Disseminating action-based cognitive remediation to an early psychosis network: Clinician perspectives on feasibility and implementation barriers.

AIM: Action-based cognitive remediation (ABCR) is a group cognitive remediation treatment that aims to improve neurocognitive impairments experienced in patients with severe mental illness. Developed in research settings, ABCR is not yet widely available in community settings. As such, this study examines the feasibility of implementing ABCR in community clinics in an early psychosis network. METHODS: Eighty-five allied health professionals who work within an early psychosis intervention network were trained in the provision of ABCR. They were surveyed 6-months after training to gather information regarding their experience implementing ABCR within their clinical settings (e.g., barriers, perceived helpfulness of the treatment, modifications made to the manualized treatment). Access to ongoing training supports (e.g., treatment manual, asynchronous digital communication, conference calls) was also assessed. RESULTS: Fifty-one clinicians responded to the survey. Staff time, manager support, and equipment were rated as organizational barriers. Geographic location, other responsibilities, and motivation were rated as patient barriers. Over half of the sample modified the overall dose of ABCR to offer fewer sessions and/or shorter duration of sessions than the manualized approach. Clinicians that reduced the dose of ABCR reported significantly higher barriers with manager support than staff who delivered ABCR as manualized but did not report worse patient outcomes. We found asynchronous learning opportunities (i.e., manual, online discussion forum) were perceived as the most accessible and helpful methods of ongoing training support. CONCLUSIONS: The results provide preliminary information about barriers to implementing time-intensive cognitive treatments into clinical settings and may inform future training practices to increase successful implementation of cognitive remediation treatments.

A neuropsychological approach to differentiating cannabis-induced and primary psychotic disorders.

AIM: Rates of cannabis use are elevated in early psychosis populations, rendering it difficult to determine if an episode of psychosis is related to cannabis use (e.g., cannabis-induced psychosis), or if substance use is co-occurring with a primary psychotic disorder (e.g., schizophrenia). Clinical presentations of these disorders are often indistinguishable, hindering assessment and treatment. Despite substantial research identifying cognitive deficits, eye movement abnormalities and speech impairment associated with primary psychotic disorders, these neuropsychological features have not been explored as targets for diagnostic differentiation in early psychosis. METHODS: Eighteen participants with cannabis-induced psychosis (Mage  = 21.9, SDage  = 4.25, 14 male) and 19 participants with primary psychosis (Mage  = 29.2, SDage  = 7.65, 17 male) were recruited from early intervention programs. Diagnoses were ascertained by primary treatment teams after a minimum of 6 months in the program. Participants completed tasks assessing cognitive performance, saccadic eye movements and speech. Clinical symptoms, trauma, substance use, premorbid functioning and illness insight were also assessed. RESULTS: Relative to individuals with primary psychosis, individuals with cannabis-induced psychosis demonstrated significantly better performance on the pro-saccade task, faster RT on pro- and anti-saccade tasks, better premorbid adjustment, and a higher degree of insight into their illness. There were no significant differences between groups on psychiatric symptoms, premorbid intellectual functioning, or problems related to cannabis use. CONCLUSIONS: In early stages of illness, reliance on traditional diagnostic tools or clinical interviews may be insufficient to distinguish between cannabis-induced and primary psychosis. Future research should continue to explore neuropsychological differences between these diagnoses to improve diagnostic accuracy.

Neurocognition and Depressive Symptoms have Unique Pathways to Predicting Different Domains of Functioning in Major Depressive Disorder.

BACKGROUND: Research has established the independent relationships between depressive symptoms to cognition and functioning in depression; however, little is known about the role of mediators in this relationship. We explored the role of neurocognitive abilities, depressive symptom severity, dysfunctional attitudes, and functional capacity in predicting two dimensions of daily functioning in individuals with major depressive disorder (MDD). METHODS: One hundred and twenty-four participants (mean age = 46.26, SD = 12.27; 56% female) with a diagnosis of MDD were assessed on a standard neurocognitive battery, self-reported depressive symptoms, dysfunctional attitudes, and clinician-rated functional impairment. They completed a performance-based assessment of functional competence. RESULTS: Confirmatory path analyses were used to model the independent and mediated effects of variables on two domains of functioning: social (relationships and social engagement) and productive (household and community activities). Cognition and depressive symptoms both predicted productive functioning, and dysfunctional attitudes mediated each of these relationships. Functional competence was a significant mediator in the relationship between neurocognition and productive functioning. Depressive symptoms and cognition were direct predictors of social functioning with no significant mediators. CONCLUSIONS: There are divergent pathways to different dimensions of daily functioning in MDD. Measurement implications include the consideration of multiple levels of predicting productive activities and more direct relationships with social outcomes. Treatments that directly target depressive symptoms and cognition might not generalize to improvements in everyday functioning if additional pathways to functioning are not addressed.

Self- versus informant-report of cognitive decline in mild cognitive impairment: Concordance with cognitive and functional performance.

OBJECTIVE: Debate continues regarding the use of self- versus informant-report to diagnose mild cognitive impairment (MCI) with studies reporting patients both overestimating and underestimating their abilities relative to informants. We assessed concordance of self- versus informant-report of cognitive decline with objective cognitive and functional performance in the participants of the preventing Alzheimer's dementia with cognitive remediation plus transcranial direct current stimulation in mild cognitive impairment and depression randomized controlled trial (PACt-MD). METHOD: Three hundred six participants with MCI, and their informants, reported on cognitive decline; the participants also completed a comprehensive assessment of objective cognitive and functional performance. Based on the discrepancy between self- versus informant-report of cognitive decline, we grouped participants into categories of underestimators, congruent estimators, and overestimators. RESULTS: Informant- but not self-reported cognitive decline significantly correlated with objective cognitive performance. There were 68 underestimators, 94 congruent estimators, and 144 overestimators. Underestimators had significantly lower objective cognitive performance and functional performance than congruent estimators and overestimators. Cognitive performance significantly predicted functional performance in all three groups, and the relationship between cognitive and functional performance was moderated by the discrepancy between self- and informant-report. CONCLUSIONS: We showed a poor concordance among self-report of cognitive decline and both informant-report of cognitive decline and cognitive performance in patients with MCI. Our findings highlight clinical and research value in the assessment and consideration of degree of discrepancy between self- and informant-reports of cognitive decline in MCI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).