Devvarta Kumar

Neuropsychology of Prefrontal Cortex

The history of clinical frontal lobe study is long and rich which provides valuable insights into neuropsychologic determinants of functions of prefrontal cortex (PFC). PFC is often classified as multimodal association cortex as extremely processed information from various sensory modalities is integrated here in a precise fashion to form the physiologic constructs of memory, perception, and diverse cognitive processes. Human neuropsychologic studies also support the notion of different functional operations within the PFC. The specification of the component ‘executive’ processes and their localization to particular regions of PFC have been implicated in a wide variety of psychiatric disorders.

Effect of meta-cognitive training in the reduction of positive symptoms in schizophrenia

Metacognitive training (MCT), a variant of Cognitive Behaviour Therapy, is a recently developed therapeutic method that targets active positive symptoms, primarily delusions. It translates basic research related to cognitive biases behind these symptoms into a training procedure for schizophrenia patients. To see the effectiveness of MCT a total of sixteen recently admitted schizophrenia patients were randomly divided into two groups. One group underwent treatment as usual (TAU) and the other group underwent MCT plus TAU. The MCT group showed steeper decline in positive symptoms with medium to large effect sizes. Findings are discussed in the light of their practical implications.

Event-based Prospective Memory in Schizophrenia

Although memory deficits have been well documented in schizophrenia, so far, there is dearth of literature about prospective memory (PM), that is memory for future events, in this disorder. The present study investigated event-based PM in schizophrenia. Additionally, the relationship of event-based PM with clinical variables of schizophrenia was also assessed. Task incorporating event-based prospective memory was administered on 42 schizophrenia patients and 42 nonpsychiatric comparison subjects. Patients with schizophrenia were additionally rated on The Scale for the Assessment of Positive Symptoms, The Scale for the Assessment of Negative Symptoms and The Brief Psychiatric Rating Scale. Results showed schizophrenia patients to have poor event-based prospective memory. However, no significant correlation was observed between the clinical variables and PM.

ACTIVITY-BASED PROSPECTIVE MEMORY IN SCHIZOPHRENIA

The study reports activity-based prospective memory as well as its clinical and neuropsychological correlates in schizophrenia. A total of 42 persons diagnosed with schizophrenia and 42 healthy controls were administered prospective memory, set-shifting, and verbal working memory tasks. The schizophrenia group was additionally administered various psychopathology rating scales. Group differences, with poorer performances of the schizophrenia group, were observed on the measures of prospective memory, working memory, and set shifting. The performance on prospective memory tasks correlated with the performance levels on verbal working memory and set-shifting tasks but not with the clinical measures. This study demonstrated impaired activity-based prospective memory in schizophrenia. The impairment can be due to deficits in various neuropsychological domains.

Using the back door: Metacognitive training for psychosis

Delusions have traditionally been considered impervious to counter-arguments and thus not amenable to psychotherapy. However, a growing body of evidence from Cognitive Behavior Therapy for psychosis (CBT-p) has indicated that challenging the delusional beliefs may be effective in reducing their severity. Metacognitive Training/Therapy (MCT) for psychosis also targets delusions, using a back door approach by helping clients gain insight into the cognitive biases behind delusions, followed by attempts to plant the seeds of doubt, and weaken delusional beliefs. There are two variants of MCT, the group format MCT and the individual therapy format MCT (i.e. MCT+). The MCT intervention has three components: (a) normalization, (b) facilitating insight into the relationship between cognitive biases and delusions, and (c) sowing the seeds of doubt in delusional beliefs. Among these, the first two components are common to both MCT and MCT+, whereas the third is specific to MCT+. Initial findings about the effects of MCT in reducing the delusional convictions are encouraging. The present article elaborates on the theoretical background, process, clinical implications, empirical status, and the advantages and limitations of this intervention.

Beginning steps in school mental health in India: a teacher workshop

As emphasised by this journal, school mental health (SMH) programmes and services, when done well, lead to valued outcomes for students and systems focused on children and adolescents. However, SMH is nearly non-existent in India. Acute scarcity of trained manpower is the main stumbling block. It is therefore imperative to facilitate the process of SMH with some alternative measures, and one way is to enable the primary stakeholders. Towards this end, at the Central Institute of Psychiatry, Ranchi, India a workshop for teachers was conducted which focused on various aspects of SMH. The effectiveness of the workshop was assessed with the help of pre-post and five-month follow-up assessments which showed increased understanding by teachers of psychological problems in children from participation in the workshop. Admittedly, this is a very early step, but we hope that our experiences will be helpful in moving SMH forward in developing nations.

Metacognitive training for delusion in treatment-resistant schizophrenia.

Metacognitive training for patients with schizophrenia (MCT) is a novel form of psychotherapy that aims to promote insight into the relationship between metacognitive deficits and psychotic symptoms, especially delusions. MCT has been found to be effective in reducing the delusional conviction and other positive symptoms in patients with schizophrenia. However, we are not aware of any research in which MCT has been used specifically to manage treatment-resistant schizophrenia patients. We report the case of a patient with treatment-resistant schizophrenia who responded to MCT. Her persecutory and referential delusions improved with a course of twelve sessions of therapy. Further, the improvement in delusions had a positive impact on her psychosocial functioning. A follow-up after two months of therapy revealed sustained improvement.

Eyewitness susceptibility to co-witness misinformation is influenced by co-witness confidence and own self-confidence

ABSTRACT If an eyewitness is exposed to a co-witness statement that incorrectly blames an innocent bystander for a crime, the eyewitness can be influenced by this statement and also blame the innocent bystander for the crime. This effect is known as blame conformity. In two studies, we examined whether or not this effect is influenced by the degree of confidence a co-witness expresses in her incorrect statement (Study 1) and an eyewitness’s own level of self-confidence (Study 2). Participant eyewitnesses first watched a crime video featuring a perpetrator and an innocent bystander, then read a co-witness statement about the crime that either correctly blamed the perpetrator, incorrectly blamed the innocent bystander, or blamed nobody (a control condition). They were then asked who committed the crime. In Study 1, participants who read an incorrect statement were at increased risk of engaging in blame conformity when the co-witness expressed a high level of confidence, compared to a low level of confidence, in the accuracy of her statement. In Study 2, participants who were lowest in self-confidence were at increased risk of engaging in blame conformity. The theoretical underpinnings of these effects are considered.

Prospective memory in first-degree relatives of patients with schizophrenia

Abstract Objectives: Among various cognitive impairments in schizophrenia, prospective memory (ProM) deficit is unequivocally established. However, there is a paucity of research examining whether ProM impairment can be considered a cognitive endophenotypic marker in schizophrenia. An important step toward this is to assess the status of ProM in first-degree relatives (FDRs) of patients with schizophrenia. Keeping this in view, present study has been conducted to assess event- and time-based ProM in FDRs of patients with schizophrenia. Methods: Twenty patients with schizophrenia, 20 FDRs of these patients, and 20 nonpsychiatric (healthy) controls were administered event- and time-based ProM tasks. Results: Findings show that the FDRs had poorer performance on event-based ProM task in comparison to healthy controls. On time-based task, though the FDRs performed poorly in comparison to healthy controls the difference was statistically non-significant. The patient group performed poorer than healthy controls on both event- and time-based tasks. Conclusions: Findings of the present study indicate that the FDRs of patients with schizophrenia exhibit ProM impairment, though to a lesser degree than the patients with schizophrenia.

Repetitive love proposing: A case report and review of phenomenology of impulsivity and compulsivity

Interest in opposite sex is a normal phenomenon; however, when this interest starts affecting ones own or others life in a pathological manner, it warrants clinical attention. We report the case of a young man who had a tendency to propose love to girls impulsively. Apart from the presence of this, otherwise, normal behavior in a pathological manner, another dimension of this case was that he was having obsessive-compulsive disorder too. Since both impulsivity and compulsivity are repetitive in nature and result in a sense of relief when the act is committed, the chance of impulsivity to be misconstrued as compulsivity is high. In light of important differences between compulsive and impulsive behavior, the psychopathology of the present case has been discussed.