Wisconsin Card Sorting Task-64 performance among HIV+ Black/African American and Latinx adults compared to normative samples and by sociocultural and health variables.

Many people living with HIV experience cognitive impairment, and HIV disproportionately affects racial/ethnic minority groups. Independent of HIV, racial/ethnic minority individuals perform worse than White individuals on cognitive tasks, even after accounting for education. Our goals were to (1) compare WCST-64 scores between HIV+ Black/African American (Black/AA) (n = 45) and Latinx (n = 41) urban-dwelling adults; (2) compare our total sample to the WCST-64 manual's normative (N) and clinical normative (CN) groups; and (3) explore relationships between WCST-64 performance and sociocultural/health variables. In our sample, employment (12%), mean annual income (<$10,000), and mean education (<12 years) were low, while mean medication adherence rates were high for both Black/AA (90%) and Latinx (87%). WCST-64 scores were similar between groups (p > .05). Percentages of "below average" and "mildly impaired" scores in our sample were higher than the N group, and similar to the CN group. Lifetime heroin use, dementia, and longer HIV illness duration were significantly associated with worse WCST-64 performance (ps < .05). The observed low scores in our asymptomatic sample are likely due to the intersectionality of sociocultural and medical burden, highlighting complexities in interpreting neuropsychological data in real-world HIV+ clinics. Executive deficits are linked to poorer outcomes, and routine cognitive screening may be clinically indicated.

Predicting Attention-Shaping Response in People With Schizophrenia.

ABSTRACT: People with schizophrenia often experience attentional impairments that hinder learning during psychological interventions. Attention shaping is a behavioral technique that improves attentiveness in this population. Because reinforcement learning (RL) is thought to be the mechanism by which attention shaping operates, we investigated if preshaping RL performance predicted level of response to attention shaping in people with schizophrenia. Contrary to hypotheses, a steeper attentiveness growth curve was predicted by less intact pretreatment RL ability and lower baseline attentiveness, accounting for 59% of the variance. Moreover, baseline attentiveness accounted for over 13 times more variance in response to attention shaping than did RL ability. Results suggest attention shaping is most effective for lower-functioning patients, and those high in RL ability may already be close to ceiling in terms of their response to reinforcers. Attention shaping may not be a primarily RL-driven intervention, and other mechanisms of its effects should be considered.

Relationships Between Working Alliance and Outcomes in Group Therapy for People Diagnosed with Schizophrenia.

Working alliance (WA) is an important predictor of treatment outcomes in therapy. Forming a strong WA can be challenging with people diagnosed with schizophrenia, and differences between client-rated and clinician-rated WA have been found in this population. This project examined WA in people diagnosed with schizophrenia who completed a skills training and attention shaping group intervention. Paired samples t-tests revealed differences between client and clinician ratings on the Working Alliance Inventory Short Form (WAI-S). Clinician-rated WAI-S scores were related to symptom severity, cognitive functioning, and attention during group sessions. Yet, the primary hypothesis was not supported as WAI-S scores were unrelated to clients' treatment response. Clinician-rated WAI-S was found to partially mediate the relationship between negative symptoms and overall attention. Client-rated WAI-S scores were associated with client measures of self-efficacy and mastery. Results reinforce the importance of working alliance in the treatment of those diagnosed with schizophrenia and indicate clinical and functional factors that may influence the quality of WA.

Trends in Cigar Use in the United States, 2002-2016: Diverging Trends by Race/Ethnicity.

INTRODUCTION: Although there are racial/ethnic differences in cigarette use, little is known about how non-cigarette tobacco use differs among racial/ethnic groups. This study investigated trends in cigar use from 2002 to 2016, by racial/ethnic group, in nationally representative US data. METHODS: Data were drawn from the 2002-2016 National Survey on Drug Use and Health public use data files (total analytic sample n = 630 547 including 54 060 past-month cigar users). Linear time trends of past-month cigar use were examined by racial/ethnic group (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other/Mixed Race/Ethnicity) using logistic regression models. RESULTS: In 2016, the prevalence of past-month cigar use was significantly higher among NH Black respondents than among other racial/ethnic groups (ps < .001). Cigar use was also higher among NH White respondents than among Hispanic and NH Other/Mixed Race/Ethnicity respondents. The year by racial/ethnic group interaction was significant (p < .001). Past-month cigar use decreased significantly from 2002 to 2016 among NH White and Hispanic respondents (ps = .001), whereas no change in prevalence was observed among NH Black (p = .779) and NH Other/Mixed Race/Ethnicity respondents (p = .152). Cigar use decreased for NH White men (p < .001) and did not change for NH White women (p = .884). Conversely, cigar use increased for NH Black women (p < .001) and did not change for NH Black men (p = .546). CONCLUSIONS: Cigar use remains significantly more common among NH Black individuals in the United States and is not declining among NH Black and NH Other/Mixed Race/Ethnicity individuals over time, in contrast to declines among NH White and Hispanic individuals. IMPLICATIONS: This study identified racial/ethnic differences in trends in past-month cigar use over 15 years among annual cross-sectional samples of US individuals. The highest prevalence of cigar use in 2016 was found among NH Black individuals. In addition, cigar use prevalence did not decline from 2002 to 2016 among NH Black and NH Other/Mixed Race/Ethnicity groups over time, in contrast to NH White and Hispanic groups. Further, cigar use increased over time for NH Black women. Targeted public health and clinical efforts may be needed to decrease the prevalence of cigar use, especially for NH Black individuals.

Self-Reported Visual Perceptual Abnormalities Are Strongly Associated with Core Clinical Features in Psychotic Disorders.

BACKGROUND: Past studies using the Bonn Scale for the Assessment of Basic Symptoms (hereafter, Bonn Scale) have shown that self-reported perceptual/cognitive disturbances reveal which persons have or will soon develop schizophrenia. Here, we focused specifically on the clinical value of self-reported visual perceptual abnormalities (VPAs) since they are underexplored and have been associated with suicidal ideation, negative symptoms, and objective visual dysfunction. METHOD: Using the 17 Bonn Scale vision items, we cross-sectionally investigated lifetime occurrence of VPAs in 21 first-episode psychosis and 22 chronic schizophrenia/schizoaffective disorder (SZ/SA) patients. Relationships were probed between VPAs and illness duration, symptom severity, current functioning, premorbid functioning, diagnosis, and age of onset. RESULTS: Increased VPAs were associated with: earlier age of onset; more delusions, hallucinations, bizarre behavior, and depressive symptoms; and worse premorbid social functioning, especially in the childhood and early adolescent phases. SZ/SA participants endorsed more VPAs as compared to those with schizophreniform or psychotic disorder-NOS, especially in the perception of color, bodies, faces, object movement, and double/reversed vision. The range of self-reported VPAs was strikingly similar between first-episode and chronic patients and did not depend on the type or amount of antipsychotic medication. As a comparative benchmark, lifetime occurrence of visual hallucinations did not depend on diagnosis and was linked only to poor premorbid social functioning. CONCLUSION: A brief 17-item interview derived from the Bonn Scale is strongly associated with core clinical features in schizophrenia. VPAs hold promise for clarifying diagnosis, predicting outcome, and guiding neurocognitive investigations.

Longitudinal determinants of client treatment satisfaction in an intensive first-episode psychosis treatment programme.

AIM: Previous evidence demonstrates that higher treatment satisfaction is strongly associated with improved clinical outcomes and functioning. The aim of the current study is to explore potential associations between clinical and demographic attributes, as well as changes in role, social and cognitive functioning occurring over the course of treatment, on self-reported treatment satisfaction within the context of an intensive first-episode psychosis intervention programme. METHODS: Forty-four young adults attending a first-episode psychosis treatment programme completed a battery of clinical and neuropsychological measures at intake to the programme and again after 6 months of treatment. A modified version of the Client Satisfaction Questionnaire was administered at 6 months. Baseline, 6-month and change scores across the clinical and demographic measures were examined relative to the satisfaction questionnaire to evaluate determinants of treatment satisfaction. RESULTS: Better premorbid adjustment during childhood and early adolescence was associated with higher treatment satisfaction, as did positive changes in clients' cognitive performance and their use of humour as a coping strategy. Clients' use of emotional support as a coping strategy at 6 months was also positively associated with treatment satisfaction. Although clients' social and role functioning improved significantly during the 6-month treatment window, changes in functional outcomes were not significantly associated with treatment satisfaction. CONCLUSIONS: The current study highlights the role of premorbid adjustment and changes in coping and neurocognition as factors influencing treatment satisfaction. Future research designs might be able to more specifically ascertain causal relationships between patient characteristics, treatment components, client satisfaction and clinical effects.