Application of 360° virtual reality videos in the assessment of paranoia in schizophrenia patients: a pilot study. / Zastosowanie wirtualnej rzeczywistosci w formie filmów 360° do oceny nasilenia paranoi u pacjentów ze schizofrenia: badanie pilotazowe.

OBJECTIVES: Virtual Reality (VR) has been widely used in psychiatry, including psychotic disorders. The main advantage of VR is its high ecological validity and controllability of the virtual environment. Our main goal was to test whether, similarly to computer-generated VR, 360-degree videos are able to elicit a state of social paranoia in prone individuals. METHODS: Sixteen schizophrenia patients and twenty-three healthy individuals were assessed using Leibowitz Social Anxiety Scale and additionally, in the patient group, the Positive and Negative Syndrome Scale (PANSS-6) and Peters Delusional Inventory (PDI) were used. The participants viewed four 360-degree videos with and without social content on a VR headset. Meanwhile, subjects' heart rate was measured continuously. After the exposure, both groups were assessed with Social State Paranoia Scale (SSPS) and asked about momentary anxiety and sense of presence. RESULTS: The schizophrenia patients reported higher momentary anxiety, although the results of SSPS did not differ significantly between groups. In the control group the heart rate decreased between first non-social and social video, whereas in the patient group it did not differ significantly. There was a significant correlation of paranoid ideation experienced on daily basis (PDI) and elicited in VR (SSPS) in the patient group. CONCLUSIONS: In conclusion, paranoid responses can be triggered in patients with schizophrenia by 360-degree videos.

The effects of mindfulness-based training in virtual reality on psychotic symptoms, mood and cognitive functioning - a pilot study. / Wplyw treningu uwaznosci w wirtualnej rzeczywistosci na objawy psychotyczne, nastrój i funkcjonowanie poznawcze ­ badanie pilotazowe.

OBJECTIVES: Virtual reality (VR) is growing in popularity in treating various psychiatric disorders, including psychotic ones. However, no studies have been published on mindfulness interventions aided by virtual reality in psychotic patients to date. METHODS: 25 patients with schizophrenia or schizoaffective disorder were assessed at three time points with 4-week intervals using the six-item Positive and Negative Syndrome Scale (PANSS-6), Quick Inventory of Depressive Symptomatology (QIDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10), and the Addenbrooke's Cognitive Examination III (ACE-III). Additionally, the intensity of seven emotions was rated using the Visual Analog Scale (VAS) before and after each training session. RESULTS: The subjects achieved a significant reduction in symptom severity after completing mindfulness training. This was reflected by the PANSS-6 total score, as well as by the subscales for negative and positive symptoms. A significant increase in cognitive functioning (ACE-III scores) was also found. No significant changes in these measures were observed when only the standard intervention was used. CONCLUSIONS: Our study indicates good feasibility of the developed mindfulness intervention in VR in schizophrenic patients. The results indicate potential benefits in terms of lessening of the symptoms and improvement in cognition.

The relationships of need for closure dimensions with psychotic-like experiences and jumping to conclusions. A study of a large cross-population sample. / Zwiazki miedzy wymiarami potrzeby domkniecia poznawczego a doswiadczeniami podobnymi do objawów psychotycznych oraz przeskokiem do konkluzji Badanie na duzej próbie populacyjnej.

OBJECTIVES: The theoretical affinity between need for closure (NFC) construct and psychotic symptomatology, especially delusionality, has been tested in various studies and brought diverse results. This study tested this relationship on a large sample from the general population using an online survey. METHODS: "Preference for Predictability","Discomfort with Ambiguity" and "Decisiveness" from an abridged NFC scale (NFCS) were used to check for associations with the symptoms of delusion-like ideations and hallucination-like experiences measured with an abridged version of Prodromal Questionnaire (PQ-16). Analyses included both linear and cluster models. Additionally, we examined the associations between jumping to conclusions (JTC) task, full abridged NFCS and psychotic-like symptoms (PLEs) in asmaller sample of individuals who had the highest scores in the online PLEs assessment. RESULTS: Our study confirmed that NFC is not a homogenous construct. It showed weak associations with psychotic-like symptoms and virtually no associations with JTC results. "Decisiveness" exhibited negative associations with the severity of PLEs. CONCLUSIONS: The NFCS should not be used as auniform measure and the clinical utility of high NFCS results as an indicatorof vulnerability to psychopathology seems questionable. However, being indecisive might be a general sign of struggling with some sort of mental problems.

The neural substrates of diminished humor comprehension in schizophrenia and its relationship with psychopathology.

Patients with schizophrenia commonly revealed difficulties in understanding humor. Previous research suggested links between impaired humor comprehension, psychopathology symptoms and cognitive deficits. In this study, we investigated the associations between neural substrates of humor processing and psychopathology and cognition in schizophrenia. We assessed 25 schizophrenia outpatients in an functional magnetic resonance imaging (fMRI) procedure and 40 in an electroencephalography (EEG) procedure. A punchline­based humor comprehension task was used in which outpatients rated stories by their comprehensibility and funniness. The symptom severity and cognition were correlated with activation within the humor processing network using fMRI and effective connectivity using an EEG­based directed transfer function (DTF) method. More severe positive and disorganization symptoms were associated with impaired humor comprehension and with altered temporo­parietal effective connectivity during humor processing. More severe excitement and emotional reactivity symptoms were associated with increased activation in the bilateral frontal and temporo­parietal regions. Moreover, schizophrenia outpatients with better cognitive functioning were more accurate in humor comprehension that was associated with increased fronto­temporo­parietal activation and effective connectivity. We found the intensity of humor processing (fMRI) in schizophrenia is related to the level of cognitive abilities and the severity of schizophrenia psychopathology that is also reflected in altered effective connectivity (EEG­DTF) in the humor processing network.

Premorbid social relationships and the course of schizophrenia in a 20-year follow-up study. / Relacje spoleczne przed wybuchem choroby a przebieg schizofrenii przez okres 20 lat.

OBJECTIVES: An important dimension indicating a growing risk of psychosis outbreak and its subsequent unfavorable course is deteriorating social functioning, especially the lack of sufficient social relationships. The aim of the study was to evaluate the association of the quality of social contacts and the scope of support system before the onset of the illness with treatment outcomes in clinical and social dimension in various time intervals of the 20-year illness course. METHODS: During the first hospitalization, an 80-person group living in Krakow and suffering from schizophrenia was selected, diagnosed according to DSM-IV-TR criteria and examined six times: at admission and discharge during first hospitalization, after 3, 7, 12 and 20 years. The analysis involved 55 persons (69% of the group included to the study) who went through all the examinations over a period of 20 years. Two-factor analysis of variance was used with one grouping factor (social contacts) and one repeated measures factor (follow-ups) for the results of GAF, BPRS, DSM-III Axis V and a series of simple linear regressions for the associations between these outcome indicators and the Surtees' Index of Social Support. RESULTS: Satisfactory, positive contacts before the outbreak of the illness translated, especially after 20 years, into better general and social functioning and fewer symptoms, especially negative ones. Awider social support before the outbreak was associated with better general and social functioning of patients and lesser severity of general, positiveand negative symptoms; however, in this last case the effect disappeared after 20 years. CONCLUSIONS: The quality and scope of social contacts before the outbreak of the illness, especially satisfactory relationship in non-familial milieu, are an important prognostic factor of amany-year beneficial clinical and social course of psychoses from the schizophrenia group.

Sheltered employment in schizophrenia is related to disorganization symptoms, processing speed and metaphor comprehension. / Zatrudnienie chronione w schizofrenii jest zwiazane z objawami dezorganizacji, szybkoscia przetwarzania i rozumieniem metafor.

OBJECTIVES: The significance of cognitive functioning deficits in schizophrenia is already well acknowledged. The relationships among lower and higher order cognitive skills and symptoms, as well as their relevance to holding a paid job are relatively less researched, though. The purpose of this study was to conduct an analysis concerning these issues. METHODS: This study included 62 individuals with schizophrenia, 33 of them employed in paid sheltered jobs and 29 attending occupational therapy. They were assessed with tests of cognitive functions including communication skills. Psychopathological symptoms were assessed with the PANSS. RESULTS: The assessed cognitive skills turned out to be interrelated as well as showed associations with positive, negative and disorganization symptoms. Furthermore, regression analysis showed that sheltered employment status is predicted by shorter reaction time, better comprehension of metaphors and lower severity of disorganization symptoms. CONCLUSIONS: Multiple associations among basic and higher cognitive skills provide support for the concept of a generalized cognitive dysfunction in schizophrenia. Beside psychopathology symptoms, both basic and higher cognitive skills are also independently predictive of professional functioning in schizophrenia. This suggests potential areas of cognitive rehabilitation that could affect employability.

Mediating role of cognitive biases, resilience and depressive symptoms in the relationship between childhood trauma and psychotic-like experiences in young adults.

OBJECTIVES: The present study aimed to test a hypothetical model where causally linked and ordered cognitive biases, resilience and depressive symptoms serve as mediators of the relationship between early traumatic life events and psychotic-like experiences (PLEs) in the general population of young adults. METHODS: Two thousand six hundred and fourteen people (1673 females) took part in the online survey. Participants completed self-report questionnaires measuring exposure to early traumatic life events, PLEs, cognitive biases, resilience and depressive symptoms. Correlation and multiple mediation analyses were performed. RESULTS: All three mediators turned out to be significantly correlated with early trauma, PLEs and with each other. Mediational analysis demonstrated that hypothesized model of causally linked mediators was significant (P ≤ .001) and accounted for 33% (P < .001) of the explained variance in PLEs in comparison to 11% (P ≤ .001) without mediators. CONCLUSIONS: First, our results provide evidence for significant associations between early traumatic life events, cognitive biases, depressive symptoms, psychological resilience and PLEs. Second, they indicate significant indirect effects of early trauma exposure on PLEs through a path consisted of cognitive biases, psychological resilience and depressive symptoms that suggest a possible importance of interventions bolstering resilience in young people in order to minimize the severity of depressive and psychotic psychopathology.

Humor perception in schizophrenia appears to be related to disorganization syndrome.

Perception of humor seems to be often disturbed in schizophrenia, yet current literature is limited and ambiguous on its relationship to psychopathology. A sample of 40 schizophrenia-diagnosed subjects provided humor comprehension and funniness ratings for 60 cartoons and 60 stories with funny, neutral and absurd punchlines. Disorganization syndrome was found to associate with deficits in humor comprehension and experienced funniness in non-humorous stimuli after controlling for cognitive performance, age, sex and medication. The findings are discussed in relation to previous studies on the topic.

Resilience and cognitive biases mediate the relationship between early exposure to traumatic life events and depressive symptoms in young adults.

BACKGROUND: Early trauma is an important risk factor for depression. However, little is known about the mechanisms of how traumatic life events shape the risk of depression. The present study focused on the mediating role of cognitive biases and mental resilience between early trauma and depressive symptoms in young men and women. METHODS: 2218 non-clinical young adults completed an online Computer Assisted Web Interview (CAWI). It comprised selected items from several questionnaires including: a short version of the Center for Epidemiological Studies-Depression (CES-D, five items) questionnaire, the Traumatic Experience Checklist (TEC, three items) and the Childhood Experience of Care and Abuse Questionnaire (CECA.Q, three items), a short version (nine items) of Davos Assessment of Cognitive Biases Scale (DACOBS-18), the abridged version of the Connor-Davidson Resilience Scale (CD-RISC-10). Parallel mediation analyses were performed. The role of gender was considered. RESULTS: A significant standardized indirect effect of childhood trauma on depressive symptoms through cognitive biases and resilience was found in the total sample. A standardized direct effect of childhood traumatic life events on depressive symptoms remained also significant, meaning that mediation is complementary. An analysis by gender showed similar results for women and men. LIMITATIONS: Sample was limited to non-clinical young adults. The questionnaires were shortened, and items were selected arbitrarily due to the nature of the study (online screening). The data may include biases resulting from the use of self-report scales. CONCLUSIONS: Cognitive biases and resilience are important, but not exclusive, mechanisms of the relationship between early trauma and depressive symptoms.

Dynamics of impaired humour processing in schizophrenia - An EEG effective connectivity study.

Specific language and communication abilities, such as humour comprehension, are commonly impaired in schizophrenia. The present study investigates the dynamics of the humour-related neural network underlying this deficit. Specifically, we focused on the abnormalities of information flow in schizophrenia within the fronto-temporo-parietal circuit. We estimated the direction and strength of cortical information flow in the time course of humour processing by the EEG Directed Transfer Function. The study included 40 schizophrenia outpatients and 40 healthy controls (age-sex-education matched) assessed with an EEG punchline-based humour comprehension task (written and cartoon jokes). The linear mixed models procedure was used to test group effects across three processes: 1. incongruity detection, 2. incongruity resolution and elaboration, 3. complete humour processing. Conjunction maps for both types of jokes were created to investigate fundamental between-group differences, beyond the context of modality. Clinical subjects indicated a lower level of understanding of the funny punchlines, indicated absurd punchlines as more understandable and gave higher funniness ratings to both absurd and neutral punchlines. The EEG effective connectivity results revealed that humour processing in schizophrenia engages alternative circuits, exhibiting a pronounced abnormal leftward shifted lateralization related to diminished activity of the right hemisphere in fronto-temporo-parietal regions. In conclusion, the present paper presents the dynamics of cortical propagation of information in the humour-related circuit as a neural substrate of humour impairment in schizophrenia.

Neural circuit of verbal humor comprehension in schizophrenia - an fMRI study.

Individuals with schizophrenia exhibit problems with understanding the figurative meaning of language. This study evaluates neural correlates of diminished humor comprehension observed in schizophrenia. The study included chronic schizophrenia (SCH) outpatients (n = 20), and sex, age and education level matched healthy controls (n = 20). The fMRI punchline based humor comprehension task consisted of 60 stories of which 20 had funny, 20 nonsensical and 20 neutral (not funny) punchlines. After the punchlines were presented, the participants were asked to indicate whether the story was comprehensible and how funny it was. Three contrasts were analyzed in both groups reflecting stages of humor processing: abstract vs neutral stories - incongruity detection; funny vs abstract - incongruity resolution and elaboration; and funny vs neutral - complete humor processing. Additionally, parametric modulation analysis was performed using both subjective ratings separately. Between-group comparisons revealed that the SCH subjects had attenuated activation in the right posterior superior temporal gyrus (BA 41) in case of irresolvable incongruity processing of nonsensical puns; in the left dorsomedial middle and superior frontal gyri (BA 8/9) in case of incongruity resolution and elaboration processing of funny puns; and in the interhemispheric dorsal anterior cingulate cortex (BA 24) in case of complete processing of funny puns. Additionally, during comprehensibility ratings the SCH group showed a suppressed activity in the left dorsomedial middle and superior frontal gyri (BA 8/9) and revealed weaker activation during funniness ratings in the left dorsal anterior cingulate cortex (BA 24). Interestingly, these differences in the SCH group were accompanied behaviorally by a protraction of time in both types of rating responses and by indicating funny punchlines less comprehensible. Summarizing, our results indicate neural substrates of humor comprehension processing impairments in schizophrenia, which is accompanied by fronto-temporal hypoactivation.

Do better communication skills promote sheltered employment in schizophrenia?

Alongside various psychopathological symptoms and neurocognitive dysfunctions, communication skill impairments may be considered core feature of schizophrenia. Although many studies examined the relation between employment status and neurocognition in schizophrenia, we still know very little about the role of communication skills in vocational status among people with schizophrenia. The purpose of this study is to identify the most characteristic communication, neurocognitive and social cognition differences which separate the employed schizophrenia outpatients from those who do not work. The study included three groups: 33 schizophrenia outpatients employed in social firms, 29 unemployed schizophrenia outpatients participating in occupational therapy and sex & age matched 31 healthy controls. We assessed communication skills, global cognitive functioning, executive functions, memory, social cognition as well as severity of psychopathology. Our results indicate that the most characteristic differences between employed and unemployed schizophrenia outpatients are associated with selective language and communication skills, i.e. paralinguistic aspects of communication, understanding of discrete meaning of linguistic context and figurative meaning of language. We find no significant differences between both clinical groups with regard to neurocognition and social cognition. Moreover, unemployed group had more severe psychopathology than the employed group, so we re-analyzed results controlling for symptom severity. The only differences that endured were related to general communication skills and explanation of pictured metaphors, but only when controlling solely for positive or negative syndrome. In conclusion, the present study indicates that employment in schizophrenia is associated with better symptomatic remission and communication skills, but not with better neurocognition and social cognition.

The predictive validity of expressed emotions (EE) in schizophrenia. A 20-year prospective study.

BACKGROUND: The level of expressed emotions in the family (EE) and components thereof (emotional over-involvement EOI, and critical comments CC) have been found to be related to treatment outcomes in psychotic patients. One point of interest is the dynamic of various outcomes in relation to initial EE, CC and EOI levels. METHOD: 43 individuals with diagnosis of schizophrenia were assessed at 1, 3, 7, 12 and 20-year follow-ups. The EE indicator was evaluated during the index hospitalization. Outcome indicators included: number of relapses, number and duration of in-patient rehospitalizations, and severity of psychopathological symptoms. RESULTS: 1) A high EE indicator was associated with a higher number of relapses in every follow-up and differences between the groups with low and high EE indicators proved significant after 3, 7, 12 and 20 years of the illness. 2) A high EE indicator was associated with a higher number of rehospitalizations after 3 and 7 years, and showed as a clear trend after 12 and 20 years. 3) A high level of CC was associated with a higher number of relapses. 4) The severity of positive symptoms increased only in the group with high CC. 5) The negative syndrome was not associated with EE, EOI or CC. CONCLUSIONS: The EE indicator may be considered a valid prolonged predictor of relapses and rehospitalizations. A high level of CC was associated with a higher number of relapses and intensification of the positive syndrome in both the short-term and long-term course of the illness.

[The effect of two predictors' interaction on short- and long-term treatment outcomes of schizophrenia]. / Wplyw interakcji dwóch predyktorów na wczesne i odlegle wyniki leczenia schizofrenii.

OBJECTIVES: To monitor the effect of interaction of duration of untreated psychosis (DUP) and expressed emotion (EE) on treatment outcomes in schizophrenia. METHODS: 56 individuals diagnosed with schizophrenia were assessed at 4 time points. The number of relapses, the number and duration of rehospitalizations and the severity of symptoms were assessed at index hospitalization and at 3, 7 and 12-year follow-ups. RESULTS: No correlation was found between DUP and EE measured at index hospitalization. Over the 12-year period the number of rehospitalizations for individuals with short DUP and low EE did not increase, as opposed to those with short DUP and with high EE. In the group with long DUP, the number of rehospitalizations increased irrespectively of EE level. The positive syndrome in the group with short DUP and high EE was less severe than in individuals with long DUP and high EE. Analogous differences appeared in the group with low EE. CONCLUSIONS: 1) No correlation was found between DUP and EE at index hospitalization. 2) Number of rehospitalizations and intensity of positive symptoms proved to be associated over time with the interaction of DUP and EE. 3) Long-time observation and multiple assessments allow to obtain more reliable results.