The results of cognitive training in schizophrenic patients

Some schizophrenic patients are characterized by cognitive deficits. These deficits are independent of the duration of the illness and seem remarkably stable after the onset of the illness. There is no progressive deterioration into a defect state. The degree to which a patient has cognitive deficits is related to outcome. Those patients with most serious cognitive disturbances have the poorest prognosis. If clinicians could rehabilitate cognitive function, this might result in a better outcome too. So, from a clinical point of view, rehabilitation training of cognitive function is highly relevant. Some negative symptoms such as slowness are very stable over the years, while other negative symptoms such as poverty of speech and flattening of affect can improve by an adequate psychosocial (ward) climate. We presume the same to be true for cognitive deficits. Some will be persistent and associated with the biological vulnerability of the patient, while others are open to rehabilitation. ... Zie: Summar

The Effectiveness of Transdiagnostic Applications of Competitive Memory Training (COMET) on Low Self-Esteem and Comorbid Depression:A Meta-analysis of Randomized Controlled Trials

Background: Low self-esteem is a relevant transdiagnostic condition in the etiology, manifestation, and aggravation of different types of psychopathology. While low self-esteem is expected to ameliorate automatically after successful treatment of the principal emotional disorder the patient is suffering from, this does not always happen. Therefore, several specific interventions for enhancing low self-esteem have been developed, amongst them competitive memory training or COMET. The current meta-analysis investigated the efficacy of COMET in a variety of patient populations. Methods: Several databases were simultaneously examined after which 11 randomized COMET studies were identified. They encompassed a total of 662 patients with a diversity of emotional disorders of whom 344 had been treated in the experimental COMET conditions. Effects of COMET were expressed as Hedges’ g and were assessed on self-esteem and comorbid depression. When heterogeneity or publication bias were detected, original outcomes were corrected. Results: Low self-esteem was enhanced (g = 0.50; after correction g = 0.61), while comorbid depression was reduced (g = 0.68; after correction g = 0.54). Conclusions: COMET is a promising transdiagnostic intervention producing moderate enhancements in low self-esteem and moderate reductions in comorbid depression compared to control conditions in a variety of emotional disorders. Study Registration: Prospero ID: CRD42021237905

Anxiety Partially Mediates Cybersickness Symptoms in Immersive Virtual Reality Environments

The use of virtual reality (VR) in psychological treatment is expected to increase. Cybersickness (CS) is a negative side effect of VR exposure and is associated with treatment dropout. This study aimed to investigate the following: (a) if gender differences in CS can be replicated, (b) if differences in anxiety and CS symptoms between patients and controls can be replicated, and (c) whether the relationship between exposure to VR and CS symptoms is mediated by anxiety. A sample (N = 170) of participants with different levels of psychosis liability was exposed to VR environments. CS and anxiety were assessed with self-report measures before and after the VR experiment. This study replicated gender differences in CS symptoms, most of which were present before exposure to VR. It also replicated findings that a significant correlation between anxiety and CS can be found in healthy individuals, but not in patients. In a VR environment, anxiety partially mediated CS symptoms, specifically nausea and disorientation. A partial explanation for the differences found between patients and controls may lie in a ceiling effect for the symptoms of CS. A second explanation may be the partial overlap between CS symptoms and physiological anxiety responses. CS symptoms reported at baseline cannot be explained by exposure to VR, but are related to anxiety. Caution is required when interpreting studies on both CS and anxiety, until the specificity in measurements has been improved. Since anxiety mediated the CS symptoms, CS is expected to decline during treatment together with the reduction of anxiety

Ultrahigh risk for developing psychosis and psychotic personality organization

Aims: Childhood adversities combined with unsafe parenting may disturb personality development. This study investigated whether psychotic personality organization as defined by Kernberg and assessed with de Dutch Short Form of the MMPI (DSFM) is more prevalent in ultrahigh risk (UHR) for psychosis compared with non-psychotic psychiatric control patients (NPPC). Methods: A total of 73 UHR and 119 NPPC patients were assessed with the DSFM and the Comprehensive Assessment of at Risk Mental States (CAARMS). Results: The results showed that the psychotic personality organization (PPO) was not associated to UHR status. The UHR group showed more severe symptoms, particularly higher scores on DSFM subscales negativism (negative affect) and somatization (vague somatic complaints) and severe psychopathology (psychotic symptoms and dissociation). Conclusion: The PPO profile is not associated to the risk of developing psychosis

Effect of virtual reality exposure therapy on social participation in people with a psychotic disorder (VRETp):study protocol for a randomized controlled trial

Background: Many patients with a psychotic disorder participate poorly in society. When psychotic disorders are in partial remission, feelings of paranoia, delusions of reference, social anxiety and self-stigmatization often remain at diminished severity and may lead to avoidance of places and people. Virtual reality exposure therapy (VRET) is an evidence-based treatment for several anxiety disorders. For patients with a psychotic disorder, the VRETp was developed to help them experience exposure to feared social situations. The present study aims to investigate the effects of VRETp on social participation in real life among patients with a psychotic disorder. Methods/design: The study is a single-blind randomized controlled trial with two conditions: the active condition, in which participants receive the virtual reality treatment together with treatment as usual (TAU), and the waiting list condition, in which participants receive TAU only. The two groups are compared at baseline, at 3 months posttreatment and at 6 months follow-up. All participants on the waiting list are also offered the virtual reality treatment after the follow-up measurements are completed. The primary outcome is social participation. Secondary outcomes are quality of life, interaction anxiety, depression and social functioning in general. Moderator and mediator analyses are conducted with stigma, cognitive schemata, cognitive biases, medication adherence, simulator sickness and presence in virtual reality. If effective, a cost-effectiveness analysis will be conducted. Discussion: Results from the posttreatment measurement can be considered strong empirical indicators of the effectiveness of VRETp. The 6-month follow-up data may provide reliable documentation of the long-term effects of the treatment on the outcome variables. Data from pre-treatment and mid-treatment can be used to reveal possible pathways of change

REFLEX, a social-cognitive group treatment to improve insight in schizophrenia:Study protocol of a multi-center RCT

BACKGROUND: Insight is impaired in a majority of people with schizophrenia. Impaired insight is associated with poorer outcomes of the disorder. Based on existing literature, we developed a model that explains which processes may possibly play a role in impaired insight. This model was the starting point of the development of REFLEX: a brief psychosocial intervention to improve insight in schizophrenia. REFLEX is a 12-sessions group training, consisting of three modules of four sessions each. Modules in this intervention are: "coping with stigma", "you and your personal narrative", and "you in the present". METHODS/DESIGN: REFLEX is currently evaluated in a multicenter randomized controlled trial. Eight mental health institutions in the Netherlands participate in this evaluation. Patients are randomly assigned to either REFLEX or an active control condition, existing of cognitive remediation exercises in a group. In a subgroup of patients, fMRI scans are made before and after training in order to assess potential haemodynamic changes associated with the effects of the training. DISCUSSION: REFLEX is one of the few interventions aiming specifically to improving insight in schizophrenia and has potential value for improving insight. Targeting insight in schizophrenia is a complex task, that comes with several methodological issues. These issues are addressed in the discussion of this paper. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN5024753