George C. Nitzburg

Eating Disorders in Middle-Aged Women

Eating disorders are generally viewed as afflicting females during adolescence and early adulthood. However, in recent years there has been a growing recognition that these disorders may occur during midlife as well. When eating disorders have been observed in middle age, they have often been believed to be associated with depression. In an Internet survey, responses by middle-aged women (N = 290; aged 45-60 years) indicated that the factors significantly associated with eating pathology—body image dissatisfaction, sociocultural pressures to be thin, and perfectionism—closely parallel those reported for younger people. Furthermore, in the presence of these factors, depression and concerns about the effects of aging on appearance are not significantly related to eating pathology.

The Relation between Childhood Maltreatment and Psychosis in Patients with Schizophrenia and Non-Psychiatric Controls

Several lines of evidence suggest that childhood maltreatment is associated with an increased risk for both psychotic disorders and subclinical psychotic-like experiences in the general population. Few studies, however, have sought to examine whether the strength of this relationship is comparable across patient and non-patient groups. The present study sought to compare the strength of the association between childhood maltreatment and self-reported psychotic symptoms in 447 healthy adult volunteers and 184 stable outpatients with schizophrenia or schizoaffective disorder. Strong positive correlations between childhood maltreatment and self-reported symptoms were observed in both groups. Although patients scored significantly higher than controls on both history of childhood maltreatment and self-reported symptoms, the strength of the relationship did not differ between groups. These data provide strong support for etiological continuity between subclinical psychotic symptoms and psychotic disorders.

The relationship between temperament and character and subclinical psychotic-like experiences in healthy adults

BACKGROUND Considerable data support phenomenological and temporal continuity between psychotic disorders and subclinical psychotic-like experiences (PLEs). Although numerous studies have found similar personality correlates for schizophrenia and schizotypal personality disorder patients, their unaffected first-degree relatives, and healthy adults characterized for schizotypal traits, no study has yet investigated personality correlates of PLEs measured by the Community Assessment of Psychic Experiences (CAPE). Our study sought to examine personality correlates of PLEs using the CAPE in healthy adults. METHOD The CAPE and temperament and character inventory (TCI) were administered to 415 healthy adults. Regressions examined links between TCI traits and overall PLE levels as well as positive and negative PLEs separately. RESULTS Consistent with past studies, lower self-directedness (SD) and reward dependence (RD) and higher self-transcendence (ST) and harm avoidance (HA) significantly predicted overall PLE levels. Higher ST and persistence (P) and lower SD significantly predicted higher levels of positive PLEs while lower SD and RD and higher HA, ST, and cooperativeness (C) predicted higher levels of negative PLEs. CONCLUSIONS Associations between TCI and PLEs using the CAPE are strikingly similar to past work in non-clinical and patient samples and provide additional support for phenomenological continuity between psychotic disorders and sub-syndromal psychotic symptoms.

Coping strategies and real-world functioning in bipolar disorder.

BACKGROUND Bipolar disorder (BD) patients encounter significant life adversity, which has contributed to bipolar disorder being a leading cause of disability worldwide. Studies suggest BD patients have more maladaptive coping strategies, some of which can impact their illness course. Yet research on which coping strategies most influence disability is lacking. Such research could inform cognitive-behavioral targets to improve functional outcomes. Thus, we sought to identify relations between coping strategies and real-world function in BD. METHODS In 92 affectively-stable BD outpatients, we measured coping strategies via the Brief COPE, real-world disability via the World Health Organization Disability Assessment Schedule, current symptoms, illness chronicity, and neurocognitive functioning via the MATRICS. Multiple regression analysis served to identify the neurocognitive domains predictive of disability for entry into subsequent analyses. Multiple regressions assessed how adaptive and maladaptive coping strategies influenced disability. RESULTS Only one neurocognitive domain, verbal learning, significantly predicted disability and was included in subsequent analyses. Maladaptive coping significantly predicted disability while adaptive coping did not. Behavioral disengagement (giving up) and self-blame were the only remaining predictors of disability, after controlling for age, sex, illness chronicity, current symptoms, and neurocognitive functioning. LIMITATIONS The study was limited by the use of a self-report disability measure and a brief-form coping scale. CONCLUSIONS Results suggest that giving up and self-blame are significant predictors of real-world functioning beyond sub-threshold depressive symptoms. Our results in BD expand upon recent schizophrenia studies suggesting that defeatist beliefs negatively influence functional outcomes across the range of major psychiatric disorders.

MATRICS cognitive consensus battery (MCCB) performance in children, adolescents, and young adults

BACKGROUND Neurodevelopmental models of schizophrenia suggest that cognitive deficits may be observed during childhood and adolescence, long before the onset of psychotic symptoms. Elucidating the trajectory of normal cognitive development during childhood and adolescence may therefore provide a basis for identifying specific abnormalities related to the development of schizophrenia. The MATRICS Consensus Cognitive Battery (MCCB), which was designed for use in clinical trials targeting cognitive deficits most common in schizophrenia, may provide a mechanism to understand this trajectory. To date, however, there is no performance data for the MCCB in healthy children and adolescents. The present study sought to establish performance data for the MCCB in healthy children, adolescents, and young adults. METHODS The MCCB was administered to a community sample of 190 healthy subjects between the ages of 8 and 23years. All MCCB domain scores were converted to T-scores using sample means and standard deviations and were compared for significant performance differences between sex and age strata. RESULTS Analyses revealed age effects following quadratic trends in all MCCB domains, which is consistent with research showing a leveling off of childhood cognitive improvement upon approaching late adolescence. Sex effects after controlling for age only presented for one MCCB domain, with males exhibiting well-known spatial reasoning advantages. CONCLUSIONS Utilizing this performance data may aid future research seeking to elucidate specific deficits that may be predictive of later development of SZ.

Social cognition in patients with schizophrenia spectrum and bipolar disorders with and without psychotic features

Background Social cognition may be critical to the impoverished social functioning seen in serious mental illness. However, although social-cognitive deficits are consistently demonstrated in schizophrenia spectrum disorders (SSD), studies in bipolar disorder (BD) have produced inconsistent results. This inconsistency may relate to symptom profiles of patients studied, particularly the presence or absence of psychotic features. Thus, we examined social cognition in bipolar disorder with psychotic features (BD +) versus without psychotic features (BD −) relative to SSD and controls. Methods A sample of 537 SSD patients, 85 BD + patients, 37 BD − patients, and 309 controls were administered the MATRICS Consensus Cognitive Battery, including a social cognition measure, the managing emotions branch of the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). Analyses of covariance compared MSCEIT performance between diagnostic groups while controlling for race, psychotropic medication status, and neurocognition. Results SSD but not BD − or BD + patients showed significant MSCEIT deficits relative to controls. Conclusions MSCEIT deficits were found in SSD but not BD − or BD +, suggesting that social cognition may represent an underlying difference between SSD and BD. However, variance in MSCEIT performance among BD patients may also suggest latent BD subgroups characterized by social-cognitive deficits. Findings can help inform future investigations into how social cognition and social brain development differ between SSD and BD.

Dimensional symptom severity and global cognitive function predict subjective quality of life in patients with schizophrenia and healthy adults

Over the last several decades Quality of Life (QoL) has become increasingly important as an indicator of treatment outcomes; particularly in schizophrenia spectrum disorders because of its close association with functional disability. Numerous studies seeking to elucidate the factors that contribute to QoL in this population have implicated both symptom severity and cognition in determining QoL but the findings have been mixed. The critical factors that appear to impede the lack of consensus in the extant literature examining determinants of QoL include the heterogeneity of the samples and measures examined as well as medication effects across different studies. Thus, the present study sought to address some of these issues by examining the relationship between subjective QoL and both symptom severity and cognitive function in a relatively homogeneous patient sample of patients and a community control sample assessed for dimensional symptom severity. Our results suggest that both global cognitive function and psychiatric symptoms have a significant impact on the subjective QoL of both people with schizophrenia spectrum disorders and psychiatrically healthy adults. Specifically, we found that a global index of cognition as well as self-reported avolitional and depressive symptoms were significantly predictive of QoL in both samples. These findings highlight the importance of addressing cognitive, depressive and avolitional symptoms in the treatment of patients with schizophrenia spectrum disorders and suggest that improvements in these domains may have a meaningful impact on their overall QoL.

Young adult self-disclosures in psychotherapy and on Facebook

While psychotherapy offers young adults a private and confidential avenue for speaking about psychologically sensitive personal information, Facebook has recently emerged as a pervasive and culturally normative platform for personal disclosure. The present study investigated young adult clients’ levels of disclosure across these two contexts, variables (e.g. age and gender) associated with these disclosure patterns, and specific emotional experiences following disclosures in these two contexts. A repeated measures ANOVA indicated that Facebook disclosure occurred at significantly lower levels than psychotherapy disclosure for all gender and age groups under study. In addition, Facebook disclosure was found to be associated with positive emotions following posts, whereas therapy disclosure was significantly associated with negative emotions following therapy sessions. Findings suggest that disclosure across these two platforms serves different needs.

Effects of childhood trauma on adult moral decision-making: Clinical correlates and insights from bipolar disorder

BACKGROUND Childhood adversity has been shown to exert profound effects on basic psychological processes well into adulthood. Some of these processes, such as those related to reward and emotion, play critical roles in moral decision-making. As a population with high rates of childhood trauma as well as heterogenous clinical presentation, individuals with bipolar disorder (BD) constitute an enriched group in which to examine the correlates of trauma and other clinical variables with moral cognition. METHODS 62 euthymic BD patients and 27 controls responded to moral dilemma scenarios and completed the Childhood Trauma Questionnaire. RESULTS Results revealed a main effect of diagnosis on moral decision-making only when both personal force and an intention were required, indicating a more utilitarian style in BD patients relative to controls. Several interesting patterns also emerged regardless of diagnostic status. Higher ratings of physical neglect were significantly associated with higher ratings of acceptability (a utilitarian tendency) across dilemma types, and a similar pattern was observed at the trend level for experiences of emotional neglect. Significant main effects on moral decision-making were also observed for sex, illness duration, and history of psychotic features in the BD sample. LIMITATIONS The present study is limited by the self-reported nature of the CTQ and by the small number of trials of moral dilemmas. In addition, practical and clinical implications of the moral dilemmas paradigm are limited due to its abstract nature. CONCLUSIONS Our results indicate that certain clinical features as well as childhood maltreatment (in particular neglect) may significantly impact moral decision making in adult life. Surprisingly, childhood trauma was associated with a more utilitarian style, which is in the opposite direction from previous effects shown in PTSD. Although speculative, our results suggest that there may be a protective quality associated with utilitarian moral decision-making tendencies.

Social cognition moderates the relationship between neurocognition and community functioning in bipolar disorder

BACKGROUND Schizophrenia (SZ) studies suggest that neurocognition predicts functional outcome and that social cognition mediates this relationship. Bipolar disorder (BD) patients also have cognitive, social, and functional impairments but the relationship among these factors in BD is not well established. We assessed whether social cognition modulates the influence of neurocognition on community functioning in BD, as found in SZ. METHODS 200 BD patients and 49 healthy controls (HC) were administered and compared on a battery of tests assessing neurocognition, social cognition, and community functioning. We conducted a series of regression analyses to investigate potential mediation or moderation of social cognition on the relationship between neurocognition and community functioning. RESULTS BD patients performed worse on neurocognitive domains of processing speed, attention, verbal learning, and global neurocognition. Also, BD patients performed worse on theory of mind, the social cognition composite score, and community functioning. Neurocognition did not significantly predict functional outcome in our BD sample. However, we found a moderating effect of social cognition: among patients with poor social cognition, better neurocognition was associated with better community functioning, a relationship not seen in BD patients with good social cognition. LIMITATIONS The study was limited by a relatively small HC group and assessing one subtype of functioning status. CONCLUSIONS The relationship between neurocognition and community functioning in BD may be dependent on social cognition status, implying the presence of social cognitive heterogeneity. Results may be relevant to choosing proper treatment interventions depending on the patients social cognitive level.