. Severity of psychiatric symptoms, demographic variables and patients' anger, and hostility severity were also examined. We found patients who committed acts of aggression were differentiated from their nonaggressive counterparts by exhibiting significantly higher levels of self-esteem and narcissistic superiority. In addition, aggressors demonstrated self-serving ToM biases, attributing more positive attributes to themselves, relative to their perceptions of how others viewed them. Aggressors also showed increased psychosis, fewer depressive symptoms, and had significantly fewer years of formal education than their nonaggressive peers. These results support and extend the view that in addition to clinical variables, specific personality traits and self-serving attributions are linked to aggressive behavior in acutely ill psychiatric patients.

Neurocognition, symptomatology, and functional skills in older alcohol-abusing schizophrenia patients.

Deficits in neurocognitive functioning are common to both schizophrenia and alcoholism. Recent studies suggest that neurocognitive functioning is the most significant predictor of social-adaptive functioning in schizophrenia. Cognitive impairment induced by alcoholism may result in more impaired functional outcome for comorbid patients. Past research examining alcohol-abusing schizophrenia patients has not examined correlates with functional outcome and has generally been limited to relatively younger patients. This study examined neurocognitive functioning and its correlates in alcohol-abusing schizophrenia patients between the ages of 40 and 80. Outpatients with schizophrenia (SZ; n = 17) or both schizophrenia and alcohol abuse or dependence (SZ + ETOH; n = 18) were tested on a neurocognitive battery, rated for symptomatology, and assessed for functional abilities. The results suggest that alcohol abuse in schizophrenia is associated with more impaired functioning across many domains, including memory impairment, negative and general psychopathology symptoms, and adaptive functions. The only significant predictor of impaired functional status in the overall sample and the SZ + ETOH group was neurocognitive functioning.

Predictors of aggression on the psychiatric inpatient service.

Patients with severe mental illness are at increased risk to commit acts of aggression in the inpatient hospital setting. Aggressive behaviors have severe negative consequences for the patient, victims, clinical staff, and the therapeutic community as a whole. While risk factors of community and inpatient aggression overlap, many predictive factors diverge between the two settings. For example, while medication noncompliance has been a robust predictor of community aggression, this factor has little predictive value for inpatient settings where patients' pharmacotherapy is closely monitored. Relatively fewer investigators have examined a wide range of predictive factors associated with aggressive acts committed on the psychiatry inpatient service, often with conflicting results. The present study examined demographic, clinical, and neurocognitive performance predictors of self, other, object, and verbal aggressiveness in 118 acute inpatients. Results revealed that the arrival status at the hospital (voluntary vs involuntary), female gender, and substance abuse diagnosis were predictors of verbal aggression and aggression against others. Impaired memory functioning also predicted object aggression. Fewer symptoms, combined with higher cognition functioning, however, were significant predictors of self-aggressive acts committed on the inpatient service. The need for relating predictors of specific types of aggressiveness in schizophrenia is discussed.

Cocaine craving and attentional bias in cocaine-dependent schizophrenic patients.

Cocaine craving has been implicated as a major factor underlying addiction and drug relapse. From a cognitive viewpoint, craving may reflect, in part, attentional processing biased in favor of drug-related cues and stimuli. Schizophrenic individuals (SZ), however, abuse cocaine in high numbers but typically manifest baseline cognitive deficits that impair their ability to selectively allocate their attentional resources. In this study, we examined the relationship between attentional bias and craving in patients with cocaine dependence (COC; n=20), schizophrenic patients comorbid for cocaine dependence (COC+SZ; n=23), as well as two other comparison groups using a modified version of the Stroop test to include cocaine-relevant words. Results revealed that only the COC patients demonstrated Stroop interference on the cocaine-related words. Moreover, COC patients' attentional processing biases were significantly associated with their cocaine craving severity ratings. COC+SZ patients, in contrast, did not demonstrate Stroop interference and manifested significantly fewer craving symptoms than their COC counterparts. These results suggest that COC+SZ patients' inability to selectively encode their drug-use experience may limit and shape their subjective experience of craving cocaine and motivation for cocaine use.

Interpersonal attributional biases in hallucinatory-prone individuals.

Research in the area of auditory hallucinations has found that the occurrence of a hallucinatory experience is mediated, in part, by a bias towards making an external attribution for private events and experiences. The current study examined whether external attributional biases in hallucinators extend to their interpretation of social-cognitive interpersonal events. University students scoring high and low on the Launay-Slade Hallucination Scale (LSHS) were compared on self-report measures of locus-of-control (LOC) orientation, psychosis proneness and on the Phares [Journal of Abnormal and Social Psychology 54 (1957) 339-342] "betting task" designed to encourage internal locus-of-control attributions. We predicted that high LSHS scorers would be less susceptible to a reinforcement paradigm designed to encourage internal locus-of-control judgments compared to low LSHS scorers. Consistent with our hypothesis, results revealed that hallucinatory predisposed individuals were less likely to show increased success expectancy following reinforcement and to decrease success expectancy following failure than were non-hallucinatory predisposed subjects. These findings suggest that hallucinatory-prone individuals not only make external attributions for private events and experiences, but are more likely to make external attributions to social-interpersonal events as well. We also found that subjects' severity of hallucinatory predisposition was significantly associated with their Chapman Magical Ideation and Perceptual Aberration scale scores. These results are consistent with past studies that suggest that hallucinatory subjects are more vulnerable to suggestion and support the notion that external loci of control over interpersonal experiences are associated with increased psychosis vulnerability.