Neural Indicator of Altered Mismatch Detection Predicts Atypical Cognitive-Perceptual Experiences in Psychotic Psychopathology.

BACKGROUND: Atypical auditory processing (AAP) in psychotic psychopathology is evident in early (N1), mid-latency (P2/N2/mismatch negativity), and late (P3) neural responses. The influence of attention on AAP, and how temporal stages of AAP are associated with phenomenology of psychotic psychopathology are not well understood. METHODS: We used a directed attention oddball task to characterize stages of AAP in psychosis and to examine the influence of selective attention. Ninety patients with schizophrenia (SCZ), 53 patients with bipolar disorder (BP), 90 healthy controls and 72 first-degree relatives of SCZ (SREL) were studied. We used principal components analysis to decompose average-reference 64-channel subject-level ERPs. RESULTS: Altered attentional modulation was evident in SCZ at early (N1 factor) and late (P3 factor) stages of AAP, but not at mid-latency P2 factor. Irrespective of condition, N1 and P3 were reduced in SCZ, which predicted greater psychopathology and schizotypal personality traits. Diminished mid-latency mismatch detection (P2 factor) was evident in SCZ, BP, and SREL and was associated with greater positive symptoms of psychosis as well as self-reported atypical cognitive-perceptual experiences. CONCLUSIONS: Attentional modulation of early N1, and later P3 neural responses was atypical in patients, but the degree of attentional modulation did not relate to symptom severity or schizotypal traits. Our findings suggest the link between mid-latency mismatch detection and atypical cognitive/perceptual experiences is not driven by attentional deficits alone and point to the promise of mid-latency mismatch detection as a candidate endophenotype and intervention target.

The Evolving Nexus of Sleep and Depression.

Sleep disturbances and depression are closely linked and share a bidirectional relationship. These interconnections can inform the pathophysiology underlying each condition. Insomnia is an established and modifiable risk factor for depression, the treatment of which offers the critical opportunity to prevent major depressive episodes, a paradigm-shifting model for psychiatry. Identification of occult sleep disorders may also improve outcomes in treatment-resistant depression. Sleep alterations and manipulations may additionally clarify the mechanisms that underlie rapid-acting antidepressant therapies. Both sleep disturbance and depression are heterogeneous processes, and evolving standards in psychiatric research that consider the transdiagnostic components of each are more likely to lead to translational progress at their nexus. Emerging tools to objectively quantify sleep and its disturbances in the home environment offer great potential to advance clinical care and research, but nascent technologies require further advances and validation prior to widespread application at the interface of sleep and depression.

Self-disorders and psychopathology: a systematic review.

In foundational texts on schizophrenia, the mental disorder was constitutively linked to a specific disintegration of subjectivity (often termed a self-disorder). Apart from Scharfetter's work on ego-pathology, research on self-disorders generally faded into oblivion, and self-disorders were only rediscovered as notable psychopathological features of the schizophrenia spectrum nearly two decades ago. Subsequently, the Examination of Anomalous Self-Experience (EASE) scale was constructed to allow systematic assessment of non-psychotic self-disorders. This Review is the first systematic review of empirical studies on self-disorders based on the EASE or other related scales. The results consistently show that self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders; that self-disorders are found in individuals at a clinical risk of developing psychosis; that self-disorders show a high degree of temporal stability; that self-disorders predict the later development of schizophrenia spectrum disorders; and that self-disorders correlate with the canonical dimensions of the psychopathology of schizophrenia, impaired social functioning, and suicidality. Issues with the methods of the reviewed literature are critically discussed and the role of self-disorders in clinical psychiatry and future research is outlined.

Emotional imagination of negative situations: Functional neuroimaging in anorexia and bulimia.

AIM: The present study aims to extend the knowledge of the neural correlates of emotion processing in first episode subjects affected by anorexia nervosa (AN) or bulimia nervosa (BN). We applied an emotional distress paradigm targeting negative emotions thought to be relevant for interpersonal difficulties and therapeutic resistance mechanisms. METHODS: The current study applied to 44 female participants with newly diagnosed AN or BN and 20 matched controls a neuroimaging paradigm eliciting affective responses. The measurements also included an extensive assessment comprising clinical scales, neuropsychological tests, measures of emotion processing and empathy. RESULTS: AN and BN did not differ from controls in terms of emotional response, emotion matching, self-reported empathy and cognitive performance. However, eating disorder and psychopathological clinical scores, as well as alexithymia levels, were increased in AN and BN. On a neural level, no significant group differences emerged, even when focusing on a region of interest selected a priori: the amygdala. Some interesting findings put in relation the hippocampal activity with the level of Body Dissatisfaction of the participants, the relative importance of the key nodes for the common network in the decoding of different emotions (BN = right amygdala, AN = anterior cingulate area), and the qualitative profile of the deactivations. CONCLUSIONS: Our data do not support the hypothesis that participants with AN or BN display reduced emotional responsiveness. However, peculiar characteristics in emotion processing could be associated to the three different groups. Therefore, relational difficulties in eating disorders, as well as therapeutic resistance, could be not secondary to a simple difficulty in feeling and identifying basic negative emotions in AN and BN participants.

Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program.

BACKGROUND: Aripiprazole has been linked to cases of problem gambling (PBG), but evidence supporting this association remains preliminary. Additionally, data specific to PBG in individuals with first-episode psychosis (FEP) receiving aripiprazole are limited to a few case reports, even though aripiprazole is widely used among this population that might be especially vulnerable to PBG. METHODS: To examine this association, a nested case-control study was conducted in a cohort of 219 patients followed at a FEP program located in the Quebec City, Quebec, Canada, metropolitan area. Fourteen cases meeting the PBG criteria according to the Problem Gambling Severity Index were identified and matched for gender and index date to 56 control subjects. RESULTS: In the univariable conditional logistic regression analysis, the use of aripiprazole was associated with an increased risk of PBG (odds ratio [OR] 15.2; 95% confidence interval [CI] 2.1-670.5). Cases were more likely to have a prior gambling history (either recreational or problematic) than controls at admittance in the program; they were also more frequently in a relationship and employed. After adjustment for age, relationship status, employment and Cluster B personality disorders, the use of aripiprazole remained associated with an increased risk of PBG (OR 8.6 [95% CI 1.5-227.2]). CONCLUSIONS: Findings from this study suggest that FEP patients with a gambling history, problematic or not, may be at increased risk of developing PBG when receiving aripiprazole. They also highlight the importance of systematically screening for PBG all individuals with psychotic disorders, as this comorbidity hinders recovery. While the results also add credence to a causal association between aripiprazole and PBG, further prospective studies are needed to address some of the limitations of this present study.

Effectiveness of current psychological interventions to improve emotion regulation in youth: a meta-analysis.

BACKGROUND: Research investigating the role of emotion regulation (ER) in the development and treatment of psychopathology has increased in recent years. Evidence suggests that an increased focus on ER in treatment can improve existing interventions. Most ER research has neglected young people, therefore the present meta-analysis summarizes the evidence for existing psychosocial intervention and their effectiveness to improve ER in youth. A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Twenty-one randomized-control-trials (RCTs) assessed changes in ER following a psychological intervention in youth exhibiting various psychopathological symptoms. We found moderate effect sizes for current interventions to decrease emotion dysregulation in youth (g = - 0.46) and small effect sizes to improve emotion regulation (g = 0.36). Significant differences between studies including intervention components, ER measures and populations studied resulted in large heterogeneity. This is the first meta-analysis that summarizes the effectiveness for existing interventions to improve ER in youth. The results suggest that interventions can enhance ER in youth, and that these improvements correlate with improvements in psychopathology. More RCTs including larger sample sizes, different age groups and psychopathologies are needed to increase our understanding of what works for who and when.

Risk factors for obsessive-compulsive symptoms. Follow-up of a community-based youth cohort.

Environmental factors are at least as important as genetic factors for the development of obsessive-compulsive symptoms (OCS), but the identification of such factors remain a research priority. Our study aimed to investigate the association between a broad scope of potential risk factors and OCS in a large community cohort of children and adolescents. We evaluated 1877 participants and their caregivers at baseline and after 3 years to assess various demographic, prenatal, perinatal, childhood adversity, and psychopathological factors. Mean age at baseline was 10.2 years (SD 1.9) and mean age at follow-up was 13.4 years (SD 1.9). Reports of OCS at baseline and follow-up were analyzed using latent variable models. At preliminary regression analysis, 15 parameters were significantly associated with higher OCS scores at follow-up. At subsequent regression analysis, we found that eight of these parameters remained significantly associated with higher follow-up OCS scores while being controlled by each other and by baseline OCS scores. The significant predictors of follow-up OCS were: lower socioeconomic status (p = 0.033); lower intelligence quotient (p = 0.013); lower age (p < 0.001); higher maternal stress level during pregnancy (p = 0.028); absence of breastfeeding (p = 0.017); parental baseline OCS (p = 0.038); youth baseline anxiety disorder (p = 0.023); and youth baseline OCS scores (p < 0.001). These findings may better inform clinicians and policymakers engaged in the mental health assessment and prevention in children and adolescents.

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study.

We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.

Lifetime psychopathology in child and adolescent offspring of parents diagnosed with schizophrenia or bipolar disorder: a 2-year follow-up study.

Having one parent diagnosed with a severe mental disorder is considered one of the main risk factors for developing that disorder in adulthood, and it also increases the risk of a wide range of mental disorders in the offspring. The aim of this study is to compare the prevalence of several psychopathological diagnoses, the presence of prodromal symptoms, and global functioning in offspring of parents with schizophrenia or bipolar disorder and in offspring of controls at baseline and 2-year follow-up. This study included 41 offspring of parents with schizophrenia, 90 offspring of parents with bipolar disorder, and 107 offspring of controls (mean age 11.7 ± 3.2 at baseline and 13.9 ± 3.2 at follow-up). The prevalence of psychopathology and comorbidity was higher in offspring of parents with schizophrenia and offspring of parents with bipolar disorder than in offspring of controls at baseline and at 2-year follow-up. Interestingly, mood disorders were more prevalent in offspring of parents with bipolar disorder and disruptive disorders were more prevalent in offspring of parents with schizophrenia. Prodromal symptoms were more frequent in offspring of parents with schizophrenia than in offspring of controls, while the offspring of parents with bipolar disorder showed an intermediate pattern. Finally, global functioning was lower in the offspring of parents with schizophrenia than the offspring of parents with bipolar disorder and the offspring of controls. Screening patients' children is clinically relevant, since, as a group, they have an elevated risk of developing a psychiatric disorder and of experiencing their first symptoms during childhood and adolescence.

The levels problem in psychopathology.

Psychiatric disorders are studied at multiple levels, but there is no agreement on how these levels are related to each other, or how they should be understood in the first place. In this paper, I provide an account of levels and their relationships that is suited for psychopathology, drawing from recent debates in philosophy of science. Instead of metaphysical issues, the focus is on delivering an understanding of levels that is relevant and useful for scientific practice. I also defend a pragmatic approach to the question of reduction, arguing that even in-principle reductionists should embrace pluralism in practice. Finally, I discuss the benefits and challenges in integrating explanations and models of different levels.

Stability of nightmare frequency and its relation to neuroticism: A longitudinal study.

Models of nightmare aetiology postulate an interaction between trait and state factors. However, most of the studies that support these models have been cross-sectional and longitudinal studies are scarce. The present data were obtained from N = 888 participants completing two online dream studies carried out independently with the same online panel 2 years apart. Nightmare frequency declined over the 2-year period and these changes were related to changes in neuroticism. The effect of current psychopathology (state aspect) on nightmare frequency was significant but much smaller compared to the effect of previously measured nightmare frequency (trait aspect) and, thus, the study provided empirical evidence for diathesis-stress models. Future longitudinal studies should take a closer look at life events and other factors that increase and/or decrease nightmare frequencies.

Schizotypy and psychopathic tendencies interactively improve misattribution of affect in boys with conduct problems.

Psychopathic tendencies are associated with difficulties in affective theory of mind (ToM), that is, in recognizing others affective mental states. In clinical and non-clinical adult samples, it has been shown that where psychopathic tendencies co-occur with schizophrenia spectrum disorders, the impairing effects of psychopathic tendencies on ToM are attenuated. These effects are yet to be examined in adolescents. We examined if the impairing effect of psychopathic tendencies on affective ToM was attenuated with increasing severity of schizotypal personality disorder (PD) in a sample of 80 incarcerated adolescent boys. We showed that the impairing effect of psychopathic tendencies on the recognition of neutral mental states, but not positive or negative mental states, was evident when the relative severity of schizotypal PD was low. However, with higher scores on both measures, we observed better performance in judging neutral mental states. The preservation of affective ToM in adolescents who show elevations in psychopathic tendencies and schizotypal PD may enable them to manipulate and extort their victims for personal gain. Our results emphasize the need to consider comorbidity in clinical case formulation when working with adolescents with conduct problems and psychopathic tendencies. More broadly, our results also suggest that the pattern of social cognitive abilities associated with co-occurring psychopathology does not always conform to an often-theorized double-dose of deficit hypothesis.

MicroRNA-195 predicts olanzapine response in drug-free patients with schizophrenia: A prospective cohort study.

BACKGROUND: Disturbances of microRNA-195 have been implicated in the pathogenesis of schizophrenia. However, microRNA-195 levels in schizophrenia are controversial. AIMS: To the best of our knowledge, this is the first study to examine microRNA-195 levels in untreated schizophrenia patients and their relationship to olanzapine response. METHODS: We recruited 81 untreated schizophrenia patients and 96 healthy controls. The patients received 2 months olanzapine treatment. MicroRNA-195 levels in peripheral blood mononuclear cells were measured using quantitative real-time polymerase chain reaction testing. Psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale. RESULTS: No significant differences in microRNA-195 levels were found between patients and healthy controls (p > 0.05). Olanzapine significantly reduced microRNA-195 levels after 2 months treatment (p = 0.003). Interestingly, microRNA-195 levels decreased significantly in responders (p = 0.010), but not in non-responders (p > 0.05). Both baseline microRNA-195 levels (p = 0.027, p = 0.030) and the reduction rate of microRNA-195 levels (p = 0.034, p = 0.044) were positively associated with the reduction rate of Positive and Negative Syndrome Scale total score and general psychopathological subscale score. Multiple stepwise regression analysis revealed that baseline microRNA-195 level was an independent contributor to the reduction in Positive and Negative Syndrome Scale total score and the general psychopathological subscale score (p = 0.018, p = 0.030). Finally, logistic regression analysis suggested that baseline microRNA-195 level can serve as a biomarker for response to olanzapine (p = 0.037). CONCLUSIONS: Our data indicate that microRNA-195 level may predict symptomatic improvement and olanzapine response in schizophrenia patients, suggesting that microRNA-195 should be considered as a potential therapeutic target for antipsychotics.

Creativity and Psychopathology: An Interdisciplinary View.

Since ancient philosophy, extraordinary creativity is associated with mental disorders, emotional and cognitive destabilization, and melancholia. We here summarize the results of empirical and narrative studies and analyze the most prominent case of a highly creative person who suffered from dysthymia and major depression with suicidality. Hereby, we focus on the interaction of different phases of the creative process with "bipolar" personality traits. Finally, we offer an interdisciplinary interpretation of the creative dialectics between order and chaos. The results show that severe psychopathology inhibits creativity. Mild and moderate disorders can inspire and motivate creative work but are only leading to new and useful solutions when creators succeed in transforming their emotional instability and cognitive incoherence into stable and coherent forms. The cultural idea that creativity emerges in dialectical processes between order and chaos, is also to be found in the psychologic interplay of coherence and incoherence, and in neuro-scientific models of the dynamics between tightening and loosening of neuronal structures. Consequences are drawn for the psychotherapeutic treatment of persons striving for creativity.

Exploration of Everydayness in Schizophrenia: A Phenomenological Approach.

This article explores everydayness as a specific form of experience of the world and its alterations in schizophrenia. In the field of phenomenological psychopathology, the transformations of subjective experience in schizophrenia have been the subject of a great deal of work, but the relationship between these alterations of subjective experience and the experience of the everyday remains largely unexplored. A phenomenological point of view leads us to explore everydayness as a constitutive framework of experience, one that may be impeded in schizophrenia. The question of the everyday allows us to bridge the gap between the descriptions of subjective experience proposed by phenomenological psychopathology and what is at stake in therapeutic treatment. It seems to us that the work of constructing an individual narrative of the everyday may be a useful psychotherapeutic approach for helping patients rebuild the framework of everydayness.

Eating-disorder psychopathology and driven exercise change models: A latent change score analysis.

OBJECTIVE: Approximately 50% of people with eating disorders (EDs) engage in driven exercise to influence their weight or shape and/or to compensate for loss-of-control eating. When present, driven exercise is associated with a lower quality-of-life, longer hospital stays, and faster rates-of-relapse. Despite the seriousness of driven exercise, most treatments for EDs do not target maladaptive exercise behaviors directly. Given the large proportion of patients with an ED who engage in driven exercise and its effect on treatment outcomes, it is critical to understand what predicts change in driven exercise. The purpose of this study was to test whether ED symptoms prospectively predicted change in driven exercise and vice versa. METHOD: Participants were Recovery Record (RR) users (N = 4,568; 86.8% female) seeking treatment for an ED. Participants completed the Eating Pathology Symptoms Inventory (EPSI) monthly for 3 months. RESULTS: In the full sample, dynamic bivariate latent change score analyses indicated that high levels of dietary restraint and restricting prospectively predicted reductions in driven exercise. Among persons with anorexia nervosa (AN), high levels of binge eating predicted increased driven exercise. Among persons with bulimia nervosa (BN), high levels of body dissatisfaction predicted increased driven exercise. Among persons with binge-eating disorder (BED), high levels of binge eating, purging, and restricting predicted reductions in driven exercise. DISCUSSION: Results highlight changes that may predict increased or decreased driven exercise relative to other ED symptoms for AN, BN, and BED groups. These preliminary findings could inform future research on ED treatment efforts to manage driven exercise.

Examining cognitive control and reward interactions in adolescent externalizing symptoms.

During adolescence, rapid development and reorganization of the dopaminergic system supports increasingly sophisticated reward learning and the ability to exert behavioral control. Disruptions in the ability to exert control over previously rewarded behavior may underlie some forms of adolescent psychopathology. Specifically, symptoms of externalizing psychopathology may be associated with difficulties in flexibly adapting behavior in the context of reward. However, the direct interaction of cognitive control and reward learning in adolescent psychopathology symptoms has not yet been investigated. The present study used a Research Domain Criteria framework to investigate whether behavioral and neuronal indices of inhibition to previously rewarded stimuli underlie individual differences in externalizing symptoms in N = 61 typically developing adolescents. Using a task that integrates the Monetary Incentive Delay and Go-No-Go paradigms, we observed a positive association between externalizing symptoms and activation of the left middle frontal gyrus during response inhibition to cues with a history of reward. These associations were robust to controls for internalizing symptoms and neural recruitment during inhibition of cues with no reward history. Our findings suggest that inhibitory control over stimuli with a history of reward may be a useful marker for future inquiry into the development of externalizing psychopathology in adolescence.

Early warning signals in psychopathology: what do they tell?

BACKGROUND: Despite the increasing understanding of factors that might underlie psychiatric disorders, prospectively detecting shifts from a healthy towards a symptomatic state has remained unattainable. A complex systems perspective on psychopathology implies that such symptom shifts may be foreseen by generic indicators of instability, or early warning signals (EWS). EWS include, for instance, increasing variability, covariance, and autocorrelation in momentary affective states-of which the latter was studied. The present study investigated if EWS predict (i) future worsening of symptoms as well as (ii) the type of symptoms that will develop, meaning that the association between EWS and future symptom shifts would be most pronounced for congruent affective states and psychopathological domains (e.g., feeling down and depression). METHODS: A registered general population cohort of adolescents (mean age 18 years, 36% male) provided ten daily ratings of their affective states for 6 consecutive days. The resulting time series were used to compute EWS in feeling down, listless, anxious, not relaxed, insecure, suspicious, and unwell. At baseline and 1-year follow-up, symptom severity was assessed by the Symptom Checklist-90 (SCL-90). We selected four subsamples of participants who reported an increase in one of the following SCL-90 domains: depression (N = 180), anxiety (N = 192), interpersonal sensitivity (N = 184), or somatic complaints (N = 166). RESULTS: Multilevel models showed that EWS in feeling suspicious anticipated increases in interpersonal sensitivity, as hypothesized. EWS were absent for other domains. While the association between EWS and symptom increases was restricted to the interpersonal sensitivity domain, post hoc analyses showed that symptom severity at baseline was related to heightened autocorrelations in congruent affective states for interpersonal sensitivity, depression, and anxiety. This pattern replicated in a second, independent dataset. CONCLUSIONS: The presence of EWS prior to symptom shifts may depend on the dynamics of the psychopathological domain under consideration: for depression, EWS may manifest only several weeks prior to a shift, while for interpersonal sensitivity, EWS may already occur 1 year in advance. Intensive longitudinal designs where EWS and symptoms are assessed in real-time are required in order to determine at what timescale and for what type of domain EWS are most informative of future psychopathology.

Imagination and Self Disorders in Schizophrenia: A Review.

Anomalies of imagination are frequent and handicapping in schizophrenia spectrum disorders (SSDs) but neglected in psychopathology due to the lack of a conceptual framework to model disorders of imagination. Recently, the link between minimal self disorders and pathology of imagination has been emphasized. The aim of the present article is to discuss this initiative by stressing their paradigm drawing on the recent imaginary turn in phenomenological research. Although this field of research is currently very active in philosophy, there are very few translational approaches in psychopathology or cognitive sciences. In this paper, we examine how contemporary research concerning fantasy and imagination can lead to the elaboration of an epistemological and phenomenological framework for schizophrenia research. We first examine the psychopathological literature on anomalous fantasy and imagination in SSDs. Then we propose an exhaustive overview of the imaginary turn of philosophical phenomenology. Further, we examine the theoretical and practical implications of such a recasting of phenomenological research. We show how fantasy and imagination are involved in the embodiment process, and how identity and imagination are interlinked. Finally, we propose an overview of the possible implications for the understanding of psychotherapeutic processes and recovery strategies.