Exploring the cognitive profiles related to unimodal auditory versus multisensory hallucinations in schizophrenia-spectrum disorders.

INTRODUCTION: Hallucinations can be experienced across multiple sensory modalities, but psychiatric studies investigating the cognitive mechanisms of hallucinations have been somewhat restricted to the auditory domain. This study explored the cognitive profiles of individuals experiencing multisensory hallucinations (MH) in schizophrenia-spectrum disorders (SSD) and compared these to those experiencing unimodal auditory hallucinations (AH) or no hallucinations (NH). METHODS: Participants included SSD patients (n = 119) stratified by current hallucination status (NH, AH, MH) and nonclinical controls (NCs; n = 113). Group performance was compared across several cognitive domains: speed of processing, attention, working memory, verbal learning, visual learning, reasoning and problem-solving, social cognition, and inhibition. RESULTS: The clinical groups performed worse than NCs but differences between the clinical groups were not evident across most cognitive domains. Exploratory analyses revealed that the MH group was more impaired on the visual learning task compared to the NH (but not AH) group. CONCLUSIONS: Preliminary results suggest that impaired visual learning may be related to MH. This could be attributed to the presence of visual hallucinations (VH), or greater psychopathology, in this group. However, replication is needed, as well as the investigation of other potential cognitive mechanisms of MH.

Evidence for the factor structure of formal thought disorder: A systematic review.

Disorganised speech, or, formal thought disorder (FTD), is considered one of the core features of psychosis, yet its factor structure remains debated. This systematic review aimed to identify the core dimensions of FTD. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), a systematic review was conducted on the FTD factor analytic literature. Sixteen studies were identified from PsycINFO, PubMed and Web of Science between October 1971 and January 2023. Across the 39 factor analyses investigated, findings demonstrated the prominence of a three-factor structure. Broad agreement was found for two factors within the three-factor model, which were typically referred to as disorganisation and negative, with the exact nature of the third dimension requiring further clarification. The quality assessment revealed some methodological challenges relating to the assessment of FTD and conducted factor analyses. Future research should clarify the exact nature of the third dimension across different patient groups and methodologies to determine whether a consistent transdiagnostic concept of FTD can be elucidated.

A detailed examination of pitch discrimination deficits associated with auditory verbal hallucinations in schizophrenia.

Individuals with schizophrenia spectrum disorders (SSD) and a history of experiencing auditory verbal hallucinations (AVH) exhibit poor pitch discrimination relative to those with an SSD but no AVH history. The present study extended this research, asking if a lifetime history, and the current presence, of AVH exacerbated the pitch discrimination challenges that are seen in SSD. Participants completed a pitch discrimination task, where the tones presented differed in pitch by either 2 %, 5 %, 10 %, 25 % or 50 %. Pitch discrimination accuracy, sensitivity, reaction time (RT) and intra-individual RT variability (IIV) were examined in individuals with SSD and AVHs (AVH+; n = 46), or without AVHs (AVH-; n = 31), and healthy controls (HC; n = 131). Secondary analyses split the AVH+ group into state (i.e., actively experiencing AVH; n = 32) and trait hallucinators (i.e., a history of, but not actively experiencing, AVH; n = 16). Relative to HC, significantly poorer accuracy and sensitivity was detected in individuals with SSD at 2 % and 5 % pitch deviants, and in hallucinators at 10 %; however, no significant differences in accuracy, sensitivity, RT nor IIV were found between AVH+ and AVH- groups. No differences between state and trait hallucinators were observed. A general SSD deficit drove the current findings. The findings may inform future research into the auditory processing capabilities of AVH+ individuals.

Language and Psychosis: Tightening the Association.

This special issue of DISCOURSE in Psychosis focuses on the role of language in psychosis, including the relationships between formal thought disorder and conceptual disorganization, with speech and language markers and the neural mechanisms underlying these features in psychosis. It also covers the application of computational techniques in the study of language in psychosis, as well as the potential for using speech and language data for digital phenotyping in psychiatry.

Comparing the impact of high versus low lockdown severity on the mental health of young people in Australia during the COVID-19 pandemic.

Young Australians have been differentially affected by lockdowns and social restrictions during the COVID-19 pandemic. This study compared the mental health impacts of the COVID-19 pandemic and associated restrictions for young people in two Australian states, Victoria and Queensland, with Victoria experiencing more days in lockdown and greater infection rates. An online survey was completed between 01/04/2021 and 31/07/2021 by 687 young people, aged 16 to 24 years; 337 from Victoria and 350 from Queensland. Levels of negative emotion feelings (as measured by the Depression Anxiety Stress Scale), and COVID-19 risk factors for negative emotions (such as financial hardship, education disruption, loneliness and household conflict), as well as protective factors (resilience and self-esteem) were compared between the Victorian and Queensland samples, also considering some early pandemic data and pre-pandemic norms. No significant differences in negative emotions were found between young people living in the two states, despite substantial differences in pandemic restrictions. The results indicated that young people in Queensland and Victoria had experienced similarly high levels of negative emotions, at levels also seen at the start of the pandemic in Victoria. This is of grave concern, requiring urgent attention as the pandemic continues.

Depressive symptoms are specifically related to speech pauses in schizophrenia spectrum disorders.

Depression is a common and debilitating mental illness associated with sadness and negativity and is often comorbid with other psychiatric conditions, such as schizophrenia. Depressive symptoms are presently primarily assessed through clinical interviews, however there are other behavioural indicators being investigated as more objective methods of depressive symptom assessment. The present study aimed to evaluate the utility of assessing depression using quantitative speech parameters by comparing speech between 23 schizophrenia/schizoaffective patients with clinically significant depressive symptoms (DP) 19 schizophrenia/schizoaffective patients without depressive symptoms (NDP) and 22 healthy controls with no psychiatric history (HC). Participant audio recordings were transcribed and analyzed to extract five types of speech variables: utterances, words, speaking rate, formulation errors and pauses. The results indicated that DP patients produced significantly more pauses within utterances, and had more utterances with pauses compared to NDP patients and HCs (p = <.05), who performed similarly to each other. Word, speaking rate and formulation errors variables were not significantly different between the patient groups (p > .05). The findings suggest that depressive symptoms may have a specific relationship to speech pauses, and support the potential future use of speech pause assessments as an alternative and objective depression rating and monitoring tool.

The relationship between cognitive clusters and telomere length in bipolar-schizophrenia spectrum disorders.

BACKGROUND: Schizophrenia and bipolar disorder are complex mental illnesses that are associated with cognitive deficits. There is considerable cognitive heterogeneity that exists within both disorders. Studies that cluster schizophrenia and bipolar patients into subgroups based on their cognitive profile increasingly demonstrate that, relative to healthy controls, there is a severely compromised subgroup and a relatively intact subgroup. There is emerging evidence that telomere shortening, a marker of cellular senescence, may be associated with cognitive impairments. The aim of this study was to explore the relationship between cognitive subgroups in bipolar-schizophrenia spectrum disorders and telomere length against a healthy control sample. METHODS: Participants included a transdiagnostic group diagnosed with bipolar, schizophrenia or schizoaffective disorder (n = 73) and healthy controls (n = 113). Cognitive clusters within the transdiagnostic patient group, were determined using K-means cluster analysis based on current cognitive functioning (MATRICS Consensus Cognitive Battery scores). Telomere length was determined using quantitative PCRs genomic DNA extracted from whole blood. Emergent clusters were then compared to the healthy control group on telomere length. RESULTS: Two clusters emerged within the patient group that were deemed to reflect a relatively intact cognitive group and a cognitively impaired subgroup. Telomere length was significantly shorter in the severely impaired cognitive subgroup compared to the healthy control group. CONCLUSIONS: This study replicates previous findings of transdiagnostic cognitive subgroups and associates shorter telomere length with the severely impaired cognitive subgroup. These findings support emerging literature associating cognitive impairments in psychiatric disorders to accelerated cellular aging as indexed by telomere length.

Psychological-health correlates of physical activity and sedentary behaviour during the COVID pandemic.

Background: While physical inactivity is associated with adverse psychological outcomes, less is known about the psychological outcomes associated with sedentary behaviour, and specifically, its mentally active and passive forms. The COVID-19 pandemic represents a unique opportunity to study associations between these variables in light of widespread stay-at-home mandates and restrictions on outdoor exercise/social activities. Using a cross-sectional dataset acquired during the COVID-19 pandemic in Australia, we examined whether physical activity and sedentary behaviour were associated with subjective quality of life (sQoL) and subjective cognitive dysfunction, and whether these associations were mediated by depressive symptoms. Methods: 658 participants (males = 169, females = 489) self-reported data on physical activity and sedentary behaviour in an online survey during May 2020-May 2021. Data on physical activity and sedentary behaviour (both mentally active and passive types) was compared according to whether it was collected during or out of a lockdown period. Regression models were used to test associations of physical activity and sedentary behaviour with sQoL and subjective cognitive dysfunction, and whether these associations were mediated by depression severity. Results: Physical activity was beneficially associated with sQoL, whereas sedentary behaviour (both total hours and the reduction of mentally active/increase in mentally passive behaviour) was detrimentally associated with sQoL. These associations were mediated by depression severity. Physical activity and sedentary behaviour were also indirectly associated with subjective cognitive dysfunction by virtue of their associations with depression severity. Conclusions: There are important differences in the psychological correlates of mentally passive and active sedentary behaviours. Our findings suggest that health promotion strategies should focus on not only increasing physical activity but also reducing passive sedentary behaviours as a means of maintaining good psychological health.

Evidence that a working memory cognitive phenotype within schizophrenia has a unique underlying biology.

It is suggested studying phenotypes within the syndrome of schizophrenia will accelerate understanding the complex molecular pathology of the disorder. Supporting this hypothesis, we have identified a sub-group within schizophrenia with impaired working memory (WM) and have used Affymetrix™ Human Exon 1.0 ST Arrays to compare their blood RNA levels (n=16) to a group of with intact WM (n=18). Levels of 72 RNAs were higher in blood from patients with impaired WM, 11 of which have proven links to the maintenance of different aspects of working memory (cognition). Overall, changed gene expression in those with impaired WM could be linked to cognition through glutamatergic activity, olfaction, immunity, inflammation as well as energy and metabolism. Our data gives preliminary support to the hypotheses that there is a working memory deficit phenotype within the syndrome of schizophrenia with has a biological underpinning. In addition, our data raises the possibility that a larger study could show that the specific changes in gene expression we have identified could prove to be the biomarkers needed to develop a blood test to identify those with impaired WM; a significant step toward allowing the use of personalised medicine directed toward improving their impaired working memory.

Surviving the COVID-19 pandemic: An examination of adaptive coping strategies.

The mental health consequences of the COVID-19 pandemic have been significant in Australia. The aim of this study was to investigate coping strategies that individuals have adopted to assist them through this stressful period. Survey data collected in September and December 2020 as part of a larger study (the COLLATE project) were analysed. The number of adaptive coping strategies endorsed by respondents had a significant negative relationship with depression and a significant positive relationship with resilience. Females tended to use more of these strategies than men, as did people who said their mental health had improved rather than deteriorated because of the COVID-19 restrictions imposed by government. Specific adaptive coping strategies differed for those with and without a mental illness. People with a mental illness were more likely to seek professional and online help, while people without a mental illness were more likely to use self-help. Focusing on what one is grateful for and keeping oneself productively occupied ("using the time to do things around the house") were the most beneficial coping strategies in terms of alleviating depression, anxiety and stress. Public health messaging promoting adaptive coping strategies may be useful in bolstering the mental health of individuals during lockdown periods. In particular, the promotion of coping flexibility should be recommended rather than the frequent use of the same coping strategies.

Age of onset by sex in schizophrenia: Proximal and distal characteristics.

BACKGROUND: Earlier schizophrenia onset in men relative to women has been a consistent finding in the literature, but a nuanced understanding of underlying reasons remains elusive. Further consideration should be given to factors associated with sex differences in age of onset. METHOD: Participants with schizophrenia were derived from the 2010 Australian Survey of High Impact Psychosis (n = 857). The SHIP survey constituted a representative, population-based study of almost 1.5 million Australian adults seen at various mental health services, and assessed personal health information, psychiatric comorbidities as well as psychosis illness and treatment. Hierarchical clustering was employed to identify age of onset by sex. Within-sex comparisons on distal and proximal factors affecting age of onset were conducted. RESULTS: Using modal age, two and three clusters were respectively found in men (early versus late onset) and women (early versus mid versus late onset). Early onset groups in both sexes had an increased family history of psychosis compared to older onset, but other risk factors were not consistent across the sexes. Less premorbid impairment was noted in females with middle to later onset schizophrenia. CONCLUSION: These findings further inform our understanding of the pathogenesis of schizophrenia. Added explorations of trends in older onset schizophrenia cohorts is especially important.

Investigating predictors contributing to the expression of schizotypy during the COVID-19 pandemic.

The coronavirus (COVID-19) pandemic has caused major disruptions to social and other forms of functioning, which may influence schizotypy expression. The current study aimed to explore possible distal and proximal predictors contributing to schizotypy in a sample of the Australian general population during the COVID-19 pandemic. The COvid-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project is an online mental health study aimed at tracking key mental health indicators over the progression of the pandemic. Adults residing in Australia were invited to take part using non-discriminative snowball sampling. Demographic-clinical information was collected for 850 participants in either October 2020 or January 2021. To assess schizotypy facets, the Launay-Slade Hallucinations Scale-Extended (LSHS-E) and Peters Delusions Inventory (PDI-21) were used to measure hallucination and delusion proneness respectively. Generalised linear models (with gamma and negative binomial distributions) were employed. Age, negative emotions and loneliness significantly contributed to both hallucination and delusion proneness; gender, education and religiosity also significantly contributed to delusion proneness, in the final regression models. Our study corroborated the specific contribution of loneliness, amongst other factors, in the prediction of schizotypy facets. Tackling loneliness represents a public health challenge that needs to be urgently addressed, especially in the face of the ongoing COVID-19 pandemic.

No influence of sex on the relationship between schizotypy factors and executive control across the schizophrenia spectrum.

Sex differences in symptoms and executive control across schizophrenia spectrum disorders (SSD) are consistently reported. Similarly, these findings of sex differences are also observed in schizotypy, that is, schizophrenia-like features occurring in healthy individuals in the absence of a clinical diagnosis. This study aimed to examine the relationships between performance on three major domains of executive control: performance monitoring, response inhibition, and cognitive set-shifting, and schizotypy factor scores in both SSD patients and healthy controls (HCs), and whether sex moderated any relationships observed. A total of 111 (67 males and 44 females) patients with SSD and 258 (129 males and 129 females) HCs were included in this study. Schizotypal personality traits (in both SSD and HC) was assessed using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). Executive control performance was assessed using seven tasks. Stepwise linear regressions revealed that performance on cognitive set-shifting tasks was significantly associated with the introvertive anhedonia, cognitive disorganisation, and unusual experiences subscales of the O-LIFE. When sex was examined as a moderator, it was not a significant moderator of any of the relationships between cognitive set-shifting tasks and schizotypy factors. The results suggest that independent of sex, cognitive set-shifting ability is associated to an increased vulnerability to schizotypal personality traits, although performance monitoring and response inhibition did not.

Psychosis and Hopelessness Mediate the Relationship Between Reduced Sleep and Suicidal Ideation in Schizophrenia Spectrum Disorders.

OBJECTIVE: Suicide is a major cause of death amongst individuals with schizophrenia spectrum disorders (SSD). Despite numerous risk factors being identified, accurate prediction of suicidality and provision of tailored and effective treatment is difficult. One factor that may warrant particular attention as a contributor to increased psychopathology and suicidality in SSD is disturbed sleep. Sleep disturbances have been reliably linked to greater levels of suicidal ideation and are highly prevalent amongst individuals with SSD. This study aimed to examine if reduced sleep duration and psychopathology are associated with increased suicidal ideation. METHOD: One-hundred and eighteen adults with chronic SSD living within the community participated in this cross-sectional study. Psychosis symptoms were assessed using the Positive and Negative Syndrome Scale. Items 4 and 10 from the Montgomery-Asperg Depression Rating Scale and Item 2 from the Calgary Depression Scale for Schizophrenia were used to assess reduced sleep duration, current suicidal ideation, and hopelessness, respectively. All measures were rated concurrently. RESULTS: A hierarchical logistic regression revealed that greater acute sleep disturbances were associated with increased suicidal ideation and this relationship was found to be uniquely mediated by both positive symptom severity and hopelessness. CONCLUSION: These results suggest that individuals with SSD who exhibited disrupted or disordered sleep, positive symptoms and/or hopelessness should be routinely screened for suicidal thinking. Furthermore, interventions that effectively target sleep disruptions may provide much-needed action against suicidal ideation.HIGHLIGHTSReduced sleep found to be associated with increased suicidal ideationThis was uniquely mediated by both hopelessness and positive symptomsMore regular screening of sleep problems in schizophrenia is needed.

Considerations for improving diversity, equity and inclusivity within research designs and teams.

This article addresses the growing movement towards greater diversity, equity and inclusivity (DEI) within the research community. We present the case for increasing DEI among research teams and participants, discussing the benefits of this, as well as some of the current hindrances to achieving better DEI, particularly implicit biases. Lastly, we present some interventions that can be implemented within four key aspects of the research process: research methods, the research team, funding access and scientific dissemination. It is contingent on all players to engage in efforts to improve DEI in research settings, as they each are a critical step to improving the scientific method, rigor and accuracy of research outcomes.

Investigating the diagnostic utility of speech patterns in schizophrenia and their symptom associations.

BACKGROUND: Speech disturbances are a recognised aspect of schizophrenia that may have potential utility as a diagnostic indicator. Recent advances in quantitative speech assessment methods have led to more reproducible and precise metrics making this possible. The current study sought firstly to characterise the speech profile of schizophrenia patients using quantitative speech measures, then examine the diagnostic utility of these measures and explore their relationship to symptoms. METHODS: Speech recordings from 43 schizophrenia/schizoaffective disorder (SZ) patients and 46 healthy controls (HC) were obtained and transcribed. Cognitive and symptom measures were also administered. RESULTS: Compared to HCs, SZ patients had higher incidences of aberrance across five types of quantitative speech variables: utterances, single words, time/speaking rate, turns and formulation errors, but not pauses. Based on two machine learning algorithms, 21 speech variables across the same five speech variable types (again not including pauses) were identified as significant classifiers for a schizophrenia diagnosis with 90-100% specificity and 80-90% sensitivity for both models. Selective relationships were also observed between these speech variables and only positive, disorganisation, excitement and formal thought disorder symptoms. CONCLUSIONS: The findings support pervasive speech impairments in schizophrenia patients relative to HCs, and the potential diagnostic utility of these speech disturbances. Continued work is needed to build the evidence base for quantitative speech assessment as a future objective diagnostic tool for schizophrenia. It holds the promise of improved diagnostic accuracy leading to increased treatment efficacy and better patient outcomes.

Mental health of individuals with and without eating disorders across six months and two waves of COVID-19.

PURPOSE: The COVID-19 global pandemic has resulted in a significant mental health toll, and recent findings suggest that individuals with an eating disorder (ED) history may be particularly vulnerable. The current study aimed to: (1) identify changes in the pattern of mental health symptoms over the first six months of the pandemic between individuals with an ED history, compared to a community sample without an ED history (non-ED); and (2) identify differences in mental health symptoms and concerns between two waves of the virus and associated lockdowns. METHOD: Data from 4915 respondents - 231 with an ED history - were compared across monthly time points from April to September 2020 on psychological symptoms including negative mood, quality of life, coping and hopefulness, as well as changes to eating and exercise behaviours. RESULTS: Mental health symptoms were increased in the ED group, but generally did not differ from non-ED in the pattern of symptoms reported over time. Increased depressive symptoms and restrictive eating behaviours were found across both groups in relation to the second wave/lockdown, as well as decreased hopefulness and quality of life. Respondents in both groups also reported coping worse during the second wave of the virus compared to the first wave. CONCLUSION: Although non-ED and ED groups tended to generally show the same pattern of symptoms, the mental health status of the ED group was significantly poorer than the non-ED group throughout the pandemic, and exacerbations in some symptoms (i.e. increased food restriction and depressive symptoms) is cause for concern.

Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment.

BACKGROUND: Patients with schizophrenia spectrum disorders have been increasingly recognised to form cognitive subgroups with differential levels of impairment. Using cluster analytical techniques, this study sought to identify cognitive clusters in a sample of first-episode psychosis (FEP) patients and examine clinical and developmental differences across the resultant groups. METHODS: In total, 105 FEP patients in the University of California Los Angeles Aftercare Research Program were assessed for cognition, symptoms and premorbid developmental adjustment. Hierarchical cluster analysis with Ward's method and squared Euclidean distance was conducted, confirmed by discriminant function analysis and optimised with k-means clustering. The stability of the solution was evaluated through split-sample (random, 80 and 70% samples) and alternate method (average linkage method) replication via Cohen's κ analysis. Controlling for multiple comparisons, one-way analysis of variances examined group differences in symptom severity and premorbid adjustment. RESULTS: Three groups were identified: severely impaired (n = 27), moderately impaired (n = 41) and relatively intact (n = 37). There were no significant differences in symptom severity across the groups. Significant differences were observed for scholastic performance at three different developmental stages: childhood, early adolescence and late adolescence, with the relatively intact group demonstrating significantly better scholastic performance at all three stages than both the moderately impaired and severely impaired groups (who did not significantly differ from each other). CONCLUSIONS: The findings add to growing evidence that cognitive clusters in FEP mirror that of later-stage schizophrenia. They also suggest that premorbid scholastic performance may not just be a risk factor for developing schizophrenia, but is also related to cognitive impairment severity and potentially to prognosis.