YanYan Wei

Correlation of social cognition and neurocognition on psychotic outcome: a naturalistic follow-up study of subjects with attenuated psychosis syndrome

Neurocognitive decline has been observed in patients with psychosis as well as attenuated psychosis syndrome (APS). We tested the hypothesis that APS increases dependence on neurocognition during the interpretation of others’ mental states and that a combination index of Theory of Mind (ToM) and neurocognition improves the predictive accuracy of psychosis conversion. A sample of 83 APS individuals and 90 healthy controls (HC) were assessed by comprehensive cognitive tests. The cohort also completed a one-year follow-up. In the APS group, ToM was associated with an apparent increase in neurocognition, but this trend was not evident in the HC group. Using the new index of combined neurocognition and ToM scores, the sensitivity for predicting psychosis-proneness was 75% and the specificity was 69%. Our data suggest that the correlations between ToM function and neurocognition in APS subjects were stronger than those in healthy controls. A composite index of neurocognition and ToM could improve the predictive validity of a future conversion to psychosis.

Progressive decline of cognition during the conversion from prodrome to psychosis with a characteristic pattern of the theory of mind compensated by neurocognition

The association between neurocognition and the theory of mind (ToM) abilities during the progression of psychosis is unclear. This study included 83 individuals with attenuated psychosis syndrome (APS), from which 26 converted to psychosis (converters) after a follow up period of 18months. Comprehensive cognitive tests (including MATRICS Consensus Cognitive Battery, Faux-Pas Task, and Reading-Mind-in-Eyes Tasks) were administered at baseline. A structural equation modeling (SEM) analysis was conducted to estimate the effects of neurocognition on the ToM functioning in both APS and healthy controls (HC) datasets. At baseline, the converters and non-converters groups differed significantly on several domains of cognitive performance. The SEM analysis demonstrated that the path from neurocognition to ToM was statistically significant in the APS dataset (p<0.001). However, in the HC dataset, the result of the same analysis was not significant (p=0.117). Positive correlations between neurocognition and ToM were observed, and the most obvious correlations were found in the converters group compared with the non-converters group (p=0.064) and compared with the HC group (p=0.002). The correlation between ToM abilities and neurocognition may be increased during the progression of the condition, especially for individuals who convert to psychosis after a short period.

Isolated hallucination is less predictive than thought disorder in psychosis: Insight from a longitudinal study in a clinical population at high risk for psychosis

Perceptual abnormalities (PAs) such as auditory hallucinations are one of the most common symptoms of psychotic patients. However, it remains unclear whether symptoms of sub-clinical PAs also play a key role in predicting psychosis. In an ongoing prospective follow-up study of individuals at a clinical high risk (CHR) of psychosis, we evaluated the potential of first-time experience of PAs and/or thought content disorders (TCDs) to predict psychosis. Conversion to psychosis was the major focus of this follow-up study. A total of 511 CHRs were recruited, of whom 443 (86.7%) completed the clinical follow-up of at least 6 months and up to 2 years. CHRs were divided into four groups according to the presence of PAs and/or TCDs. At the follow-up endpoint, 39 (19.9%) CHRs in the “TCDs-only” group, 2 (8.3%) in the “PAs-only” group, 45 (17.0%) in the “TCDs-and-PAs” group, and 1 (3.8%) in the “None” group converted to psychosis. Survival analysis revealed a higher conversion rate in CHRs with TCDs compared with those with PAs only. CHRs with isolated PAs had shown a higher level of dysphoric mood at baseline compared with those with TCDs. About 89% TCDs contents were related with their experienced PAs. Compared with TCDs, the isolated PAs are not strongly associated with increased susceptibility to psychosis.

Identification and prediction of clinical high risk of psychosis in Chinese outpatients using two-stage screening

Two-stage screening, involving a self-rating report, followed by a structured interview, has been proposed for identifying clinical high risk of psychosis (CHR) for nearly two decades. This study used PRIME Screen-Revised (PS-R) and Structured Interview for Prodromal Syndromes (SIPS) to investigate the predictive validity of the two-stage screening. Of 566 participants who completed two-stage screening in this study, 192 were PS-R(-) and 374 were PS-R(+). After being interviewed with SIPS, 112 were rated as CHR(+), 109 were diagnosed with psychosis, and the other 345 individuals were CHR(-). Those who were rated through SIPS as CHR(+) and CHR(-) were followed up within 2 years to observe their clinical outcome. Ninety one (81.3%) CHR(+) and 171 (49.6%) CHR(-) individuals completed the investigation at baseline and the two-year follow-up. The cumulative conversion rate to psychosis was 27.5% in CHR(+) group, but only 1.7% in CHR(-) group, with a significant difference between the two groups (log-rank test, χ2 = 30.07, p < 0.001). In terms of two-stage screening, PS-R(-)/CHR(-), PS-R(-)/CHR(+), and PS-R(+)/CHR(-) groups were viewed as expected negative (EN), and the PS-R(+)/CHR(+) group as expected positive (EP), and the sensitivity and specificity was 64.3% and 79.1%, respectively. Furthermore, Kaplan-Meyer survival analysis showed that EP group were more likely to convert to psychosis than EN group (log-rank test, χ2 = 16.702, p < 0.001). Two-stage screening indeed saves much time and alleviates the workload, but may exclude some target individuals. Optimizing self-report scale, and forming a nurse-doctor-interviewer coalition are likely to improve the use of self-rating report and structured interview.

Changes in correlation characteristics of time consumption and mind-reading performance in pre-onset and post-onset psychosis

There is a strong correlation between neurocognition and social cognition. However, none of these studies have examined the key role of time consumption during social cognition tasks. Participants included 84 individuals with clinical high risk of psychosis (CHR), 95 healthy controls (HC), and 66 case controls (schizophrenia patients, SZ), who were assessed through the Reading-Mind-in-Eyes Tasks (RMET) with computerized recording of the response time (RT). Neurocognitive tests were also performed for the HC and CHR groups. A comparison of RMET performance revealed significantly lower scores in the SZ group compared to the HC group, with CHR individuals scoring between these two. However, both CHR and SZ subjects spent almost twice as long of the time on RMET compared to the HC subjects. Significant positive correlation was found between RMET accuracy and RT, though only in SZ patients. Taking the RT into consideration, the RMET performances were impacted by different neurocognition domains. Our findings provide new evidence about how time consumption in mind-reading may impact the relationship between social cognition and neurocognition, and we discuss the potential importance of recording the response time during social cognition assessment in individuals with early psychosis.

Add-on rTMS for the acute treatment of depressive symptoms is probably more effective in adolescents than in adults: Evidence from real-world clinical practice

BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is considered as an effective treatment for adults with major depressive disorder. However, it remains unknown whether rTMS has comparable or better efficacy in adolescents. OBJECTIVE The current naturalistic study aimed to investigate the efficacy and clinical outcome of add-on rTMS in a large sample of adolescent patients compared to adult patients. METHODS This study included 117 patients (42 adolescents vs. 75 adults) with mood or anxiety disorders who were treated with at least 10 sessions of rTMS. rTMS was applied over the left dorsolateral prefrontal cortex (10 Hz). Symptoms of depression and anxiety were measured using the Hamilton Rating Scale for Depression (HAMD) and the Hamilton Rating Scale for Anxiety (HAMA) respectively, at baseline and after 2 and 4 weeks of follow-up. Comparisons of clinical improvement and rates of response/remission were made across age groups. MAJOR FINDINGS AND CONCLUSIONS All the age groups showed significant improvements in clinical symptoms. No safety or tolerability concerns were identified. Symptomatic improvements and response/remission rates were more significant in adolescent patients than in adults. Decrease in HAMD and HAMA scores after 2 weeks and 4 weeks of rTMS treatment were positively correlated in adolescents, but not in adults. General linear model repeated measures demonstrated significant effect of time × age group interaction on the HAMD score, in response to 10 sessions of rTMS. Add-on rTMS is feasible, tolerable, effective and more applicable to adolescents with mood or anxiety disorders. However, double-blinded and sham-controlled trials are needed for validating this conclusion.