Cindy Woolverton

Social participation predicts cognitive functioning in aging adults over time: comparisons with physical health, depression, and physical activity

Objectives: Several risk and protective factors are associated with changes in cognitive functioning in aging adults – including physical health, depression, physical activity, and social activities – though the findings for participation in social activities are mixed. This study investigated the longitudinal association between social participation and two domains of cognitive functioning, memory and executive function. A primary goal of our analyses was to determine whether social participation predicted cognitive functioning over-and-above physical health, depression, and physical activity in a sample with adequate power to detect unique effects. Method: The sample included aging adults (N = 19,832) who participated in a large, multi-national study and provided data across six years; split into two random subsamples. Unique associations between the predictors of interest and cognitive functioning over time and within occasion were assessed in a latent curve growth model. Results: Social participation predicted both domains of cognitive functioning at each occasion, and the relative magnitude of this effect was comparable to physical health, depression, and physical activity level. In addition, social participation at the first time point predicted change in cognitive functioning over time. The substantive results in the initial sample were replicated in the second independent subsample. Conclusion: Overall, the magnitude of the association of social participation is comparable to other well-established predictors of cognitive functioning, providing evidence that social participation plays an important role in cognitive functioning and successful aging.

The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service

BackgroundThere is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER).MethodsSixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation.ResultsOver the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system.ConclusionsThe results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States.Trial registrationClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011

A randomized controlled trial of cognitive remediation and d-cycloserine for individuals with bipolar disorder.

BackgroundCognitive remediation (CR) has shown significant promise in addressing the cognitive deficits that accompany serious mental illness. However, this intervention does not appear to completely ameliorate the cognitive deficits that accompany these illnesses. D-cycloserine (DCS), an NMDA receptor partial agonist, has been shown to enhance the therapeutic benefits of learning-based psychosocial interventions for psychiatric disorders. Thus, the goal of this study is to examine the utility of combining cognitive remediation and d-cycloserine in the treatment of cognitive deficits among individuals with bipolar disorder.Methods/DesignApproximately forty individuals with bipolar disorder will be recruited to participate in this study. Participants will be randomized to one of two study arms: CR + DCS or CR + placebo. The primary outcome for this study is change in cognitive functioning. We will also examine several secondary outcomes, including the rate of change of cognitive functioning, social functioning, and symptomatology.DiscussionCognitive deficits are a rate-limiting factor in functional recovery among individuals with bipolar disorder. Unfortunately, treatment options for these deficits are limited. The results of the proposed study may reveal a valuable intervention strategy (i.e., CR with concurrent DCS) to improve cognitive functioning among individuals with bipolar disorder. Ultimately, this treatment strategy may prove useful in addressing the cognitive deficits that are ubiquitous across serious mental illnesses.Trial registrationClinicalTrials.gov NCT01934972.

Meta-cognitive skills training enhances computerized cognitive remediation outcomes among individuals with first-episode psychosis.

Meta‐cognitive skills training (MST) is a frequent component of cognitive remediation programmes for individuals with psychosis. However, no study has investigated whether incorporating such activities produces increased clinical benefits compared with computerized cognitive remediation alone.

Self-Determination Theory and First-Episode Psychosis: A Replication

Self-determination theory (SDT) posits that human well-being depends on the satisfaction of three basic psychological needs: autonomy, competence, and relatedness. Although many scholars have suggested that SDT may be relevant to psychotic disorders, only one empirical study of SDT in individuals with psychosis has been completed to date by Breitborde and colleagues (2012). This study revealed that individuals with first-episode psychosis reported lower satisfaction of the three basic psychological needs as compared to individuals without psychosis. Moreover, greater satisfaction of basic psychological needs was modestly associated with lower general symptoms (e.g., anxiety and depression), greater social functioning, and better quality of life. Thus, the goal of this project was to replicate Breitborde et al.’s (2012) investigation of basic psychological need satisfaction among individuals with first-episode psychosis. Our results supported the conclusion that individuals with first-episode psychosis report lower autonomy, competence, and relatedness than individuals without psychosis. Moreover, our results comport with the finding that greater need satisfaction was associated with less severe symptomatology and better social functioning and quality of life. In total, the findings lend further credence to the hypothesis that SDT may help to inform the development of improved clinical services for individuals with psychotic disorders.

Clinical correlates of distorted auditory perception in first-episode psychosis.

Auditory hallucinations are hypothesized to be based in distorted sensory perceptions, with increasingly distorted perceptions of reality possibly prompting the first psychotic phase of schizophrenia spectrum disorders. Our goal was to examine the association between distorted auditory perceptions and psychotic symptomatology, social functioning and quality of life among individuals with first‐episode psychosis.

An uncontrolled trial of multi‐component care for first‐episode psychosis: Effects on social cognition

Growing evidence suggests that specialized, multi‐component treatment programmes produce improvements in numerous outcomes among individuals with first‐episode psychosis. However, these programmes often lack interventions specifically designed to address deficits in social cognition. This raises questions about the effectiveness of such programmes in addressing deficits in social cognition that accompany psychotic disorders. We investigated the effect of participation in a multi‐component treatment programme on social cognition among 71 individuals with first‐episode psychosis. Participants experienced gains in emotion processing, social knowledge, social perception and theory of mind. However, after controlling for multiple comparisons, these improvements were limited to theory of mind and recognition of social cues in low emotion interactions. Although our findings should be interpreted cautiously, they raise the possibility that individuals participating in multi‐component treatment programmes for first‐episode psychosis without interventions specifically targeting social cognition may still experience gains in social cognition.

Self-reference and emotional memory effects in older adults at increased genetic risk of Alzheimer’s disease

ABSTRACT The present study investigated whether cognitively healthy older adults who are carriers of the ε4 allele of apolipoprotein E, the most prevalent genetic risk factor for late-onset Alzheimer’s disease, benefit from self-referential processing and emotional processing to the same degree as noncarriers of this gene. Participants encoded emotional and nonemotional narratives using a baseline-orienting task, semantic elaboration, or imagination-based self-referential processing and then completed a recognition memory test. Both groups of older adults showed enhanced recognition memory for narrative information following self-referential processing relative to semantic elaboration, and the magnitude of this memory effect was not affected by ε4 status. However, older adult ε4 carriers did not show an emotional enhancement effect, whereas older adult ε4 noncarriers did. These results indicate that whereas the self-reference effect is not attenuated in cognitively healthy older adults ε4 carriers, deficits in emotional memory may be an early cognitive marker of abnormal decline.

Activity-regulated cytoskeleton-associated protein predicts response to cognitive remediation among individuals with first-episode psychosis

Fig. 1a. Putative biological pathway for memory and response to cognitive remediation. Numerous proteins associated with risk for psychotic disorders (outlined in red) regulate expression of ARC. As IEGs, both EGR3 and ARC are activated in response to environmental stimuli (red hatched arrows) such as those that trigger learning. This may be via NMDARs or other pathway genes. Maintenance of ARC expression requires EGR3. Dysfunction in ARC, or its upstream regulators may disrupt the normal neurobiological response to stress, setting the stage for symptoms of schizophrenia. Abbreviations: NMDAR N-methyl d-aspartate receptor; NRG2, Neuregulin 1; ERBB4, ErbB4 receptor; NFAT, nuclear factor of activated T cells; EGR3, Early growth response 3; ARC, Activity-regulated cytoskeleton-associated protein. Growing evidence suggests that cognitive remediation (CR) defined by the Cognitive Remediation Experts Workshop as “a behavioral training based intervention that aims to improve cognitive processes with the goal of durability and generalization” -may ameliorate the cognitive deficits that accompany psychotic disorders. However, as a therapy, it is costly and requires specially trained clinicians with expertise and instrumentation. Therefore, the ability to pre-identify individuals who would most likely benefit from this intervention would decrease the time and cost of treatment. Consequently, several studies have investigated possible genetic predictors of response to CR. Focusing primarily on the dopaminergic modulator catechol-O-methyltransferase (COMT), results from these studies are equivocal andmay be confounded by the effects of antipsychotic medication (Bosia et al., 2014). We hypothesized that genes involved in memory and synaptic plasticity may influence the response to CR as these processes are likely stimulated by, and critical for, this therapy. Our prior work has defined an activity-dependent pathway of neuronal proteins that may influence the cognitive symptoms of psychotic illnesses (Huentelman et al., 2015). The proteins in this pathway, beginning with N-methyl D-aspartate receptors and culminating in expression of the immediate early gene activity-regulated cytoskeleton-associated protein (ARC), are essential for memory formation and synaptic plasticity (see Fig. 1a). For the current study, we focused on the role of ARC in moderating response to CR given (i) its association with schizophrenia susceptibility (Huentelman et al., 2015) and (ii) evidence supporting a putative role of ARC in translating environmental learning events (e.g., CR exercises) into changes in neural circuitry (Shepherd and Bear, 2011). This project was approved by the University of Arizona Institutional Review Board. All participants provided informed consent prior to completing study procedures. This study was completed in accordance with the Declaration of Helsinki. Seventy-two individuals with first-episode psychosis were recruited from the Early Psychosis Intervention Center (EPICENTER: Breitborde et al., 2015). Eligibility criteria included: diagnosis of a schizophreniaspectrum disorder or affective disorder with psychotic features, less than 5 years since first onset of psychotic symptoms, being between the ages of 15–35, and no evidence of premorbid intellectual disability. Among our participants, there were 19 women and 53 men, with an average age of 22.72 years and a median duration of psychotic illness of 12.34 months. Participants completed a six-month trial of metacognitive remediation therapy (MCR: Breitborde et al., 2016)—an intervention combining computerized CR exercises and therapist lead metacognitive skills development activities. Cognitive functioning was assessed before and after MCR using the overall cognitive composite score of the MATRICS Consensus Cognitive Battery (MCCB: Nuechterlein et al., 2008).

Social cognition and the course of social functioning in first-episode psychosis

Social functioning deficits greatly affect individuals with psychotic disorders resulting in decreased ability to maintain relationships, jobs and pursuit of educational goals. Deficits in social cognition have been hypothesized to be an important contributor to these deficits in social functioning. In particular, 5 domains of social cognition have been suggested to be relevant in the study of psychotic disorders: (1) attributional style, (2) emotion recognition, (3) social knowledge, (4) social perception and (5) theory of mind. Yet, to date, no study has simultaneously investigated the association between these 5 domains of social cognition and social functioning.