Gary Bryson

Positive and negative affect recognition in schizophrenia: a comparison with substance abuse and normal control subjects

This study had three aims: to compare a schizophrenia sample (n = 50) with a substance abuse (n = 25) and normal sample (n = 81) on affect recognition; to compare differences in their performance between positive and negative affect recognition; and to introduce a new videotape method of stimulus presentation. Subjects were asked to identify the predominant affect depicted in 21 5-10-s vignettes containing three trials of seven affect states. Results demonstrate significant group differences: normal subjects scored in the normal or mild range, substance abuse (s/a) subjects scored in the mild and moderate ranges, and the schizophrenia sample scored predominantly in the moderate to severe ranges. Accuracies were 92.3% for the normal sample, 77.2 for the s/a sample and 64.8 for the schizophrenia sample. Response dispersions were 97.6% for the schizophrenia group, 69% for the s/a sample and 38% in the normal sample. A repeated measures ANOVA revealed a group by type of affect interaction with schizophrenia subjects showing far greater differential impairment on negative affect recognition. Difficulty of item did not contribute to this difference. Test-retest reliability at 5 months for this new method was r = 0.76, and stability of categorization was very high over 5 months (weighted kappa = 0.93). These affect recognition deficits in schizophrenia are discussed as they relate to lateralization of brain function, high EE families, social skills impairment and implications for rehabilitation services.

Theory of mind performance in schizophrenia: diagnostic, symptom, and neuropsychological correlates.

The purpose of this study was to explore the relationship between Theory of Mind (ToM) performance and schizophrenia subtype, symptom, and neuropsychological variables. One hundred twenty-eight stable outpatients with schizophrenia or schizoaffective disorder were assessed during the intake phase of a vocational and cognitive rehabilitation study. Results indicate that ToM performance differed significantly by schizophrenia diagnosis, with people diagnosed with disorganized schizophrenia performing the most poorly. Theory of Mind performance was also significantly correlated with measures of thought disorder and verbal memory. Regression analysis revealed that thought disorder and verbal memory measures explained 30% of the variance in ToM scores. Findings suggest that there is theory of mind variance in the schizophrenia population and theory of mind is strongly related to thought disorder, verbal memory, and cognitive disorganization. Contrary to previous reports, ToM was not related to measures of paranoia.

Neurocognition, Social Cognition, Perceived Social Discomfort, and Vocational Outcomes in Schizophrenia

Social cognition has been suggested to be an important mediating variable in the relationship between neurocognition and functional outcome. The present study tested this model in relation to work rehabilitation outcome and added self-reported social discomfort as a possible mediator. One hundred fifty-one participants with schizophrenia or schizoaffective disorder participated in a 26-week work therapy program. Neurocognition was constructed as a latent construct comprised of selected variables from our intake test battery representing executive functioning, verbal memory, attention and working memory, processing speed, and thought disorder. Social cognition at intake was the other latent construct comprised of variables representing affect recognition, theory of mind, self-reported egocentricity, and ratings of rapport. The 2 latent constructs received support from confirmatory factor analysis. Social discomfort on the job was based on their self-report on a weekly questionnaire. In addition, we constructed a composite rehabilitation outcome that was based on how many hours they worked, how well they worked, and how complex was the job that they were doing. Path analysis showed direct effects of neurocognition on rehabilitation outcome and indirect effects mediated by social cognition and social discomfort. This model proved to be a good fit to the data and far superior to another model where only social cognition was the mediating variable between neurocognition and rehabilitation outcome. Findings suggest that neurocognition affects social cognition and that poorer social cognition leads to social discomfort on the job, which in turn leads to poorer rehabilitation outcomes. Implications for rehabilitation interventions are discussed.

Initial and final work Performance in schizophrenia: Cognitive and symptom predictors

Studies have shown that cognitive functioning may limit the rate, tenure, and type of work performed by people with schizophrenia. The present study tested the hypothesis that cognitive abilities needed for initial improvement in work performance would differ from those needed in later vocational development. Ninety-six outpatients with schizophrenia or schizoaffective disorder who participated in a work rehabilitation program were administered neuropsychological testing at intake. Their work performance was evaluated biweekly for 26 weeks. Cognitive test variables were entered into regressions predicting the slope of individual performance curves from weeks 1 to 13 and 13 to 26. Neuropsychological variables accounted for 28% of the variance in slope during the initial period. The strongest predictor was a Continuous Performance Task variable that measures inattentiveness. Other important variables were measures of idiosyncratic thinking, cognitive flexibility, and verbal memory. Neuropsychological variables accounted for 19% of the variance in the slope during the final period. The strongest predictor was verbal learning, while measures of cognitive impulsivity and psychomotor functioning were also significant contributors. There was no relationship between work performance and symptoms for weeks 1 to 13 or 13 to 26. These findings suggest that while attention is more important for initial success, verbal memory becomes more important for sustained improvement. Remediating or accommodating such deficits in a time-sensitive fashion may be a necessary feature for successful rehabilitation.

Insight and interpersonal function in schizophrenia.

Research has linked impaired insight in schizophrenia to poorer medication compliance and treatment outcome. It is unclear, however, whether poorer interpersonal function is also associated with impaired insight. To examine this question, subjects with schizophrenia or schizoaffective disorder were classified as having unimpaired (N = 44) or impaired (N = 57) insight, and their scores on Heinrichs et al.s Quality of Life (QOL) Scale were compared. Multiple regressions were conducted to determine the relationship between individual components and social function. Results indicate that subjects with impaired insight had significantly poorer QOL interpersonal relation and intrapsychic foundation scores than unimpaired subjects, despite having equivalent deficit symptoms. Unawareness of the social consequences of illness was found to be the component of insight more closely linked to social dysfunction. This suggests that impairments in insight may be uniquely associated with social dysfunction.

Cognitive remediation of working memory deficits: durability of training effects in severely impaired and less severely impaired schizophrenia

Objective: To determine whether augmenting work therapy (WT) with neurocognitive enhancement therapy (NET) yields greater improvement in working memory performance than WT alone and whether there is an interaction with severity of impairment.

Neurocognitive function and insight in schizophrenia: support for an association with impairments in executive function but not with impairments in global function

It remains unclear how impaired insight and neurocognitive impairment are related to one another in schizophrenia. In order to examine this relationship, subjects with schizophrenia or schizoaffective disorder were classified as having‘impaired’(n=38) or‘unimpaired’(n=43) insight based on their insight rating on the Positive and Negative Syndrome Scale (PANSS). Their performance on neuropsychological tests of global function, executive function, memory and vigilance was then compared. Multivariate analyses followed by Scheffe tests indicated that subjects with impaired insight performed less well on the Wisconsin Card Sorting Test, demonstrating poorer abstract flexibility and heightened perseveration. No differences were found between the groups with regard to global cognitive function, memory or vigilance. This suggests that insight is closely linked to deficits in executive function, and that it may be associated with the compromise of frontal lobe function.

Insight and psychosocial treatment compliance in schizophrenia.

Research has suggested that poor insight in patients with schizophrenia is associated with poorer medication compliance and heightened levels of psychopathology. This study examined the relationship of insight to compliance with a work rehabilitation program and with levels of psychopathology and psychosocial functioning. Poor insight was found to be positively associated with fewer weeks of participation and with poorer social skills and personal presentation in the fifth week of work. Poor insight was also associated with cognitive disorganization and a lower intelligence quotient, but not with heightened levels of psychopathology. Results suggest that poor insight may predict noncompliance with psychosocial treatment and may be related to a constellation of cognitive deficits.

Insight and work performance in schizophrenia.

Research has linked impaired insight in schizophrenia to poorer medication compliance and poorer treatment outcome. The current study attempts to replicate previous findings that impaired insight is related to deficits in work function. To examine this question, 121 participants with schizophrenia or schizoaffective disorder enrolled in vocational rehabilitation were classified as having unimpaired (N = 65), or impaired (N = 56) insight. Next, participants were assigned a work placement and their work performance assessed on the third, fifth, and seventh weeks of work by using the Work Behavior Inventory. Among the 85 participants who completed these weeks of work, a multivariate analysis of variance and subsequent analysis of variance showed participants with impaired insight had significantly poorer ratings of work quality, work habits, cooperativeness, and personal presentation. When measures of global intelligence and executive function were entered as covariates in individual analysis of covariance, groups differed on measures of cooperativeness and personal presentation. Implications for rehabilitation are discussed.

Neurocognitive enhancement therapy with work therapy: Productivity outcomes at 6- and 12-month follow-ups

Neurocognitive enhancement therapy (NET), which involves computerized cognitive training and other methods, has been shown to improve working memory and executive function in schizophrenia. In the present study, 145 outpatients with diagnoses of schizophrenia or schizoaffective disorder recruited from a Department of Veterans Affairs mental hygiene clinic and from a community mental health center were ran domized to 6 months of paid work therapy (WT) or to NET+WT. Mixed random effects analyses revealed significant increase in hours worked and money earned over time for both conditions (p < 0.0001). NET+WT worked more hours than WT (p < 0.03), with differences emerging after rehabilitation. Responders to NET+WT worked the most during follow-up and tended to have more competitive-wage employment. Results indicate that work outcomes were enhanced by NET training. Effects were greatest for NET responders. Findings support the efficacy of cognitive training when it is integrated into broader rehabilitation programs.