A systematic review of visual processing in body dysmorphic disorder (BDD).

To understand the visual preponderance of perceived flaws in appearance in body dysmorphic disorder (BDD), the study of visual processing has been growing. Studies have focused on facial and other basic visual stimuli. The current literature does not provide evidence of consistent behavioural patterns, lacking an overarching body of work describing visual processing in BDD. This systematic review aims to characterise behavioural outcomes of visual processing anomalies and/or deficits in BDD. Articles were collected through online databases MEDLINE and PubMed, and were included if they comprised a clinical BDD group, and were published after 1990. Results indicate that individuals with BDD demonstrate deficits in emotional face processing, a possible overreliance on detail processing, aberrant eye-scanning behaviours, and a tendency to overvalue attractiveness. While findings consistently signal towards visual deficits in BDD, there is lack of clarity as to the type. This inconsistency may be attributed to heterogeneity within BDD samples and differences in experimental design (i.e., stimuli, tasks, conditions). There are difficulties distinguishing between BDD-associated deficits and those associated with OCD or eating disorders. A coherent framework, including sample characterisation and task design will seek to generate clear and consistent behavioural patterns to guide future treatments.

Cognitive remediation for schizophrenia: Clinician perspectives on implementation barriers and facilitators.

OBJECTIVES: Neurocognitive deficits in schizophrenia have a major impact on functioning; however, they remain poorly targeted by available treatment offerings. Cognitive remediation (CR) is effective in improving neurocognition and functioning. Despite clinical guidelines for schizophrenia recommending CR, it is still not readily available in clinical services and sizeable attrition rates are reported in clinical trials. METHOD: To elucidate the barriers and facilitators of CR access and engagement, we conducted a mixed methods qualitative-dominant study with 12 clinicians in Australia, in 2021, with 1 hr interviews and additional rating scales completed. RESULTS: Thematic analysis highlighted four themes (cognitive symptoms, CR intervention, motivation and engagement in CR, and CR implementation), and 14 subthemes. Clinicians emphasized the broad impact of cognitive deficits and outlined pros and cons of different CR approaches. Several factors were suggested as impacting engagement, including motivation assessments/techniques, neurocognitive insight, illness, and demographic factors. Lack of routine implementation in Australia was unanimously espoused and partly explained by a need for cost-effectiveness analyses, remote and flexible delivery, and increasing service resource provision and staff training in CR. CONCLUSIONS: This study offers key insights into CR access, while recommending methods for optimizing CR implementation and dissemination to improve recovery outcomes of people diagnosed with schizophrenia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Phenomenology of Visual and Other Nonauditory Hallucinations in Affective and Nonaffective Psychosis: A Mixed Methods Analysis.

ABSTRACT: Nonauditory hallucinations in psychosis have not received as much attention relative to voice-hearing experiences. The current paper aimed to document the characteristics of these hallucinations in affective and nonaffective psychosis. Participants were selected from a primary voice-hearing sample, who had endorsed visual, tactile, or olfactory hallucinations ( N = 55-75). A comprehensive, semistructured phenomenological interview was conducted, followed by mixed methods analysis. Visual hallucinations typically occurred daily, for a few minutes per episode, within one's direct line of sight; persons and/or animals were most commonly seen, with low controllability and mostly engendered negative affective outcomes. Tactile and olfactory hallucinations were endorsed by 46.8% and 39.0% of participants, respectively. The affective psychosis group ( n = 33) reported significantly greater awareness and lower functional impairment relative to the nonaffective psychosis group ( n = 42). Qualitative thematic analysis revealed notable themes and subthemes across each of these hallucinations modes. Further phenomenological investigations should be carried out in lesser known hallucination modalities, assisted by the development of appropriate assessment tools.

Factors Impacting Access and Engagement of Cognitive Remediation Therapy for People with Schizophrenia: A Systematic Review.

OBJECTIVES: Neurocognitive deficits are central in schizophrenia. Cognitive remediation has proven effective in alleviating these deficits, with medium effect sizes. However, sizeable attrition rates are reported, with the reasons still uncertain. Furthermore, cognitive remediation is not part of routine mental health care. We conducted a systematic review to investigate factors that influence access and engagement of cognitive remediation in schizophrenia. METHODS: We systematically searched the PubMed, Web of Science, and PsycINFO databases for peer-reviewed articles including a cognitive remediation arm, access, and engagement data, and participants with schizophrenia spectrum disorders aged 17-65 years old. Duplicates and studies without a distinct cognitive remediation component, protocol papers, single case studies, case series, and reviews/meta-analyses were excluded. RESULTS: We included 67 studies that reported data on access and engagement, and extracted quantitative and qualitative data. Access data were limited, with most interventions delivered on-site, to outpatients, and in middle- to high-income countries. We found a median dropout rate of 14.29%. Only a small number of studies explored differences between dropouts and completers (n = 5), and engagement factors (n = 13). Dropouts had higher negative symptomatology and baseline self-efficacy, and lower baseline neurocognitive functioning and intrinsic motivation compared to completers. The engagement was positively associated with intrinsic motivation, self-efficacy, perceived usefulness, educational level, premorbid intelligence quotient, baseline neurocognitive functioning, some neurocognitive outcomes, and therapeutic alliance; and negatively associated with subjective cognitive complaints. Qualitative results showed good acceptability of cognitive remediation, with some areas for improvement. CONCLUSIONS: Overall, access and engagement results are scarce and heterogeneous. Further investigations of cognitive remediation for inpatients, as well as remote delivery, are needed. Future clinical trials should systematically explore attrition and related factors. Determining influential factors of access and engagement will help improve the implementation and efficacy of cognitive remediation, and thus the recovery of people with schizophrenia.

Psychotic disorders amid the COVID-19 pandemic: a consideration of risks and impacts.

PURPOSE OF REVIEW: The COVID-19 pandemic has had a severe and widespread global impact but particularly for those with psychosis. This review summarizes recent evidence on the relationship between the COVID-19 pandemic and psychotic disorders, highlighting the risks faced by these individuals including the negative impacts on treatment services, complications from contracting COVID-19, and the acceptability of digital interventions. RECENT FINDINGS: Mortality, morbidity, and infection outcomes are among the worst for individuals with psychotic disorders. Presentation rates for psychotic disorders are elevated at emergency departments compared with before the COVID-19 pandemic; demand for inpatient services has increased, and there have been complications in access because of pandemic restrictions. COVID-19 related stressors have led to the exacerbation and incidence of psychotic symptoms among individuals with and without preexisting psychotic diagnoses. Digital interventions may be an acceptable method for maintaining patient contact and treatment during extended isolation. SUMMARY: More data is needed on the longitudinal trajectory for psychotic symptoms post-COVID-19 infection and pandemic restrictions to better support individuals with psychotic disorders. Development of a long-term pandemic management plan is needed to monitor and support psychiatric health across the population.

Examining relationships between state and trait psychotic symptoms and quality of life in schizophrenia spectrum disorders.

Positive and negative symptoms are core aspects of schizophrenia and have been shown to influence patient quality of life (QOL). Previous studies have largely focused on current or state symptoms, with limited work on the contributions of trait symptoms to QOL. This study sought to examine the relationship between both state and trait symptoms and objective and subjective QOL. Fifty-three schizophrenia spectrum disorder patients and 47 healthy controls were recruited. State symptomatology was assessed using the Positive and Negative Syndrome Scale in the patients only. In all participants, trait symptoms were assessed using the Oxford-Liverpool Inventory of Feelings and Experiences, and QOL using Lehman's QOL Interview. Hierarchical linear regression analyses, controlling for depression and neurocognition, revealed that negative state symptoms were related to objective QOL within the patients, while negative trait symptoms were associated with both objective and subjective QOL in patients and healthy controls. No relationships were observed with positive state or trait symptoms and either QOL measure. The findings suggest a degree of complexity in the associations between symptoms and QOL, with primacy for negative symptoms at both state and trait levels. A greater appreciation of trait symptoms may help explain non-complementary QOL changes following symptom remission.

Depression, perceived disability and unemployment are associated with reduced life satisfaction in anorexia nervosa.

Life satisfaction is a core aspect of an individual's wellbeing and describes the subjective assessment of their quality of life. Reduced life satisfaction is frequently reported in anorexia nervosa (AN),  but the factors contributing to this are still unclear. This study sought to extend previous work by examining 12 potential correlates of AN life satisfaction. One hundred and five female AN patients were administered questionnaires assessing life satisfaction, depression, anxiety, stress, employment status, marital status, body mass index, eating disorder symptomatology, perceived disability and readiness for change. A stepwise linear regression revealed that only depression, perceived disability and employment status were significantly associated with AN life satisfaction. The findings thus highlight prevailing mood and personal functioning as critical foci for clinical management strategies in people with AN. Addressing depressive symptoms and perceived disability while bettering employment prospects could facilitate improved AN life satisfaction.

Corrigendum to: Semantic Memory Impairment Across the Schizophrenia Continuum: A Meta-Analysis of Category Fluency Performance.

[This corrects the article DOI: 10.1093/schizbullopen/sgaa054.].

Alcohol use in Australia during the early days of the COVID-19 pandemic: Initial results from the COLLATE project.

AIM: The effects of social isolation measures used to control the spread of COVID-19 are negatively impacting the mental health of many. One of the consequences of exposure to disasters/pandemics is an increase in alcohol use. The current study aimed to examine what predisposing (distal) and pandemic-related (proximal) factors were associated with increased drinking in the wake of the COVID-19 pandemic. METHODS: On 1 April 2020, 5158 Australians completed a survey from the COvid-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project, a nationwide study aimed at tracking key mental health concerns. Using logistic regression, distal (demographics and previous drinking behaviors) and proximal (employment, lifestyle factors, and mood) factors were assessed for their association with increased drinking since the onset of the COVID-19 pandemic. RESULTS: Distal factors, including heavier drinking pre-pandemic, middle age, and average or higher income, and proximal factors, including job loss, eating more, changes to sleep as well as stress and depression, were all associated with increased drinking in the COVID-19 pandemic environment. Female sex and self-reported history of mental illness became nonsignificant after proximal measures were added to the model. Living alone, exercise, anxiety, and status as an essential or health-care worker were not associated with increased drinking. CONCLUSION: These results provide guidance as to who might be targeted to receive support based on predisposing demographic factors and pre-pandemic drinking behavior. Second, they indicate what behaviors/factors accompany increased alcohol use and provide targets for psychosocial and psychoeducational supports to address these proximal factors.

On the phenomenology of auditory verbal hallucinations in affective and non-affective psychosis.

Phenomenological comparisons of auditory verbal hallucinations (AVHs) in affective versus non-affective psychosis have not been adequately documented. The current study aimed to: a) comprehensively describe AVH phenomenology by diagnosis and mood state, b) investigate significant predictors of voice-related distress and functional impairment, and c) conduct qualitative thematic analysis of participants' experiences. Participants were diagnosed with: a) bipolar disorder (n = 31), b) major depressive disorder (n = 34), c) schizophrenia (n = 50), or d) schizoaffective disorder (n = 26). Current voice-hearers were also subdivided into prevailing mood states: a) euthymic (n = 23), b) depressed (n = 51), or c) mania-mixed (n = 12). An in-depth, semi-structured interview was conducted, accompanied by mixed-methods analyses. Of the 34 AVH characteristics, significant group differences across diagnoses were identified only for frequency, number of voices, form of address, perceived location, level of conviction, beliefs regarding origin, and functional interference. Random forests modelling (RFM) showed experienced distress and functional interference were best predicted by discrete AVH variables. Qualitative thematic analysis revealed first-order themes: a) content, b) form, c) function, and d) non-voice. There were more similarities than differences in the phenomenology of AVHs across diagnoses, yet significant predictors of voice-related distress and functional impairment differed across affective and non-affective psychosis. This has important nosological and therapeutic applications.

Characteristics of non-clinical hallucinations: A mixed-methods analysis of auditory, visual, tactile and olfactory hallucinations in a primary voice-hearing cohort.

Phenomenological studies involving hallucinations in non-clinical populations have been relatively neglected, especially within the non-auditory realm. Relevant knowledge would help further a more nuanced understanding of the psychosis continuum. Participants (N=33) were non-clinical voice-hearers, who have experienced auditory verbal hallucinations, but with no known mental health diagnosis and not taking any prescribed psychiatric medications. A comprehensive hallucinations phenomenology interview was conducted to assess physical, cognitive and emotional characteristics of hallucinatory experiences across sensory domains. Mixed methods analysis was employed. Characteristics of reported AVHs were mostly in agreement with existing knowledge, though some deviations did exist (e.g. controllability). In addition, 50%, 24% and 29% of our voice-hearing sample experienced hallucinations in the visual, tactile and olfactory domains at least once a week. In contrast, delusions and disordered thinking were rare. Qualitative thematic analysis yielded added phenomenological insights into contextual triggers as well as the content and perceived purpose(s) of multisensory hallucinations. Our findings highlight lesser-reported data that hallucinations in non-auditory domains are relatively frequent in non-clinical voice-hearers. However, other psychotic-like symptoms (i.e. delusions and thought disorder) seem less common. These insights should be considered in the context of the psychosis continuum argument.

Direct comparisons of anorexia nervosa and body dysmorphic disorder: A systematic review.

Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are serious psychiatric conditions, both of which are associated with a disturbance of body image. The aim of this paper was to review those studies that have directly compared groups of individuals with AN and BDD, to determine similarities and differences in presentation between the two conditions. The literature was searched to September 2018, and studies were included if they were English language, empirical research papers published in peer-reviewed journals, specifically comparing AN and BDD patients. Fifteen relevant studies were identified. The results suggested that individuals with AN and BDD share a number of similarities, including their degree of body dissatisfaction. Differences between the conditions included primary concerns with body shape and weight in AN, and much more diffuse concerns (but predominantly the face) in BDD. The small number of studies, along with the limited replication of results emphasises the need for greater research in this area. However, the studies undertaken to date highlight the high degree of overlap between AN and BDD and suggests that the conditions may represent similar body image disorders. This has implications for the nosological status of AN and BDD.