Body dissatisfaction, negative affect, and engagement in healthy behaviors: The conditional effect of future-self continuity.

The relationship between body dissatisfaction and negative affect is complex, with some research suggesting that this combination motivates individuals to engage in more health-related behaviors; while other studies find it increases unhealthy behavior. To bridge this gap, it may be the case that to the extent these individuals have continuity between their present and future selves, the more likely they are able to make positive health-related choices with this future self in mind. We examined individuals (n = 344; 51.74% men) aged between 18 and 72 years (M = 39.66, SD = 11.49) who endorsed high negative affect along with body dissatisfaction but either had high or low levels of future self-continuity. We found individuals experiencing body dissatisfaction and negative affect reported higher engagement in healthy behaviors only if they had a strong connection to their future self, index of moderated mediation = 0.07 (95% CI = 0.02, 0.13). These findings support targeting future-self continuity in therapeutic regimens to bolster engagement in healthy behaviors among individuals with body dissatisfaction and high negative affect.

Temporal self and reflected appraisals in euthymic and depressed individuals.

BACKGROUND: Temporal self-appraisal (TSA) theory, reflected appraisal theory, and their clinical applications have previously been explored as independent constructs. This study investigates how TSA corresponds to temporal reflected appraisal (TRA), and how the relationship between them differs in the presence of depression. METHODS: 273 adults (57 % female), recruited using Amazon Mechanical Turk, filled out a series of measures of mood and self-appraisal assessments (TSA and TRA versions of the Me/Not Me task). Repeated measures MANOVAs were used to assess between group differences. RESULTS: The TSA trajectory of depressed individuals replicated the 'V' shape found in previous research, whereas the TRA of depressed individuals did not decline from past to present. There was little difference between TSA and TRA "past" and "future" appraisals, though there was a significant difference in appraisal of the "present." Individuals with depression believe that others perceive them as doing much better currently than the way they view themselves. By contrast, euthymic individuals had no significant differences between the TSA and TRA appraisals of their present selves, indicating they think their self-perception matches how others view them. LIMITATIONS: We assessed depression using online self-reports. Cross-sectional data limits causality determination but suffices for studying mood-related self-perceptions over time. CONCLUSIONS: Temporal self-appraisal and temporal reflected appraisal have varying relationships among euthymic and depressed individuals. This more precise characterization of depressed individuals' identity can further aid clinicians in understanding the nature of identity development and treating identity disruption among depressed individuals.

Physical Activity, Sleep-related Behaviors and Severity of Symptoms in Schizophrenia.

The beneficial effects of a healthy sleep hygiene and regular physical activity have both been noted in improving psychopathology symptom severity. No study to date however, has evaluated the potential therapeutic effects of both sleep and exercise simultaneously in individuals diagnosed with schizophrenia. To examine the two variables concurrently, in the present report, patients with diagnoses of schizophrenia spectrum disorders (n = 64), were administered assessments that measured both their physical activity and sleep-related behaviors. Additionally, patients' symptom severity and cognitive and daily functioning abilities were also assessed. It was found sleep hygiene and physical activity were associated with patients' symptom severity and cognitive capacities, but not with their daily functioning abilities. Further, no interaction effects were found between sleep hygiene and physical activity. These results suggest that physical activity and sleep hygiene should be considered, independently, in their contribution to psychopathology.

Development and Validation of a Future Self-Continuity Questionnaire: A Preliminary Report.

Future self-continuity, the sense of persistence of selfhood from the present to the future, is a fundamental feature of personal identity. Decreased self-continuity between the present and future self is associated with disadvantageous behaviors and increased psychopathology. The primary aim of the series of studies reported in this article was to develop and assess the psychometric properties and validity of an instrument designed to measure present to future self-continuity, the Future Self-Continuity Questionnaire (FSCQ). Exploratory factor analysis techniques were used to select items for removal and inclusion and to develop a potential factor model. Confirmatory factor analysis techniques were then employed to demonstrate model fit across 4 independent samples of adults (N = 1,481). Data are also presented demonstrating convergent, discriminant, and nomological validity. Findings support the coherence of the FSCQ, indicating the scale has adequate test-retest reliability, concurrent and discriminant validity, and an internally consistent replicable factor structure related to the construct of future self-continuity and relevant indexes including levels of consideration of future consequences, temporal discounting, depression, hopelessness, suicidality, anhedonia, and subjective quality of life.

Temporal Self, Psychopathology, and Adaptive Functioning Deficits: An Examination of Acute Psychiatric Patients.

Individuals with psychiatric illness have difficulty remembering specific events from their personal past and imagining their future. We examined psychotic psychiatric inpatients' sense of self-continuity over time, predicting that low levels of temporal continuity would predict increased psychopathology and lower functionality. Inpatients (n = 60) were compared with healthy controls (n = 60) on a validated measure of self-continuity, psychiatric symptoms, insight, and adaptive functioning capacity. Results revealed that patients had significant difficulty perceiving their past, present, and future selves as unified over time compared with controls. Within the inpatient group, deficits in present to future self-continuity was associated with patients' severity of positive, negative, and mood symptoms, degree of insight, and adaptive capacity. It may be the case that temporal self-unity provides a context for deriving reinforcement from daily life experiences in the moment and in anticipating the future as well as a worthwhile goal for treatment exploration.

Predictors of residency status in chronically institutionalized and community dwelling schizophrenia patients.

BACKGROUND: This cross-sectional study contrasted chronically hospitalized schizophrenia (SZ) spectrum disorder inpatients to SZ community dwelling patients on measures of psychopathology, social competence, neuropsychological performance and real-world functioning in order to discern factors predictive of patients' residency status and to characterize the contrasting ends of the SZ outcome continuum. METHOD: Subjects included 26 chronic SZ patients hospitalized continuously on average for 12.8 years, and 26 SZ patients with a history of at least 18 months tenure in community placement. RESULTS: A series of multivariate analyses revealed both chronically hospitalized and community dwelling patients were similar in terms of their real world functioning abilities such as work skills, interpersonal skills, self-care skills and community engagement. Chronic SZ inpatients' manifested more severe functional competency and neurocognitive deficits relative to outpatients. Additionally, chronic inpatients were discriminated from community dwelling outpatients by their symptom severity and commitment of more socially undesirable/antisocial type behaviors. CONCLUSIONS: Factors associated with chronic institutionalization are, in part, related to commission of antisocial type behaviors, as well as poor social and neurocognitive competences, and total symptom severity rather than deficits in everyday functional abilities.

Characterization of Risk-Taking in Adults With Bipolar Spectrum Disorders.

Individuals with bipolar spectrum disorders experience higher morbidity and mortality rates relative to the general population because of increased commission of dangerous behaviors. Despite this impact, little is known about the overall rates of risk-taking behaviors in patients currently being treated for such illness. This study examined the frequency of a variety of risk-taking behaviors in 100 adults with bipolar spectrum disorders in an active outpatient psychiatric treatment. It was found that 70% of individuals assessed reported at least one risk-taking behavior over the preceding 7 days. Implications for assessment and intervention are discussed.

Temporal self appraisal and continuous identity: Associations with depression and hopelessness.

BACKGROUND: While depression is associated with decreased self-worth, less is known about how depression relates to the degree of perceived unity of the self over time (CI; continuous identity) and appraisal of past and future selves (temporal self-appraisal). In Study 1, we examined the relationship between depression severity and temporal self-appraisal. In Study 2, we examined depression and hopelessness severity as it relates to temporal self-appraisal and continuous identity. It was hypothesized that individuals with significant levels of depressed mood would report lower self appraisals of current and future selves and that hopelessness about the future would be associated with disturbances in perception of self over time (CI; continuous identity) and temporal self-appraisal. METHODS: Study 1 examined depressed mood (n=75) and non-depressed mood (n=144) individuals to determine their self-rated personal attributes for their past, present and future selves using a validated task of temporal self-appraisal. Study 2 examined an independent sample of subjects. Based on cutoff scores for clinically significant depression and hopelessness, Depressed/Hopeless (n=63) and Non-Depressed /Non-Hopeless (n=168) subjects were asked complete the validated task of temporal self-appraisal and also complete a validated task to assess their continuous identity. RESULTS: In Study 1, a significant difference was found between the depressed mood group and the non-depressed mood group in how they see themselves changing over time. The non-depressed group perceived themselves increasing in positive personal attributes from past, to present, to future self. The depressed mood group perceived themselves as deteriorating from the past to the present in terms of positive attributes about their self-identity. However, contrary to expectations, the depressed group perceived their future self as improved from their present self. Subjects' past and future selves were at a similar level and both were significantly higher than perception of their present self-worth. Study 2 replicated these findings and also found severity of depression was significantly related to lower levels of CI. Additionally, it was found that the severity of hopelessness was minimally associated with continuous identity and temporal self-appraisal ratings. CONCLUSION: These results suggests that even people with depressed mood have an instinctive grasp of the possibility to an improved future self-worth despite the negative cognitions associated with present self-worth and hopeless expectations about the future. While depressed and hopeless individuals may view the world negatively and feel hopeless about their general future, these results suggest that depressed individuals distinguish between hopelessness about future external success and future self-improvement. Despite perceiving their past and future selves to be more positive, depression severity was associated with less continuous identity. Since depressed individuals perceive a future self as a return to or a recovery of a past self, therapeutic strategies may focus on improving a sense of continuous identity with past and future selves and focusing on deriving meaning from current life difficulties to improve beyond a past self, growing to a superior future self. LIMITATIONS AND FUTURE RESEARCH: Limitations include using self-report measures of depression and hopelessness. Future studies may wish to use individuals who were diagnosed with depression to explore further how depressed people see themselves changing from the present to the future. Additionally, future studies could determine if depressed individuals who do not perceive their future self to be improved are at higher risk for adverse outcomes.

Sound-Color Associations in Psychosis-Prone Individuals.

Synesthetic-pseudosynesthetic characteristics have been hypothesized to be a schizophrenia endophenotype, a developmental feature, and/or a symptom of psychosis. Few studies to date, however, have examined whether individuals at risk for psychosis have synesthetic symptoms. We examined the relationship between hue and pitch in high psychosis prone (HP; n = 30) and low psychosis prone individuals (LP; n = 31). Synesthesia was evaluated using self-report and two performance-based tasks. Results revealed that HP subjects experienced more synesthetic experiences than the LP only on the self-report measure. These results suggest that high psychotic prone patients report unusual experiences but are no more likely to exhibit synesthesia than LP individuals. HP individuals, however, were more likely to choose shorter wavelength colors than LP individuals on performance tasks. These results are consistent with the notion that psychosis vulnerability is associated with a preference to light wavelengths associated with increasing emotional valence and negative affect.

Meningioma and psychiatric symptoms: A case report and brief review.

BACKGROUND: Atypical presentation of psychiatric symptoms can lead to a variety of misdiagnoses. Organic causes, including brain tumors, should be considered under these circumstances. METHODS: We present a case report of an 84-year-old woman with irritable, aggressive, and delusional behavior. Her earlier diagnoses included altered mental status, encephalopathy, dementia, nonspecified psychosis, and delirium with delusions. We suspected that a brain tumor could be causing her psychiatric symptoms. RESULTS: CT of the head revealed 2 calcified meningiomas, which did not require surgery. Neuropsychological testing results were consistent with frontal lesion type of cognitive and psychotic symptoms. Psychiatric symptoms improved with risperidone. A brief review of the literature is included. CONCLUSIONS: Brain imaging should be considered in cases of atypical psychiatric presentations. Past medical records and neuropsychological testing could assist in the diagnosis.

Emotional awareness and delusions in schizophrenia and schizoaffective disorder.

BACKGROUND AND OBJECTIVES: Emotion plays a significant role in schizophrenia. Emotional awareness (i.e., attention to and clarity of emotions) is associated with a wide range of outcomes. Given that individuals with schizophrenia and schizoaffective disorder differ in the significance of their mood symptoms, the present research examined whether the association between emotional awareness and delusions differs for these two groups of patients. METHODS: Emotional awareness (i.e., attention to and clarity of emotions) was measured with self-report in a sample of 44 individuals diagnosed with either schizophrenia or schizoaffective disorder. Clinical ratings of delusions were made using the Scale for the Assessment of Positive Symptoms. RESULTS: For the sample as a whole, individuals with higher levels of attention to emotion tended to have more severe delusions. In addition, diagnostic group significantly moderated the relation between emotional clarity and delusions. LIMITATIONS: Conclusions regarding causality cannot be drawn due to the cross-sectional design. Replication is particularly important given the small sample sizes. CONCLUSIONS: The present research indicates that emotional awareness is associated with delusions. The results raise the possibility that the emotional factors that contribute to delusional beliefs among individuals with schizophrenia differ in at least some ways from the emotional factors that contribute to delusional beliefs among individuals with schizoaffective disorder.

Depression and cognitive deficits in geriatric schizophrenia.

OBJECTIVE: Past reports have found patients with comorbid depression and schizophrenia spectrum disorders exhibit greater deficits in memory and attention compared to schizophrenia spectrum disorder patients without depressive symptoms. However, in contrast to younger schizophrenia patients, the few past studies using cognitive screens to examine the relationship between depression and cognition in inpatient geriatric schizophrenia have found that depressive symptomatology was associated with relatively enhanced cognitive performance. In the current study we examined the relationship between depressive symptoms and cognitive deficits in geriatric schizophrenia spectrum disorder patients (n=71; mean age=63.7) on an acute psychiatric inpatient service. METHOD: Patients completed a battery of cognitive tests assessing memory, attention and global cognition. Symptom severity was assessed via the PANSS and Calgary Depression Scale for Schizophrenia. RESULTS: Results revealed that geriatric patients' depression severity predicted enhancement of their attentional and verbal memory performance. Patients' global cognitive functioning and adaptive functioning were not associated with their depression severity. CONCLUSION: Contrary to patterns typically seen in younger patients and non-patient groups, increasing depression severity is associated with enhancement of memory and attention in geriatric schizophrenia spectrum disorder patients. Also, diverging from younger samples, depression severity was unassociated with patients adaptive and global cognitive functioning.

Analysis of the multidimensionality of hallucination-like experiences in clinical and nonclinical Spanish samples and their relation to clinical symptoms: implications for the model of continuity.

Numerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance, and clinical hallucinatory experiences. Nevertheless, these individual subcomponents have not been examined across a broad spectrum of clinically disordered and nonclinical groups. The goal of the present study was to analyze the differences and similarities in the distribution of responses to hallucination-like experience in clinical and nonclinical populations and to determine the relation of these hallucination-like experiences with various clinical symptoms. These groups included patients with schizophrenia, non-psychotic clinically disordered patients, and a group of individuals with no psychiatric diagnoses. The results revealed that hallucination-like experiences are related to various clinical symptoms across diverse groups of individuals. Regression analysis found that the Psychoticism dimension of the Symptom Check List (SCL-90-R) was the most important predictor of hallucination-like experiences. Additionally, increased auditory and visual hallucination was the only subcomponent that differentiated schizophrenic patients from other groups. This distribution of responses in the dimensions of hallucination-like experiences suggests that not all the dimensions are characteristic of people hearing voices. Vivid daydreams, intrusive thoughts, and auditory distortions and visual perceptual distortions may represent a state of general vulnerability that does not denote a specific risk for clinical hallucinations. Overall, these results support the notion that hallucination-like experiences are closer to a quasi-continuum approach and that total scores on these scales explain a state of vulnerability to general perceptual disturbance.

Structured assessment of violence risk in schizophrenia and other psychiatric disorders: a systematic review of the validity, reliability, and item content of 10 available instruments.

OBJECTIVES: To undertake a systematic review on structured violence risk assessment tools in individuals with schizophrenia. METHODS: A systematic search was conducted from 1990 to 2011 to identify violence risk assessment tools and studies examining their predictive validity. Item content of the identified instruments was analyzed, and areas under the curve (AUC) from the studies were extracted. In addition, an 11-item checklist was developed to assess the utility and psychometric properties of these tools. RESULTS: Ten risk assessment tools designed to predict community violence in psychiatric patients were identified, but only 2 studies reporting predictive validity estimates in patients with schizophrenia were found (median AUC = 0.69; interquartile range = 0.60-0.77). When inclusion criteria was broadened to include studies measuring accuracy for any diagnostic group, mixed evidence of predictive validity was found, with median AUCs ranging from 0.62 to 0.85 depending on the population. Item content included mostly clinical, sociodemographic, and criminal history factors. As only 1 tool included a neurobiological item, a structured review of brain-based and cognitive risk factors for violence was included, and 3 clusters (neurocognitive ability, neurocognitive awareness, and attitudinal cognition) were identified. CONCLUSIONS: While a number of violence risk assessment tools exist that can be used to predict the likelihood of community violence in psychiatric patients, there is currently little direct evidence for their utility in individuals with schizophrenia. In addition, there is large variation in item content between instruments, and further research is necessary to determine whether the inclusion of alternative factors could improve risk assessment.

Adaptive competence impairment and cognitive deficits in acutely ill schizophrenia patients residing in nursing homes.

OBJECTIVES: The loss of long-term inpatient psychiatric hospital beds over the years has caused schizophrenia patients of all ages to be increasingly placed in nursing home environments that were traditionally reserved for elderly patients. Consequently, many nongeriatric patients with chronic schizophrenia are now residing in nursing home settings. The objective of this article is to determine whether many of these nongeriatric patients are placed in nursing homes because of chronicity of illness and severity of impairment, or because of the limited alternative viable housing options. DESIGN: Multiple and stepwise regressions examined predictors of cognitive ability, adaptive competence, social skills and inpatient social and adaptive functioning, and clinical symptomatology. SETTING: Inpatient psychiatric unit in a general hospital. PARTICIPANTS: Fifty acutely ill geriatric and nongeriatric patients with schizophrenia who reside in nursing homes. MEASUREMENTS: Participants' clinical symptoms, cognitive ability, adaptive functioning, social skills, and inpatient social and adaptive functioning were assessed. RESULTS: Findings revealed that patients' cognitive impairment and age of admission to the nursing home, irrespective of patients' current age, were predictors of impaired adaptive competence. CONCLUSIONS: Examination of cognitive and adaptive deficits with assessment of symptom severity, independent of patients' current age, may aide in the determination of appropriate residential placements for individuals with schizophrenia.

Ethnicity and symptom expression in patients with acute schizophrenia.

Chinese patients have been largely ignored in the literature examining ethnic differences in schizophrenia. This study examined demographics and symptom profiles of Euro-, African-, Chinese-American, and Latino inpatients with schizophrenia. Chinese-American patients had fewer symptoms, hospitalizations, and least amount of education compared to other groups. Cultural and clinical implications are discussed.

Impact of traumatic and violent victimization experiences in individuals with schizophrenia and schizoaffective disorder.

Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients' symptomatology. We were also interested in determining whether SZ patients' pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients' autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients' symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.

Examination of clinical and cognitive insight in acute schizophrenia patients.

Lack of insight or awareness of illness is a hallmark feature of schizophrenic illness and has become an increasingly important area of investigation. Although clinical insight focuses on awareness of illness factors, the concept of cognitive insight focuses on the cognitive processes involved in correcting erroneous judgments and certainty about mistaken judgments. The present study was aimed at further investigating the clinical utility and the statistical coherence of the Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004) in acute schizoaffective and schizophrenia (SZ) patients. The present study examined the internal consistency of the scale, as well as its discriminative and predictive validity relative to a well-established traditional measure of clinical insight in a sample of 50 DSM-IV diagnosed SZ patients, presenting for acute inpatient treatment. The BCIS was found to be an internally consistent and a coherent measure of cognitive insight. The BCIS was unassociated with clinical insight, indicating the 2 constructs share little empirical overlap. Cognitive insight was found to be inversely associated with patients' severity of autistic preoccupation symptoms such that those individuals with more cognitive insight, exhibited fewer autistic/cognitive symptoms. Patients' clinical insight, however, was found to be inversely associated specifically with patients' severity of depression. Additionally, clinical insight was also found to be more impaired in patients residing in nursing home environments relative to their counterparts living in less restrictive settings when outside the hospital. Results are discussed in terms of the relationship between clinical and cognitive insight constructs to SZ symptom domains.