Mental and physical training with meditation and aerobic exercise improved mental health and well-being in teachers during the COVID-19 pandemic.

Teachers face significant stressors in relation to their work, placing them at increased risk for burnout and attrition. The COVID-19 pandemic has brought about additional challenges, resulting in an even greater burden. Thus, strategies for reducing stress that can be delivered virtually are likely to benefit this population. Mental and Physical (MAP) Training combines meditation with aerobic exercise and has resulted in positive mental and physical health outcomes in both clinical and subclinical populations. The aim of this pilot study was to evaluate the feasibility and potential effectiveness of virtual MAP Training on reducing stress and improving mood and well-being in teachers. Participants (n = 104) were from recruited online from kindergarten to grade twelve (K-12) schools in the Northeastern region of the United States and randomly assigned to a 6-week program of virtual MAP Training (n = 58) or no training (n = 13). Primary outcomes included pre-intervention and post-intervention ratings on self-report measures of social and emotional health. Changes in cognitive functioning and physical health were also examined in secondary analyses. By intervention end, participants in the MAP Training group reported less anxiety and work-related stress compared to those who received no training (ds = -0.75 to -0.78). Additionally, MAP Training participants reported improvements in depressive symptoms, rumination, work-related quality of life, perceived stress, and self-compassion (ds = 0.38 to -0.82), whereas no changes were observed in the no training group. Participants also reported increased subjective ratings of executive functioning, working memory, cognitive flexibility, and fewer sleep disturbances (ds = -0.41 to -0.74). Together, these results suggest that the combination of meditation and aerobic exercise is an effective virtual intervention for improving mental health and well-being among K-12 teachers and may enhance resilience to stressful life events such as occurred during the coronavirus pandemic.

Flash Electroretinography Parameters and Parkinson's Disease.

BACKGROUND: Parkinson's disease (PD) is known to affect retinal structure and activity. As such, retinal evaluations may be used to develop objective and possibly early PD diagnostic tools. OBJECTIVE: The aim of this study was to investigate the effects of Parkinson's disease (PD) manifestation and treatment on retinal activity. METHODS: Data were collected on 21 participants diagnosed with PD, including the number of medications taken, clinical scales and flash electroretinography (fERG) measurements, under light-adapted and dark-adapted conditions. The fERG parameters measured included a-wave and b-wave amplitude and implicit time (i.e., latency). First, we investigated correlations between symptom measure scores and the fERG parameters. Next, we divided participants into two groups based on their antiparkinsonian medication load and analyzed differences between these groups' fERG parameters. RESULTS: fERG parameters were strongly correlated with a number of clinical variables, including motor and non-motor symptoms and age at PD onset. Photoreceptor cell implicit time was longer among participants taking one or less antiparkinsonian medication as compared to those taking two or more. However, overall there was not strong evidence of a relationship between the number of antiparkinsonian medications taken and the fERG parameters. CONCLUSION: Findings suggest that fERG may be a useful, non-intrusive measure of retinal, and, perhaps overall CNS function, in PD. However, additional studies in larger samples are needed to clarify this association.

Absence of Excess Intra-Individual Variability in Retinal Function in People With Schizophrenia.

People with schizophrenia exhibit increased intra-individual variability in both behavioral and neural signatures of cognition. Examination of intra-individual variability may uncover a unique functionally relevant aspect of impairment that is not captured by typical between-group comparisons of mean or median values. We and others have observed that retinal activity measured using electroretinography (ERG) is significantly reduced in people with schizophrenia; however, it is currently unclear whether greater intra-individual variability in the retinal response can also be observed. To investigate this, we examined intra-individual variability from 25 individuals with schizophrenia and 24 healthy controls under two fERG conditions: (1) a light-adapted condition in which schizophrenia patients demonstrated reduced amplitudes; and (2) a dark-adapted condition in which the groups did not differ in amplitudes. Intraclass correlation coefficients (ICC) were generated to measure intra-individual variability for each subject, reflecting the consistency of activation values (in µv) across all sampling points (at a 2 kHz sampling rate) within all trials within a condition. Contrary to our predictions, results indicated that the schizophrenia and healthy control groups did not differ in intra-individual variability in fERG responses in either the light- or dark-adapted conditions. This finding remained consistent when variability was calculated as the standard deviation (SD) and coefficient of variation (CV) of maximum positive and negative microvolt values within the a- and b-wave time windows. This suggests that although elevated variability in schizophrenia may be observed at perceptual and cognitive levels of processing, it is not present in the earliest stages of sensory processing in vision.

Visual Impairment and Mental Health: Unmet Needs and Treatment Options.

PURPOSE: An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined. PATIENTS AND METHODS: A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted. RESULTS: Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability. CONCLUSION: In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.

Retinal functioning and reward processing in schizophrenia.

Retinal responses to light, as measured by electroretinography (ERG), have been shown to be reduced in schizophrenia. Data from a prior ERG study in healthy humans indicated that activity of a retinal cell type affected in schizophrenia can be modified by the presence of a food reward. Therefore, we aimed to determine whether ERG amplitudes would be sensitive to the well-documented reward processing impairment in schizophrenia. Flash ERG data from 15 clinically stable people with schizophrenia or schizoaffective disorder and 15 healthy controls were collected under three conditions: baseline, anticipation of a food reward, and immediately after consuming the food reward. At the group level, data indicated that controls' ERG responses varied as a function of salience of the food reward (baseline vs. anticipation vs. consumption) whereas patients' ERG responses did not vary significantly across conditions. Correlations between ERG amplitudes and scores on measures of hedonic capacity (including motivation and pleasure negative symptom ratings for patients) indicated consistent relationships. These data suggest that flash ERG amplitudes may be a sensitive indicator of the integrity of reward processing mechanisms. However, several differences in the direction of findings between this and a prior study in controls point to the need for further investigation of the contributions of a number of key variables to the observed effects.

People with current major depression resemble healthy controls on flash Electroretinogram indices associated with impairment in people with stabilized schizophrenia.

Flash electroretinography (fERG) has been used to identify anomalies in retinal functioning in several psychiatric disorders. In schizophrenia (SCZ), fERG abnormalities are reliably observed, but findings from studies of major depressive disorder (MDD) have been less consistent. In this study, fERG data were recorded from MDD patients in a current major depressive episode (n = 25), and compared to data from SCZ patients (n = 25) and healthy controls (HC; n = 25), to determine the degree to which fERG anomalies in acute MDD overlap or contrast with those observed in stabilized (though not symptom free) SCZ. The primary variables of interest were a-wave (photoreceptor activity), b-wave (bipolar-Müller cell activity), and photopic negative response (PhNR; ganglion cell activity) amplitudes and implicit times. Across most conditions, there were no significant differences between the MDD and HC groups in a- or b-wave response, but the SCZ group consistently demonstrated reduced amplitudes. Interestingly, MDD patients demonstrated an increase in photopic a-wave implicit time relative to SCZ patients, and a decrease in PhNR implicit time relative to controls. Correlations between BDI-II scores and fERG metrics were not significant for either patient group. Overall, these data indicate that, using an fERG protocol that distinguishes SCZ patients from controls, MDD patients experiencing a current depressive episode closely resemble healthy controls in their fERG responses. Therefore, MDD-related fERG changes may be more subtle than those observed in SCZ and detectable only with larger sample sizes than we employed and/or using a different set of fERG test parameters.

Schizophrenia and the retina: Towards a 2020 perspective.

BACKGROUND: Differences between people with schizophrenia and psychiatrically healthy controls have been consistently demonstrated on measures of retinal function such as electroretinography (ERG), and measures of retinal structure such as optical coherence tomography (OCT). Since our 2015 review of this literature, multiple new studies have been published using these techniques. At the same time, the accumulation of data has highlighted the "fault lines" in these fields, suggesting methodological considerations that need greater attention in future studies. METHODS: We reviewed studies of ERG and OCT in schizophrenia, as well as data from studies whose findings are relevant to interpreting these papers, such as those on effects of the following on ERG and OCT data: comorbid medical conditions that are over-represented in schizophrenia, smoking, antipsychotic medication, substance abuse, sex and gender, obesity, attention, motivation, and influences of brain activity on retinal function. RESULTS: Recent ERG and OCT studies continue to support the hypothesis of retinal structural and functional abnormalities in schizophrenia, and suggest that these are relevant to understanding broader aspects of pathophysiology, neurodevelopment, and neurodegeneration in this disorder. However, there are differences in findings which suggest that the effects of multiple variables on ERG and OCT data need further clarification. CONCLUSIONS: The retina, as the only component of the CNS that can be imaged directly in live humans, has potential to clarify important aspects of schizophrenia. With greater attention to specific methodological issues, the true potential of ERG and OCT as biomarkers for important clinical phenomena in schizophrenia should become apparent.

The Audio-Visual Abnormalities Questionnaire (AVAQ): Development and validation of a new instrument for assessing anomalies in sensory perception in schizophrenia spectrum disorders.

BACKGROUND: Anomalies in visual and auditory perception represent an important aspect of the symptomatic manifestation of schizophrenia (ScZ). However, there are currently no instruments available that allow the assessment of the full range of auditory and visual abnormalities using a self-report measure. METHODS: We developed the 85-item Audio-Visual Abnormalities Questionnaire (AVAQ) to assess abnormalities in auditory and visual processing. The AVAQ was validated in an online-sample of 355 healthy participants to establish the factorial structure, internal consistency and reliability of the instrument. In addition, participants completed the Autism-Spectrum Quotient (AQ) and the Schizotypal Personality Questionnaire (SPQ) to establish convergent validity regarding autistic and schizotypal traits. RESULTS: High internal consistency was observed for the total AVAQ-scale (α = 0.99) as well as for the visual (α = 0.98), auditory (α = 0.96) and the audio-visual subscales (α = 0.83). Principal component analyses demonstrated one factor comprising 78 items. The AVAQ was positively correlated with the SPQ (r = 0.69, p < .001) as well as the AQ (r = 0.38, p < .001). Correlations with the SPQ were highest for unusual perceptual experiences (r = 0.72, p < .001) and lowest for social anxiety (r = 0.30, p < .001). CONCLUSION: The AVAQ demonstrated excellent reliability, internal consistency and construct validity. Accordingly, the instrument could be useful for characterizing sensory dysfunctions across the schizophrenia spectrum that could guide interventions as well as aid the development of biomarkers.

Intact perception of coherent motion, dynamic rigid form, and biological motion in chronic schizophrenia.

BACKGROUND: Prior studies have documented biological motion perception deficits in schizophrenia, but it remains unclear whether the impairments arise from poor social cognition, perceptual organization, basic motion processing, or sustained attention/motivation. To address the issue, we had 24 chronic schizophrenia patients and 27 healthy controls perform three tasks: coherent motion, where subjects indicated whether a cloud of dots drifted leftward or rightward; dynamic rigid form, where subjects determined the tilt direction of a translating, point-light rectangle; and biological motion, where subjects judged whether a human point-light figure walked leftward or rightward. Task difficulty was staircase controlled and depended on the directional variability of the background dot motion. Catch trials were added to verify task attentiveness and engagement. RESULTS: Patients and controls demonstrated similar performance thresholds and near-ceiling catch trial accuracy for each task (uncorrected ps > 0.1; ds < 0.35). In all but the coherent motion task, higher IQ correlated with better performance (ps < 0.001). CONCLUSION: Schizophrenia patients have intact perception of motion coherence, dynamic rigid form, and biological motion at least for our sample and set-up. We speculate that previously documented biological motion perception deficits arose from task or stimulus differences or from group differences in IQ, attention, or motivation.

Electroretinographic anomalies in schizophrenia.

Flash electroretinography (fERG) has been used to identify anomalies in retinal cell function in schizophrenia. Several consistent findings have now emerged, but several potentially important parameters have not yet been investigated. In this study, we recorded light- (photopic) and dark-adapted (scotopic) fERG data from 25 schizophrenia patients and 25 healthy control subjects to (1) determine if past key findings on abnormal photoreceptor and bipolar cell signaling could be replicated; (2) for the first time, examine retinal ganglion cell functioning using the photopic negative response of the fERG; (3) also for the first time, determine responsiveness of schizophrenia patients to a flickering stimulus, as an additional method to isolate cone photoreceptor function; and (4) determine if schizophrenia-related changes in the fERG could be detected using a portable hand-held ERG device. In both photopic and scotopic conditions, schizophrenia patients demonstrated weakened photoreceptor and bipolar cell activations that were most pronounced in response to the most intense stimuli. A reduced cone response to a flicker stimulus and attenuation in ganglion cell activity were also observed in the schizophrenia group. In general, groups did not differ in implicit time of retinal cell responses. These findings (1) replicate and extend prior studies demonstrating reduced photoreceptor (both rod and cone) and bipolar cell functioning in schizophrenia; (2) indicate that retinal ganglion function abnormality can also be detected using fERG; and (3) indicate that these anomalies can be detected using a portable testing device, thereby opening up possibilities for more routine administration of ERG testing. (PsycINFO Database Record

Space and Objects: On the Phenomenology and Cognitive Neuroscience of Anomalous Perception in Schizophrenia (Ancillary Article to EAWE Domain 1).

BACKGROUND/AIMS: Perception of space and objects is a traditional focus within phenomenology, and disturbances in these aspects of perception among people with schizophrenia have long been discussed within phenomenological psychiatry. Despite this, there has been little empirical work on the causes and effects of most of these perceptual alterations in people with schizophrenia. Progress towards this goal can be accelerated by the use of EAWE (Examination of Anomalous World Experience), an interview-based tool to elicit, categorize, and quantify abnormal perceptual and other experiential phenomena. METHODS: In this brief paper, we review the main types of disturbances in space and object perception in schizophrenia - as described by phenomenologists, clinicians from other theoretical orientations, and experimental psychopathologists - as a first step in a research agenda to achieve a better integration of the clinical and experimental literatures. RESULTS/CONCLUSION: This review indicates that in some cases the cognitive and neurobiological mechanisms of altered space and object perception in schizophrenia are relatively well understood, while in other cases there exist only plausible hypotheses. In still other cases, however, almost nothing is known. Moreover, a fundamental hypothesis of phenomenological psychiatry - that perceptual changes are related to disturbances in the sense of self - has yet to be investigated actively. From this context, we offer suggestions for future research and suggest general research designs that may be useful for advancing progress in this area.

Screening for sub-threshold psychotic experiences and perceived need for psychological services.

AIM: Sub-threshold psychotic experiences (PEs) are common in the general population and may increase risk for psychological distress and psychosis onset, generating a need for effective community screening instruments. This study aimed to explore the utility of a brief, self-report, psychosis risk screening tool in predicting perceived need for psychological treatment among a non-clinical sample, above and beyond that accounted for by accompanying forms of psychopathology or trait neuroticism. METHODS: Construct validity, predictive validity and test-retest reliability of the brief, self-report questionnaire for screening putative prepsychotic states were determined among college students (N = 679). Multiple linear regression analyses were conducted to explore the relationship between PEs and perceived need for psychological services. RESULTS: With the exception of auditory perceptual disturbances, PEs were not significantly associated with one's need for services, or the belief from others that services are needed, after controlling for neuroticism, anxiety and depressive symptoms. Auditory perceptual disturbances were significantly associated with the perceived need for psychological services, even after accounting for these additional symptoms. CONCLUSIONS: These results confirm the usefulness of the psychosis risk screening tool in evaluating the presence of sub-threshold PEs, particularly auditory perceptual disturbances. The relationship between other PEs and a perceived need for psychological services, however, was largely explained by the existence of neurotic traits and anxiety and depressive symptoms. Screening for auditory perceptual disturbances may be useful in identifying unmet clinical need among young adults.

Computational Modeling of Contrast Sensitivity and Orientation Tuning in First-Episode and Chronic Schizophrenia.

Computational modeling is a useful method for generating hypotheses about the contributions of impaired neurobiological mechanisms, and their interactions, to psychopathology. Modeling is being increasingly used to further our understanding of schizophrenia, but to date, it has not been applied to questions regarding the common perceptual disturbances in the disorder. In this article, we model aspects of low-level visual processing and demonstrate how this can lead to testable hypotheses about both the nature of visual abnormalities in schizophrenia and the relationships between the mechanisms underlying these disturbances and psychotic symptoms. Using a model that incorporates retinal, lateral geniculate nucleus (LGN), and V1 activity, as well as gain control in the LGN, homeostatic adaptation in V1, lateral excitation and inhibition in V1, and self-organization of synaptic weights based on Hebbian learning and divisive normalization, we show that (a) prior data indicating increased contrast sensitivity for low-spatial-frequency stimuli in first-episode schizophrenia can be successfully modeled as a function of reduced retinal and LGN efferent activity, leading to overamplification at the cortical level, and (b) prior data on reduced contrast sensitivity and broadened orientation tuning in chronic schizophrenia can be successfully modeled by a combination of reduced V1 lateral inhibition and an increase in the Hebbian learning rate at V1 synapses for LGN input. These models are consistent with many current findings, and they predict several relationships that have not yet been demonstrated. They also have implications for understanding changes in brain and visual function from the first psychotic episode to the chronic stage of illness.

Duration of attenuated positive and negative symptoms in individuals at clinical high risk: Associations with risk of conversion to psychosis and functional outcome.

Research in individuals at clinical high-risk (CHR) for psychosis has focused on subjects with no more than 12 months of present or worsened attenuated positive symptoms. However, the impact of long duration attenuated positive and/or negative prodromal symptoms on outcomes is unclear. Seventy-six CHR subjects with attenuated positive symptoms and at least moderate severity level negative symptoms rated on the Scale of Prodromal Symptoms (SOPS) were prospectively followed for a mean of 3.0 ± 1.6 years. Social and Role functioning was assessed with the Global Functioning: Social and Role scales. Correlations between attenuated positive and negative symptom duration and severity and conversion to psychosis and functional outcomes were analyzed. The average onset of SOPS rated negative symptoms (M = 53.24 months, SD = 48.90, median = 37.27) was approximately twelve months prior to the emergence of attenuated positive symptom (M = 40.15 months, SD = 40.33, median = 24.77, P < 0.05). More severe positive symptoms (P = 0.004), but not longer duration of positive (P = 0.412) or negative (P = 0.754) symptoms, predicted conversion to psychosis. Neither positive symptom duration (P = 0.181) nor severity (P = 0.469) predicted role or social functioning at study endpoint. Conversely, longer negative symptom duration predicted poor social functioning (P = 0.004). Overall, our findings suggest that the severity of attenuated positive symptoms at baseline may be more important than symptom duration for determining individuals at increased risk of developing psychosis. In contrast, long-standing negative symptoms may be associated with persistent social difficulties and therefore have an important position in the treatment of disability.