A Group Intervention for Motivational Deficits: Preliminary Investigation of a Blended Care Approach Using Ambulatory Assessment.

peer reviewedMotivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of "Switch," an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants' smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants' activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes

Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults:A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL)

In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to 25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p =.027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p =.011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808

Measurement of adverse events in studies of digital health interventions for psychosis: guidance and recommendations based on a literature search and framework analysis of standard operating procedures

Background: Given the rapid expansion of research into digital health interventions (DHIs) for severe mental illness (SMI; eg, schizophrenia and other psychosis diagnoses), there is an emergent need for clear safety measures. Currently, measurement and reporting of adverse events (AEs) are inconsistent across studies. Therefore, an international network, iCharts, was assembled to systematically identify and refine a set of standard operating procedures (SOPs) for AE reporting in DHI studies for SMI. Design: The iCharts network comprised experts on DHIs for SMI from seven countries (United Kingdom, Belgium, Germany, Pakistan, Australia, United States, and China) and various professional backgrounds. Following a literature search, SOPs of AEs were obtained from authors of relevant studies, and from grey literature. Results: A thorough framework analysis of SOPs (n = 32) identified commonalities for best practice for certain domains, along with significant gaps in others; particularly around the classification of AEs during trials, and the provision of training/supervision for research staff in measuring and reporting AEs. Several areas which could lead to the observed inconsistencies in AE reporting and handling were also identified. Conclusions: The iCharts network developed best-practice guidelines and a practical resource for AE monitoring in DHI studies for psychosis, based on a systematic process which identified common features and evidence gaps. This work contributes to international efforts to standardize AE measurement and reporting in this emerging field, ensuring that safety aspects of DHIs for SMI are well-studied across the translational pathway, with monitoring systems set-up from the outset to support safe implementation in healthcare systems

Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

Background Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. Methods We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated

Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms.

Background: Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting and using a blended-care approach with complementary ecological momentary intervention. Methods: We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results: The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions: This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated

Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

BACKGROUND: Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. METHODS: We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. RESULTS: The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). CONCLUSIONS: This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT04325100 . Registered 27 March 27, 2020 -retrospectively registered. REPORTING: Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.status: publishe

The Neuropsychological Profile and Phenomenology of Late Onset Psychosis: A Cross-sectional Study on the Differential Diagnosis of Very-Late-Onset Schizophrenia-Like Psychosis, Dementia with Lewy Bodies and Alzheimers Type Dementia with Psychosis

Objective: Late onset psychosis not only occurs as a prodromal symptom to neurodegeneration, but it can also be associated with a non-progressive mild cognitive deficit. Studying the phenomenology of psychotic symptoms and the neuropsychological profile may serve as sensitive and non-invasive tools for differential diagnosis. Method: We compared 57 individuals with very-late-onset schizophrenia-like psychosis (VLOSLP), 49 participants with Dementia with Lewy Bodies (DLB) and 35 patients with Alzheimer's type Dementia and psychosis (AD+P) concerning the phenomenology of psychotic symptoms and the neuropsychological profile using several measures of cognitive function in a cross-sectional study. Results: Participants with DLB exhibited more visual hallucinations, especially those involving animals, and less partition/paranoid delusions than both other groups. VLOSLP showed more partition delusions and auditory hallucinations of human voices than both other groups. Hence, patients with DLB and VLOSLP showed greater dissimilarity in the phenomenology of psychosis, whereas individuals with AD+P held an intermediate position. Processing speed and executive function were comparably impaired among the three groups, as was expected considering a common underlying set of neurobiological abnormalities for psychosis. However, AD+P showed more strongly reduced learning and consolidation skills, whereas DLB was associated with prominent visuoconstructive deficits. Conclusions: Phenomenology of psychosis may prove especially informative when comparing individuals with DLB to those with VLOSLP. Neuropsychological profiles are able to further aid differential diagnosis of the three groups.status: publishe

The Neural Basis of an Affective Pathway to Psychosis a Study Combining Functional MRI and Experience Sampling Methodology

Affective reactivity to daily stressors are increased in individuals in the early stages of psychosis. Studies in psychosis patients and healthy individuals at increased psychosis risk show altered neural reactivity to stress in limbic (i.e., hippocampus [HC] and amygdala), prelimbic (i.e., ventromedial prefrontal cortex [vmPFC] and ventral anterior cingulate cortex [vACC]), and salience areas (i.e., anterior insula [AI]). We investigated whether a similar pattern of neural reactivity is present in early psychosis individuals and if brain activity in these regions is associated with daily-life stress reactivity.<br><br>Twenty-nine early psychosis individuals (11 clinical high risk and 18 first-episode psychosis) completed a stress task in conjunction with functional MRI. All participants also provided experience sampling methodology (ESM) data on momentary affect and stressful activities in their everyday environment. Multilevel regression models were used to estimate if daily-life stress reactivity was moderated by activity in (pre)limbic and salience areas.<br><br>Task-induced stress was associated with increased activation of the right AI and decreased activation in the vmPFC, vACC, and HC. Task-induced changes in vmPFC and vACC activity were associated with affective stress reactivity, whereas changes in HC and amygdala activity were associated with higher overall stress levels.<br><br>These preliminary results suggest region-specific roles in affective and psychotic daily-life stress reactivity in early psychosis. The observed pattern suggests that chronic stress plays a role in neural stress reactivity. Direct comparison with a control group should elucidate whether these findings reflect a neural basis for an affective pathway to psychosis

Neural correlates of daily-life affective stress reactivity in early psychosis:A study combining functional MRI and experience sampling methodology

Affective reactivity to daily stressors are increased in individuals in the early stages of psychosis. Studies in psychosis patients and healthy individuals at increased psychosis risk show altered neural reactivity to stress in limbic (i.e., hippocampus [HC] and amygdala), prelimbic (i.e., ventromedial prefrontal cortex [vmPFC] and ventral anterior cingulate cortex [vACC]), and salience areas (i.e., Anterior Insula [AI]). We investigated whether a similar pattern of neural reactivity is present in early psychosis individuals and if brain activity in these regions is associated with daily-life stress reactivity. Twenty-nine early psychosis individuals (11 at-risk mental state and 18 first-episode psychosis) completed the Montreal Imaging Stress Task in conjunction with functional MRI. The study was part of a large-scale randomized controlled trial on the efficacy of an acceptance and commitment therapy-based ecological momentary intervention for early psychosis. All participants also provided experience sampling methodology (ESM) data on momentary affect and stressful activities in their everyday environment. Multilevel regression models were used to estimate if daily-life stress reactivity was moderated by activity in (pre)limbic and salience areas. Task-induced stress was associated with increased activation of the right AI and decreased activation in the vmPFC, vACC, and HC. Task-induced changes in vmPFC and vACC activity were associated with affective stress reactivity, whereas changes in HC and amygdala activity were associated with higher overall stress ratings. These preliminary results suggest region-specific roles in affective and psychotic daily-life stress reactivity in early psychosis. The observed pattern suggests that chronic stress plays a role in neural stress reactivity.</p

Effect of stressful life events on subclinical psychotic symptoms in first-degree relatives and healthy controls

Exposure to Stressful Life Events (SLEs) has been linked to psychosis. However, the combined effect of SLEs and familial risk on subclinical psychotic symptoms over time remains unknown. The objective of the present study was to investigate the effect of SLEs on the level of subclinical psychotic symptoms in individuals with and without familial vulnerability for psychosis. Data were collected from siblings of individuals diagnosed with psychotic disorder and healthy controls at baseline (N = 293) and three years later at follow-up (N = 928). We assessed self-reported and observer-rated subclinical positive, negative, and depressive psychotic symptoms. Participants reported the number of SLEs in the preceding 6 months. A multilevel multivariate regression analysis revealed a positive association between the retrospectively assessed number of SLEs and symptom levels, regardless of vulnerability status (p < .001 for all outcomes). The prospective analysis demonstrated that exposure to SLEs at baseline predicted higher levels of subclinical psychotic symptoms at follow-up. However, after controlling for the level of symptoms at baseline, these associations were no longer significant. Again, the vulnerability status did not modify these results. Nevertheless, siblings in our sample were approximating the end of the critical period for the development of psychotic disorder (mean age at baseline M = 29 and follow-up M = 34). The findings partly support the vulnerability-stress model of psychosis, yet do not confirm the role of familial risk in this association. SLEs may represent a risk factor for psychosis at a population level, thus supporting the continuity of the psychosis spectrum in terms of associated risk factors