John M. Gray

Comprehension of irony in Schizophrenia

It has been proposed that the disordered communicative ability, as well as other signs and symptoms, observed in schizophrenia can be at least partly attributed to an impaired ability to make inferences about the mental state of others, or theory of mind (Frith, 1992). This ability is necessary for the successful understanding of utterances in which the intended and literal meanings differ (e.g. metaphor and irony), in which the listener must go beyond the literal decoding of the spoken words to perceive the speakers intended meaning and sentiments (Sperber & Wilson, 1986). Comprehension of communicative intent in schizophrenia was investigated by comparing the performance of a group of chronic schizophrenics on a task assessing comprehension of irony with the performance of a psychiatric control group. As predicted, the schizophrenic group made more misinterpretations of ironic utterances as literal than the control group, who performed at ceiling levels. This difference could not be attributed to diffe...

Bipolar patients show mood-congruent biases in sensitivity to facial expressions of emotion when exhibiting depressed symptoms, but not when exhibiting manic symptoms.

Introduction A number of studies have reported mood‐congruent biases in processing facial expressions of emotion in depression and mania. Most of them have failed to establish that mood reliably affects relevant more than irrelevant expressions, or that the effect is specifically mood‐related rather than due to resource or task difficulty artefacts. The aim was to examine, using appropriate statistical methods, whether depressed mood in bipolar patients decreases and manic mood increases sensitivity to facial expressions of happiness and vice versa for facial expressions of negative emotion. Methods Sensitivity to facial expression of six basic emotions in bipolar patients when depressed and when manic was compared to closely matched controls. Results Mood‐related biases in sensitivity to facial expressions of happiness and of negative affect in general operate in persons with bipolar disorder when depressed. There is little evidence of similar biases in persons with bipolar disorder when manic. Conclusions These data show a mood‐congruent bias in sensitivity to facial expressions in bipolar depressed patients.

Executive and visuospatial sketchpad resources in euthymic bipolar disorder: Implications for visuospatial working memory architecture

Visuospatial working memory theory is used to interpret the cognitive impairment in euthymic bipolar disorder. Such patients show deficits in the Corsi Blocks Test (CBT) and executive control. To understand these deficits, 20 euthymic bipolar patients and controls were administered the CBT, Visual Patterns Test (VPT), and a new visual memory task designed to make minimal demands on executive resources. Initial analyses validated the visual memory task and implicated executive involvement in the CBT and VPT. Subsequent analyses on a number of tests confirmed CBT and executive deficits while performance was normal on the VPT and visual memory test. ANCOVA indicated that impaired executive function underpinned patients’ CBT performance. Implications for the interface between executive and slave systems of working memory are discussed.

Neurocognitive Function Following Remission in Major Depressive Disorder: Potential Objective Marker of Response?

Objective: Neurocognitive deficits have been widely reported in patients with mood disorders. However, relatively little is known of the short-term trajectory of neurocognitive improvement once treatment has been initiated. Method: A neurocognitive test battery was administered to unipolar depressed (major depressive disorder, MDD) patients (aged 18–65 years) who had been medication-free for at least 6 weeks, and to healthy controls. Patients were then treated according to clinical need, predominantly with standard pharmacotherapy, and all participants were followed up within 6 months. Results: Of the 25 MDD patients who returned at follow up, 11 were defined as remitted and 14 as not remitted. Significantly less baseline psychomotor dysfunction was observed in patients who remitted compared to those who did not (effect size, d =0.78, 95% confidence interval (CI) =0.07–1.44). Analysis of the change scores between assessments revealed a significantly greater improvement in verbal memory in patients who remitted compared to those who did not (d =0.73, 95%CI =0.03–1.39). Conclusions: This preliminary report suggests that there may be distinct temporal trajectories of neurocognitive improvement following remission in MDD. Aspects of neurocognitive functioning should be examined further as a means of providing a useful objective marker of treatment response.

Neurocognitive functioning in bipolar depression: a component structure analysis.

BACKGROUND Previous studies of neurocognitive performance in bipolar disorder (BD) have focused predominantly on euthymia. In this study we aimed to compare the neurocognitive profile of BD patients when depressed with healthy controls and explore the component structure of neurocognitive processes in these populations. METHOD Cognitive tests of attention and executive function, immediate memory, verbal and visuospatial learning and memory and psychomotor speed were administered to 53 patients with a SCID-verified diagnosis of BD depression and 47 healthy controls. Test performance was assessed in terms of statistical significance, effect size and percentile standing. Principal component analysis (PCA) was used to explore underlying cognitive factor structure. RESULTS Multivariate analysis revealed an overall group effect, depressed BD patients performing significantly worse than controls. Patients performed significantly worse on 18/26 measures examined, with large effect sizes (d > 0.8) on tests of speed of processing, verbal learning and specific executive/working memory processes. Almost all tests produced at least one outcome measure on which ∼25-50% of the BD sample performed at more than 1 standard deviation (s.d.) below the control mean. Between 20% and 34% of patients performed at or below the fifth percentile of the control group in working memory, verbal learning and memory, and psychomotor/processing speed. PCA highlighted overall differences between groups, with fewer extracted components and less specificity in patients. CONCLUSIONS Overall, neurocognitive test performance is significantly reduced in BD patients when depressed. The use of different methods of analysing cognitive performance is highlighted, along with the relationship between processes, indicating important directions for future research.

The effect of self-monitoring on Wisconsin Card Sorting Test performance in euthymic patients with bipolar disorder: a pilot study

ABSTRACT Objectives: Euthymic patients with bipolar disorder (BD) show executive impairment. Assisting cognitive function with non-pharmacological strategies has not been widely explored in BD. In schizophrenia, concomitant verbalisation (self-monitoring) during executive tests improved performance. The present pilot study assesses the effects of self-monitoring whilst completing the Wisconsin Card Sorting Test (WCST) in BD patients. Methods: Thirty-six euthymic BD patients and 42 healthy controls participated. Twenty patients with BD and 20 controls received standard administration and 16 patients and 22 controls used self-monitoring during the test. Results: ANCOVA revealed a significant “group by administration” interaction. Patients who received the standard administration were significantly worse than healthy controls (trials administered: p = .012, η p 2 = 0.17; trials to first category: p = .046, η p 2 = 0.11; failure to maintain set: p = .003, η p 2 = 0.23). BD patients who self-monitored performed significantly better than patients receiving the standard administration (trials to first category: p = .020, η p 2 = 0.17) and showed no significant differences in performance compared to controls. Conclusion: Self-monitoring deserves further investigation as a tool that may be helpful for patients with BD. Further exploration of the utility, generalisability, and stability of the effects of self-monitoring is needed.

Empirical indices of spatial and executive processes in visuo-spatial working memory

A prominent part in the development of the theory of visuo-spatial working memory has been played by techniques such as the Corsi Blocks task. A study on a wide variety of WM tasks using a patient group, bipolar patients in the euthymic stage, indicates that the group is relatively disadvantaged on the Corsi Blocks task. However, patients are also disadvantaged on tasks involving executive processes while visual task processes are spared. A number of regression analyses clearly indicates that the Corsi task disadvantage can be explained by the executive deficit and suggest that tasks that purportedly index spatial processes may be better considered to be dependent on the executive processes. Implications for the development of visuo-spatial working memory theory are discussed.