Does Zinc Moderate Essential Fatty Acid and Amphetamine Treatment of Attention-Deficit/Hyperactivity Disorder?

Zinc is an important co-factor for metabolism relevant to neurotransmitters, fatty acids, prostaglandins, and melatonin, and indirectly affects dopamine metabolism, believed intimately involved in attention-deficit/hyperactivity disorder (ADHD). To explore the relationship of zinc nutrition to essential fatty acid supplement and stimulant effects in treatment of ADHD, we re-analyzed data from an 18-subject double-blind, placebo-controlled crossover treatment comparison of d-amphetamine and Efamol (evening primrose oil, rich in gamma-linolenic acid). Subjects were categorized as zinc-adequate (n = 5), borderline zinc (n = 5), and zinc-deficient (n = 8) by hair, red cell, and urine zinc levels; for each category, placebo-active difference means were calculated on teachers' ratings. Placebo-controlled d-amphetamine response appeared linear with zinc nutrition, but the relationship of Efamol response to zinc appeared U-shaped; Efamol benefit was evident only with borderline zinc. Placebo-controlled effect size (Cohen's d) for both treatments ranged up to 1.5 for borderline zinc and dropped to 0.3-0.7 with mild zinc deficiency. If upheld by prospective research, this post-hoc exploration suggests that zinc nutrition may be important for treatment of ADHD even by pharmacotherapy, and if Efamol benefits ADHD, it likely does so by improving or compensating for borderline zinc nutrition

Black Bear Sideliner, vol. 2, no. 4

Black Bear Sideliner biannual newsletter produced by UMaine Athletics

Self-assessment of social cognitive ability in individuals with schizophrenia: Appraising task difficulty and allocation of effort

Patients with severe mental illnesses manifest substantial deficits in self-assessment of the abilities that impact everyday functioning. This study compares patients with schizophrenia to healthy individuals on their social cognitive performance, their assessment of that performance, and the convergence between performance and indicators of effort in solving tasks. Patients with schizophrenia (n=57) and healthy controls (HC; n=47) completed the Bell-Lysaker Emotion Recognition Test (BLERT), a psychometrically sound assessment of emotion recognition. Participants rated their confidence in the accuracy of their responses after each item. Participants were instructed to respond as rapidly as possible without sacrificing accuracy; the time to complete each item was recorded. Patients with schizophrenia performed less accurately on the BLERT than HC. Both patients and HC were more confident on items that they correctly answered than for items with errors, with patients being less confident overall; there was no significant interaction for confidence between group and accuracy. HC demonstrated a more substantial adjustment of response time to task difficulty by taking considerably longer to solve items that they got wrong, whereas patients showed only a minimal adjustment. These results expand knowledge about both self-assessment of social cognitive performance and the ability to appraise difficulty and adjust effort to social cognitive task demands in patients with schizophrenia

Social Cognition Psychometric Evaluation: Results of the Initial Psychometric Study

Measurement of social cognition in treatment trials remains problematic due to poor and limited psychometric data for many tasks. As part of the Social Cognition Psychometric Evaluation (SCOPE) study, the psychometric properties of 8 tasks were assessed. One hundred and seventy-nine stable outpatients with schizophrenia and 104 healthy controls completed the battery at baseline and a 2–4-week retest period at 2 sites. Tasks included the Ambiguous Intentions Hostility Questionnaire (AIHQ), Bell Lysaker Emotion Recognition Task (BLERT), Penn Emotion Recognition Task (ER-40), Relationships Across Domains (RAD), Reading the Mind in the Eyes Task (Eyes), The Awareness of Social Inferences Test (TASIT), Hinting Task, and Trustworthiness Task. Tasks were evaluated on: (i) test-retest reliability, (ii) utility as a repeated measure, (iii) relationship to functional outcome, (iv) practicality and tolerability, (v) sensitivity to group differences, and (vi) internal consistency. The BLERT and Hinting task showed the strongest psychometric properties across all evaluation criteria and are recommended for use in clinical trials. The ER-40, Eyes Task, and TASIT showed somewhat weaker psychometric properties and require further study. The AIHQ, RAD, and Trustworthiness Task showed poorer psychometric properties that suggest caution for their use in clinical trials

Revisiting the validity of measures of social cognitive bias in schizophrenia : Additional results from the Social Cognition Psychometric Evaluation (SCOPE) study

Objective The ongoing Social Cognition Psychometric Evaluation (SCOPE) study is in the process of forming a gold-standard battery of social cognition tests for use in clinical trials. Previous SCOPE phases have not acknowledged key differences between social cognition skills and biases, and psychometric validity analyses might provide important information if tailored to bias-related outcomes. This study aims to validate these measures with such bias-related outcomes. Methods Two measures of social cognitive bias – the Ambiguous Intention Hostility Questionnaire (AIHQ; hostile attribution bias) and Trustworthiness Task (distrust bias) – were reviewed according to their relationships to (1) current and prospective symptom levels, (2) questionnaires of trait paranoia and hostility and informant-rated hostility, (3) interpersonal conflict, as well as (4) relationships to measures of trait paranoia, hostility, and interpersonal conflict above and beyond the influence of clinically rated symptoms. Results Results supported hypotheses that social cognitive bias provides information about cognition, symptoms, and functioning related to interpersonal conflict. Each bias demonstrated relationships to trait paranoia questionnaires, hostility, or interpersonal conflict outcomes, and these persisted above and beyond the influence of clinically rated symptoms. Hostile attribution bias also predicted change in symptom levels over a brief interval. Conclusions Overall, the current bias-specific psychometric analysis provides support for continued study of social cognitive biases. Practitioner points • Hostile attribution bias may play a role in important outcome variables given relationships to emotional discomfort and suspiciousness symptoms, trait paranoia and hostility, interpersonal conflict, as well as prospective hostility symptoms. • Distrust bias may also impact real-world functioning, as it is related to hostility, suspiciousness, and positive symptoms, trait paranoia, and hostility. • Relationships of social cognitive biases to interpersonal conflict outcomes exist independently of interview-rated symptoms and persist above and beyond the influence of social cognitive skills, which appear to demonstrate weaker relationships to these outcomes. • Understanding and assessing the individual's biases towards distrust or blame might help practioners predict interpersonal conflict and future increases in symptoms

A Middle School One-to-One Laptop Program: The Maine Experience

Over eight years ago, Maine embarked on a bold new initiative. Entitled the Maine Learning Technology Initiative (MLTI), this program funded by the State of Maine, provided all 7th and 8th grade students and their teachers with laptop computers, and provided schools and teachers with a wireless internet infrastructure, technical assistance, and professional development for integrating laptop technology into their curriculum and instruction. The first full implementation of MLTI began in the Fall of the 2002-03 academic year. At the same time the Maine commissioner of education contracted with the Maine Education Policy Research Institute (MEPRI) to conduct the ongoing evaluation of MLTI. MEPRI is a non-partisan research institute funded jointly by the Maine State Legislature and the University of Maine System. Over the past eight years the MEPRI research and evaluation team has used a mixed method approach in the evaluation of the MLTI program; an approach that uses both quantitative and qualitative techniques in collecting and analyzing research and evaluation evidence. The evidence presented in this report indicates the MLTI program has had a significant impact on curriculum, instruction, and learning in Maine’s middle schools. In the areas of curriculum and instruction, the evidence indicates many teachers have reached the tipping point in the adoption and integration of the laptop into their teaching. However, the adoption is uneven for some teachers, and in some content areas. Relatively speaking, mathematics teachers use the laptops less frequently than their colleagues in other core disciplines. Most teachers are not using the laptops as frequently in assessment as one might anticipate, and too few teachers report using the laptop in teaching 21st Century Skills

Update to the study protocol Face Your Fears:Virtual reality-based cognitive behavioral therapy (VR-CBT) versus standard CBT for paranoid ideations in patients with schizophrenia spectrum disorders: a randomized clinical trial

We unfortunately need to make an update to our published study protocol that describes a significant change in the design of the study. The Committee on Health Research Ethics of the Capital Region Denmark recently rejected the approval of changing the primary outcome in the trial, on the invariable grounds that the trial has already commenced. It is therefore necessary to retain the Green Paranoid Thought Scale (GPTS) part B, ideas of persecution, as our primary outcome, and GPTS part A, ideas of social reference, as a secondary outcome, which is described opposite in our published study protocol. The exchange of outcomes has not affected participation in our trial or the informed consent. Intervention in both groups and assessments are unchanged. The two outcomes together constitute GPTS and the unifying concept we attempt to treat, namely paranoid ideations. As this is a blinded, methodologically rigorous trial, we did not have—and still do not have—access to preliminary data, and therefore, we have no knowledge of the distribution of our two intervention groups nor the potential effect of the intervention. The power calculation remains unchanged irrespective of the selection of the primary outcome. We have been fully transparent with the changes in primary and secondary outcomes on ClinicalTrials.gov throughout the trial. Due to the considerations mentioned above, we assumed that there would not be any ethical implications of the change of primary outcome. We sincerely apologize for the irregularity caused because of this assumption. Trial registration: ClinicalTrials.gov NCT04902066. Initial release April 19th, 2021.</p

Intact implicit processing of facial threat cues in schizophrenia

An emerging body of research suggests that people with schizophrenia retain the ability to implicitly perceive facial affect, despite well-documented difficulty explicitly identifying emotional expressions. It remains unclear, however, whether such functional implicit processing extends beyond emotion to other socially relevant facial cues. Here, we constructed two novel versions of the Affect Misattribution Procedure, a paradigm in which affective responses to primes are projected onto neutral targets. The first version included three face primes previously validated to elicit varying inferences of threat from healthy individuals via emotion-independent structural modification (e.g., nose and eye size). The second version included the threat-relevant emotional primes of angry, neutral, and happy faces. Data from 126 participants with schizophrenia and 84 healthy controls revealed that although performing more poorly on an assessment of explicit emotion recognition, patients showed normative implicit threat processing for both non-emotional and emotional facial cues. Collectively, these results support recent hypotheses postulating that the initial perception of salient facial information remains intact in schizophrenia, but that deficits arise at subsequent stages of contextual integration and appraisal. Such a breakdown in the stream of face processing has important implications for mechanistic models of social cognitive impairment in schizophrenia and treatment strategies aiming to improve functional outcome

Face Your Fears: Virtual reality-based cognitive behavioral therapy (VR-CBT) versus standard CBT for paranoid ideations in patients with schizophrenia spectrum disorders:a randomized clinical trial

Background: Schizophrenia spectrum disorders cause suffering for patients, relatives, and the surrounding society. Paranoid ideations, encompassing ideas of social reference and manifest persecutory delusions, are among the most frequent symptoms in this population and a cause of significant distress. Recent meta-analyses of cognitive behavioral therapy (CBT) for psychosis show small to moderate effect sizes in reducing paranoid ideations. Virtual reality-based CBT (VR-CBT) could improve therapy efficacy as exposure and behavioral experiments in VR can be optimized, individualized, and carried out in a safe environment. Few VR-CBT studies exist for paranoid ideations and there is a need for large-scale, methodologically rigorous trials. Methods: This study is a randomized, assessor-blinded parallel-groups multi-center superiority clinical trial, fulfilling the CONSORT criteria for non-pharmacological treatment. A total of 256 patients diagnosed with schizophrenia spectrum disorder, including schizotypal disorder (ICD-10 F20-29), will be allocated to either 10 sessions of symptom-specific CBT-VR plus treatment as usual-versus 10 sessions of standard symptom-specific CBT for paranoid ideations (CBT) plus treatment as usual. All participants will be assessed at baseline, treatment end (3 months post baseline), and then 9 months post baseline. A stratified block-randomization with concealed randomization sequence will be conducted. Independent assessors blinded to the treatment will evaluate the outcome. Analysis of outcome will be carried out with the intention to treat principles. The primary outcome is ideas of social reference measured with Green Paranoid Thought Scale Part A (GPTS-A) at the cessation of treatment at 3 months post baseline. Secondary outcomes are ideas of persecution (GPTS-B), Social Interaction Anxiety Scale (SIAS), Personal and Social Performance scale (PSP), Safety Behavior Questionnaire (SBQ), and CANTAB Emotion Recognition Task. Discussion: The trial will elucidate whether VR-CBT can enhance therapy efficacy for paranoid ideations. Additionally, Trial findings will provide evidence on the effectiveness and cost-effectiveness of VR-CBT for paranoid ideations that can guide the possible dissemination and implementation into clinical practice