Attachment Dimensions predict Social Functioning in persons with Schizophrenia-Spectrum Disorders, regardless of Symptom Severity.

Attachment patterns and early-life adversities are relevant to understand the role of psychosocial factors in the vulnerability and the development of psychosis. The first aim of the study was to test whether a dimensional attachment instrument, the CAMIR (from French; Cartes: Modèles Individuels de Relation), may differentiate attachment styles by comparing a group of psychotic patients with a non-clinical sample. Also, we hypothesised that attachment dimensions would predict Social Functioning (SF) within the clinical group.

Las dimensiones del apego predicenel funcionamiento social en personascon trastornos del espectro de laesquizofrenia, independientemente dela gravedad de los síntomas / Attachment Dimensions predict Social Functioning in persons with Schizophrenia-Spectrum Disorders, regardless of Symptom Severity

Introducción: Los patrones de apego y las adversidadesen la infancia son relevantes para entender la vulnerabilidady desarrollo de la psicosis. El primer objetivo del estudio fueprobar si una medida dimensional del apego, el CAMIR, puede diferenciar los estilos de apego comparando un grupo depacientes psicóticos con una muestra no clínica. Hipotetizamos que las dimensiones del apego predecirían el Funcionamiento Social (FS) dentro del grupo clínico.Método. 79 personas fueron evaluadas con la versiónespañola reducida (CAMIR-R). El alfa de Cronbach se utilizó para probar su fiabilidad. Se realizaron pruebas t paraevaluar diferencias entre grupos. Se ejecutaron múltiples regresiones lineales y análisis de mediación para explorar losposibles predictores del FS.Resultados. Se encontró mayor apego inseguro en elgrupo clínico (73.8% versus 33.3%). Las dimensiones delapego diferenciaron ambas muestras con grandes tamaños del efecto. La psicopatología y la interferencia parental pronosticaron el FS general (R2 = 0.30; p < 0.05) y lapreocupación familiar predijo mayor aislamiento social (R2= 0.19; p = 0.02) y peor situación ocupacional (R2 = 0.45;p < 0.01). Permisividad parental y traumatismo infantilpredijeron peor nivel educativo (R2 = 0.31; p < 0.05). Losanálisis de mediación revelaron un efecto directo de lasdimensiones del apego sobre el FS, independientementede los síntomas.Conclusiones. El CAMIR-R resultó fiable para evaluar el apego en psicosis. Las personas con trastornos psicóticos muestranimportantes déficits en FS y mayor prevalencia de apego inseguro. Varias dimensiones del apego predicen áreas específicas del FS, independientemente de la gravedad de los síntomas. (AU)

Introduction: Attachment patterns and early-lifeadversities are relevant to understand the role of psychosocialfactors in the vulnerability and the development ofpsychosis. The first aim of the study was to test whethera dimensional attachment instrument, the CAMIR (fromFrench; Cartes: Modèles Individuels de Relation), maydifferentiate attachment styles by comparing a group ofpsychotic patients with a non-clinical sample. Also, wehypothesised that attachment dimensions would predictSocial Functioning (SF) within the clinical group.Methods. Seventy-nine persons were assessed by thereduced Spanish version (CAMIR-R). We used Cronbach’ alphato test reliability. A t-test was performed to assess differencesbetween groups. Multiple linear regressions and Mediationanalyses were conducted within the clinical group to exploreattachment dimensions as possible predictors of SF.Results. A more insecure attachment was found in theclinical group (73.8% versus 33.3%). Attachment dimensionsdifferentiated between both samples with large effect sizes.Psychopathology and parental interference predicted generalSF (R² = 0.30; p < 0.05) as family concern predicted moresocial isolation (R² = 0.19; p = 0.02) and worse employmentstatus (R² = 0.45; p < 0.01). Parental permissiveness and child traumatism inversely predicted educational level (R² = 0.31;p < 0.05). Mediation analyses revealed that attachmentdimensions were linked to SF regardless of symptoms.Conclusions. CAMIR-R was reliable to assess attachmentin psychosis. Persons with schizophrenia-spectrum disordersshow a significant impaired SF and a higher prevalence ofinsecure attachment. Several attachment dimensions predictspecific areas of SF, regardless of symptom severity. (AU)

Attributional Styles and Social Functioning in Schizophrenia. Is the Learned Helplessness Model Suitable? / Los estilos atribucionales y el funcionamiento social en la esquizofrenia. ¿Es adecuado el modelo de la indefensión aprendida?

We tried to verify whether the reformulated Learned Helplessness Model and its more fully articulated form, the Hopelessness Theory of Depression, were adequate to predict symptoms and social functioning (SF) in persons with schizophrenia-spectrum disorders by comparing a clinical group (n = 25) with a non-clinical one (n = 30). Bivariate correlations and multiple linear regressions were conducted to assess relationships between the Attribution Styles Questionnaire (ASQ), clinical variables, and SF within the clinical group. Differences between groups were found for most of attributional dimensions. A "pessimistic style" predicted depression within the clinical group. An unstable attribution bias predicted positive symptoms. General psychopathology and a global attribution style predicted 50% of the variance in general SF. The Learned Helplessness Model was suitable to predict depression regardless of psychotic symptoms and may be useful to predict clinical symptoms and SF in persons with schizophrenia spectrum disorders. Clinical and theoretical implications were discussed

El estudio analizó la adecuación del modelo de Indefensión Aprendida y la Teoría de la Desesperanza para predecir síntomas y funcionamiento social (FS) en personas con trastornos psicóticos comparando un grupo clínico (n = 25) con una muestra no-clínica (n = 30). Se calcularon correlaciones bivariadas y regresiones lineales para evaluar relaciones entre el cuestionario de Estilos Atribucionales (ASQ), variables clínicas y FS dentro del grupo clínico. Se encontraron diferencias para la mayoría de las dimensiones atribucionales. Un "estilo pesimista" predijo la depresión dentro del grupo clínico. Un sesgo de atribución inestable predijo los síntomas positivos. La psicopatología y un estilo de atribución global predijeron un 50% de la varianza del FS. El modelo de Indefensión Aprendida resultó adecuado para predecir la depresión independientemente de los síntomas psicóticos y fue útil prediciendo los síntomas clínicos y el FS en personas con trastornos del espectro de la esquizofrenia. Se discuten las implicaciones teóricas y clínicas

The centrality of secure attachment within an interacting network of symptoms, cognition, and attachment dimensions in persons with schizophrenia-spectrum disorders: A preliminary study.

BACKGROUND: Research in the field of psychosis broadly suggests that symptoms, neurocognitive deficits, social cognition, cognitive biases, and attachment experiences influence each other. However, little is known if any of these constructions play a more central role than others as they interact. METHOD: To clarify this issue, we conducted a "network" analysis to explore the interplay among a set of variables related to attachment, cognition domains, and psychotic symptoms in a small sample of outpatients with stabilised schizophrenia-spectrum disorders (n = 25). Eighteen participants (72%) were first-episode patients. We assessed psychotic symptoms, attachment dimensions, neurocognitive performance, "theory of mind", emotion recognition, and "jumping to conclusions" bias using standardised instruments. RESULTS: The study provides preliminary evidence about a network structure in which the secure attachment (SA) is the most central "node" within the interacting network considering all centrality measures, followed by general psychopathology. SA was closely connected to self-sufficiency (avoidant attachment) and child traumatism, as well as with neurocognition. Emotion recognition impairment was the most robust connection to positive symptoms and mediated the influence of SA on psychotic symptoms. CONCLUSIONS: Beyond the importance of symptoms, our results, although preliminary, suggest the need to assess attachment experiences and cognition domains to improve specific interventions that can promote recovery in outpatients with psychosis.

Cognición en la esquizofrenia. Estado actual de la cuestión (I): métodos de evaluación y correlatos neurales / Cognition in schizophrenia. State of the art (I): assessment methods and neural correlates

La investigación sugiere que los síntomas, la neurocognición y la cognición social se influyen mutuamente y se relacionan, a su vez, con el funcionamiento psicosocial en la esquizofrenia. La medida de los déficits neurocognitivos se ha desarrollado notablemente con el protocolo “MATRICS”. Estos déficits se han relacionado con un funcionamiento anormal de la corteza prefrontal dorsolateral y con defectos en su conectividad con otras áreas cerebrales. Por otro lado, el deterioro de la cognición social se ha vinculado al llamado “cerebro social” y se ha relacionado con los síntomas y el funcionamiento psicosocial. La atención, memoria y función ejecutiva parecen alteradas en la esquizofrenia, relacionándose con un funcionamiento anormal de estructuras cerebrales y su conectividad entre ellas. Déficits en diferentes dominios de la cognición social, vinculados al llamado “cerebro social”, se apuntan como un posible marcador endofenotípico de la esquizofrenia. No obstante, problemas tanto metodológicos como conceptuales impiden asumir estas conclusiones como definitivas

Research suggests that symptoms, neurocognition and social cognition influence each other and are related to psychosocial functioning in schizophrenia. The measurement of neurocognitive deficits in schizophrenia has been remarkably developed with the "MATRICS" protocol. In addition, these impairments have been linked to abnormal functioning of the dorsolateral prefrontal cortex and problems in its connectivity with other brain areas. On the other hand, deficits in social cognition have been linked to the so-called "social brain" and have been related to symptoms and psychosocial functioning. Attention, memory and executive function seem to be altered in schizophrenia, relating to abnormal functioning of brain structures and their connectivity between them. Impairments in different social cognitive domains, linked to the so-called "social brain", could be an endophenotypic marker of schizophrenia. However, possible methodological and conceptual issues prevent to take these conclusions as definitive

Cognición en la esquizofrenia. Estado actual de la cuestión (II): sesgos cognitivos, modelos explicativos y programas de intervención / Cognition in schizophrenia. State of the art (II): cognitive biases, explana-tory models, and intervention programs

La investigación sugiere que los síntomas, la neurocognición y la cognición social (CS) se influyen mutuamente y se relacionan a su vez con el funcionamiento psicosocial en la esquizofrenia. Tanto los déficits neurocognitivos como en CS podrían tener mayor responsabilidad que los síntomas clínicos sobre el funcionamiento social. Distintos sesgos de razonamiento cognitivo, como el “salto a conclusiones”, contribuyen a la formación y mantenimiento de los síntomas, y al funcionamiento en la vida real. La rehabilitación cognitiva ha mostrado cierta utilidad en la mejora de la cognición y del funcionamiento en las habilidades de la vida diaria de las personas con psicosis a través de sus posibles efectos sobre la neuroplasticidad cerebral. Diferentes programas, como el Entrenamiento Metacognitivo, aparecen como intervenciones prometedoras para mejorar los sesgos de razonamiento. La neurocognición, la CS y ciertos sesgos de razonamiento se interrelacionan para predecir el funcionamiento social en la esquizofrenia. Distintas intervenciones podrían mejorar estos procesos a través de sus efectos sobre la neuroplasticidad cerebral. No obstante, a pesar del creciente cuerpo de investigación, los resultados distan de ser concluyentes

Research suggests that symptoms, neurocognition and social cognition (SC) influence each other and are related to psychosocial functioning. Both neurocognitive (especially in verbal memory) and SC impairments could have greater responsibility than clinical symptoms on social functioning in schizophrenia. Different biases of cognitive reasoning, such as "jumping to conclusions", contribute both to the formation and main-tenance of symptoms and to the functioning in daily life. Cognitive rehabilitation has demonstrated its usefulness in improving cognition, symptoms, and daily life skills in people with psychosis through its effects on brain neuroplasticity. Different programs, such as Metacognitive Training (MCT), appear as promising interventions to improve the typical reasoning biases involved in psychotic disorders. Neurocognition, social cognition and certain reasoning biases interrelate to predict social functioning in schizophrenia. Different psychosocial interventions could improve these processes through their effects on brain neuroplasticity. However, despite the growing body of research, the results are far from being definitive