Melisa V. Rempfer

The prevalence of night eating syndrome and binge eating disorder among overweight and obese individuals with serious mental illness

The prevalence of night eating syndrome (NES) and binge eating disorder (BED) was assessed among overweight and obese, weight-loss-seeking individuals with serious mental illness (SMI). Sixty-eight consecutive overweight (BMI > or = 25 kg/m(2)) and obese (BMI > or = 30 kg/m(2)) individuals with SMI (mean age = 43.9 years; mean BMI = 37.2 kg/(2); 67.6% Caucasian, 60.3% female) who were enrolled in a group behavioral weight loss treatment program were assessed at baseline for NES and BED with clinician-administered diagnostic interviews. Using conservative criteria, 25.0% met criteria for NES, 5.9% met criteria for BED, and only one participant met criteria for both NES and BED. This is the first study to find that obese individuals with SMI, compared with previously studied populations, are at significantly greater risk for NES, but are not at greater risk for BED. Stress, sleep, and medication use might account for the high prevalence of NES found in this population.

Learning proficiency on the Wisconsin Card Sorting Test in people with serious mental illness: What are the cognitive characteristics of good learners?

Although it is widely accepted that schizophrenia and other serious mental illnesses (SMI) are associated with neurocognitive difficulties, there is great variability in neurocognitive functioning across individuals. In recent years, a growing number of schizophrenia studies have utilized the concept of learning potential to explore individual variation in cognition. Learning potential refers to the ability to benefit from instruction and is measured by assessing test performance before and after training. The present study was intended to explore the cognitive characteristics associated with learning potential in people with serious mental illness. Sixty individuals with schizophrenia, bipolar or major (unipolar) depression completed a learning potential assessment using the Wisconsin Card Sorting Test (WCST) and a battery of standard cognitive measures. Based on established criteria for WCST learner subgroups, participants were categorized as high achievers, learners or non-retainers. There were several significant cognitive differences among the three learner subgroups. Most notably, individuals who were categorized as learners on the WCST showed significantly better verbal and working memory compared to non-retainers. Secondary analyses revealed that the three SMI diagnostic groups (depression, bipolar, schizophrenia) were similar in learning potential and did not differ on any of the standard cognitive measures. This study provides support for learning potential classification in schizophrenia as well as other serious mental illnesses, and indicates that learning potential may specifically be related to verbal and working memory abilities.

Health-Related Quality of Life and Overall Life Satisfaction in People with Serious Mental Illness

Quality of life (QoL) in people with schizophrenia and other serious mental illnesses (SMI) is an important outcome goal, yet there is no consistent definition of the construct. We examined three aspects of QoL in persons with SMI: overall life satisfaction, physical health-related QoL (HRQoL), and mental HRQoL. This study had two primary aims: first, to examine whether there are differences in physical and mental HRQoL in persons with SMI, and, second, to investigate the cognitive, clinical, and functional correlates of the three QoL indicators. Participants were 48 persons with SMI who completed assessments of QoL, cognition, functional capacity, psychiatric symptomatology, and medical comorbidity. Results indicate that participants experience similar levels of physical and mental HRQoL, and these two constructs are not related to one another. Physical HRQoL is associated with less medical comorbidity, while mental HRQoL is associated with negative and depressive symptoms. Overall life satisfaction was associated with fewer psychiatric symptoms and less medical comorbidity. This study adds to the important literature defining distinct domains of QoL and supports the necessity of addressing both physical and mental health factors as they relate to recovery and well-being among persons with SMI.

Patterns of association between performance in a natural environment and measures of executive function in people with schizophrenia

This study examined the relationships between a set of real-world performance measures and a set of executive function measures with a sample of community based individuals with schizophrenia (N=80). Participants were given a battery of cognitive tests and were evaluated with a real-world performance measure, the Test of Grocery Shopping Skills (TOGSS). Using canonical correlation analysis, executive functions of planning, problem solving, working memory, and task persistence were significantly related to grocery shopping efficiency and accuracy. Two canonical variates with moderate correlations (0.547 and 0.519) explain that 30% of the variance in the executive function and grocery shopping measures was shared. These results identify patterns of association between executive function performance and the independent living skill of grocery shopping indicating the Test of Grocery Shopping Skills may be considered a sensitive measure of executive function performance in a real-world setting.

Learning potential as a predictor of skill acquisition in people with serious mental illness.

Twenty-five individuals with serious mental illness completed a grocery shopping skills intervention and a test-train-test version of the Wisconsin Card Sorting Test (WCST), which yielded indices of static performance and learning potential. WCST learning potential predicted skill acquisition beyond the static index of traditional WCST performance.

Teaching Grocery Shopping Skills to People With Schizophrenia

A pilot study was conducted to determine if a grocery shopping intervention improved skills in people with schizophrenia. The intervention was designed to compensate for cognitive impairments by providing strategies that organize and simplify the task and the environment. Thirty-eight people with schizophrenia or schizoaffective disorder completed at least six of the nine sessions of the intervention. A pretest/posttest comparison indicated that participants improved in accuracy and redundancy but not in time. The results support the efficacy of the intervention. Future research will include cognitive predictors of skill acquisition, comparisons with a control group, and an extension of the outcome measures.

Measuring learning potential in people with schizophrenia: A comparison of two tasks

Learning potential measures utilize dynamic assessment methods to capture performance changes following training on a cognitive task. Learning potential has been explored in schizophrenia research as a predictor of functional outcome and there have been calls for psychometric development in this area. Because the majority of learning potential studies have utilized the Wisconsin Card Sorting Test (WCST), we extended this work using a novel measure, the Rey Osterrieth Complex Figure Test (ROCFT). This study had the following aims: 1) to examine relationships among different learning potential indices for two dynamic assessment tasks, 2) to examine the association between WCST and ROCFT learning potential measures, and 3) to address concurrent validity with a performance-based measure of functioning (Test of Grocery Shopping Skills; TOGSS). Eighty-one adults with schizophrenia or schizoaffective disorder completed WCST and ROCFT learning measures and the TOGSS. Results indicated the various learning potential computational indices are intercorrelated and, similar to other studies, we found support for regression residuals and post-test scores as optimal indices. Further, we found modest relationships between the two learning potential measures and the TOGSS. These findings suggest learning potential includes both general and task-specific constructs but future research is needed to further explore this question.

State anxiety as a moderator of real world grocery shopping performance among people with serious mental illness

Anxiety is frequently overlooked as a factor when examining task performance among individuals with serious mental illness. Given the known effects of anxiety on performance in general populations, it is important to examine anxiety and performance within a serious mental illness population. This study examined state anxiety during a grocery-shopping task among 106 individuals diagnosed with a serious mental illness. Results indicate that state anxiety may impact task performance through its relationship with knowledge about grocery-shopping skills. These data suggest the need to examine further the impact of anxiety on task performance in serious mental illness. Furthermore, the identification and treatment of anxiety in persons with SMI may serve to improve functional outcomes and rehabilitation efforts.

S97. SOCIAL ANXIETY IN SCHIZOPHRENIA: THE IMPACT OF HALLUCINATIONS AND SELF-ESTEEM SUPPORT

Abstract Background Social anxiety is an underreported concern in schizophrenia (SCZ). Prevalence rates in the general population range from 0.5–7% (APA, 2013), but are higher in SCZ, and estimated to be 11–36% (Mazeh et al., 2009; Pallanti et al., 2004). Yet, research is limited with no established social anxiety treatments. Social anxiety is associated with decreased quality of life (Hansson, 2006), low self-esteem (Gumley et al., 2005), and increased psychopathology (Vrbova et al., 2017). Lysaker and Hammersley (2006) found that people with delusions and impairment in flexibility had the highest levels of social anxiety compared to those with fewer symptoms. Additionally, Lysaker et al. (2010) found that people with both high paranoia and theory of mind had higher social anxiety compared to those with lower levels of either paranoia or theory of mind. Taken together, this research suggests that symptoms may increase social anxiety, but other factors may inhibit their impact. The current study aims to add to this literature by exploring how different levels of hallucinations and self-esteem support affect social anxiety in SCZ. Methods Outpatients with SCZ (N=50) participated in the current study. Participants were 76% male with a mean age of 42.50. Participants were African-American (n=27; 54%), Caucasian (n=11; 22%), multi-racial (n=5; 10%), Asian (n=4, 8%), or Hispanic (n=3; 6%). Social fear, social avoidance, and overall social anxiety was measured with the Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987). Self-esteem support (SeS) was measured with a subscale taken from the Interpersonal Support Evaluation List (ISEL; Cohen & Hoberman, 1983). SeS is the appraisal of the self compared with others and other’s opinions of the self. Hallucinations (HA) were scored with the observer-rated Scale for Assessment of Positive Symptoms (SAPS; Andreasen, 1983). Participants were classified as having hallucinations if their SAPS global hallucinations were rated moderate to severe. This was chosen a priori as it reflects a level of clear hallucinations that may bother the person to some extent, as defined within the SAPS. Participants were classified as having either high or low SeS based on a mean split of the distribution of scores. Once participants were classified, we planned to compare groups on levels of social anxiety. This method was modified from previous research reporting similar groupings of symptoms and their relationship to social anxiety (Lysaker & Hammersley, 2006). Results Four groups resulted after including the dichotomized variables with the following proportions: low SeS/no HA (n=6; 12.5%), low SeS/HA (n=11, 22.9%), high SeS/no HA (n=13; 27.1%), and high SeS/HA (n=18, 37.5%). A one-way ANOVA was conducted to analyze the differences between groups. Post-Hoc analyses revealed the following differences. The HA/low SeS group had higher social anxiety than in the no HA/high SeS group (p=.030) and no HA/low SeS group (p=.039). The HA/low SeS group had higher social fear (p=.017) and social avoidance (p=.013) than in the no HA/high SeS group. There was a trending difference revealing that participants in the HA/low SeS group had higher social avoidance than in the HA/high SeS group (p=.056). There was a trending difference revealing that the HA/low SeS group had greater overall social anxiety than those in the HA/high SeS group (p=.064). Discussion These results present preliminary findings on social anxiety in people with different levels of HA and SeS. We found that people with low SeS and HA had significantly higher levels of social anxiety, social fear, and social avoidance than participants with only one of neither of these symptoms. These results will be discussed further to highlight implications to treatment and comorbidities in SCZ.

Comparison of performance-based assessment and real world skill in people with serious mental illness: Ecological validity of the Test of Grocery Shopping Skills

Valid functional measures are essential for clinical and research efforts that address recovery and community functioning in people with serious mental illness. Although there is a great deal of interest in functional assessment, there is limited research supporting how well current evaluation methods provide a true assessment of real world functioning or naturalistic behavior. To address this gap in the literature, the present study examined the performance of individuals with serious mental illness (i.e., diagnosis of schizophrenia-spectrum, bipolar disorder, or other depression/anxiety diagnoses and accompanying functional disability) on the Test of Grocery Shopping Skills (TOGSS), a performance-based naturalistic task. We compared TOGSS performance to two dimensions of real world functioning: directly observed real world grocery shopping and ratings of community functioning. Results indicated that the TOGSS was significantly associated with real life grocery shopping, in terms of both shopping accuracy (r = 0.424) and time (r = 0.491). Further, self-report and observer-rated methods of assessing real world shopping behaviors were significantly correlated (r = 0.455). To our knowledge, this is one of the first studies to directly compare a performance-based naturalistic skill assessment with carefully observed real world performance of that skill in people with serious mental illness. These findings support the feasibility and ecological validity of performance-based naturalistic assessment with the TOGSS.