Hallucinations in a Patient with Alzheimer's Disease During the COVID-19 Crisis: A Case Study.

peer reviewedWhile social distancing may be deemed necessary in order to avoid COVID-19 infections, the lockdown may impact mental health of patients with Alzheimer's disease (AD). We present a case study involving hallucinations in a patient with AD who lives in a nursing home during the COVID-19 crisis. We compared this patient's hallucination scores before and during the lockdown. We observed increased hallucinations during, compared to before, the lockdown. These increased hallucinations can be attributed to a number of elements such as the decreased in daily activities, social distancing, lack of physical contact with family members, and loneliness during the lockdown

Hallucinations and Covid-19: Increased Occurrence of Hallucinations in Patients with Alzheimer's Disease During Lockdown.

We investigated the effects of lockdown, as implemented by retirement homes to cope with the spread of Covid-19, on hallucinatory experiences in patients with Alzheimer's disease (AD). The study included 47 patients with AD living in retirement homes and who were already experiencing hallucinations prior to the lockdown. We invited caregivers to rate hallucinatory experiences in these patients during the lockdown, and compared this rating with that provided by the same caregivers prior to the lockdown. Results demonstrated increased hallucinatory experiences in patients with AD during the lockdown, compared with before the lockdown. The decrease in social and physical activities during the lockdown, and especially, the physical separation of residents from family members, might have led to decreased sensory stimulation and increased loneliness, and consequently, to the hallucinatory experiences in patients with AD living in retirement homes during the lockdown. While the restrictive measures were necessary to cope with the spread of Covid-19, these measures have increased hallucinations in patients with AD living in retirement homes, at least in those who were already experiencing hallucinations prior to the lockdown

The Ice in Voices:Understanding negative content in auditory-verbal hallucinations

Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by me- chanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emo- tional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further devel- opment of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area

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

Cognitive functioning in a group of adolescents at risk for psychosis.

peer reviewedCognitive deficits are a core feature of schizophrenia, and impairments are present in groups at-risk for psychosis. Most at-risk studies include young adults and not younger age-groups, such as adolescents. Participants are usually help-seeking individuals, even though risk factors may also be present in non-help seeking adolescents. We aim to explore cognitive functions in a group of non-help-seeking 15-year-old adolescents at risk for psychosis compared to age- and gender matched controls, including particular focus on specific cognitive domains. Hundred participants (mean age = 15.3) were invited after completing the 14-year-old survey distributed by the Norwegian Mother-, Father- and Child Study. At-risk adolescents were selected based on high scores on 19 items assessing both psychotic experiences and anomalous self-experiences. Matched controls were selected from the same sample. Cognitive functioning was assessed using the MATRICS Consensus Cognitive Battery and IQ using Wechsler's Abbreviated Test of Intelligence. We found that the adolescents at-risk for psychosis had significantly poorer scores than controls on the composite score of the MCCB. IQ scores were also significantly lower in the at-risk group. The results highlight general cognitive deficits as central in a group of non-help-seeking adolescents at-risk for psychosis. Results indicate that the development of cognitive impairments starts early in life in at-risk groups. It is still unclear whether specific cognitive domains, such as verbal learning, are related to psychotic symptoms or may be specifically vulnerable to symptoms of depression and anxiety

Multitasking capacities in persons diagnosed with schizophrenia: A preliminary examination of their neurocognitive underpinnings and ability to predict real world functioning

peer reviewedBackground: Difficulties in everyday life activities are core features of persons diagnosed with schizophrenia. Moreover, patients seem to demonstrate particular difficulties during complex and multitasking activities, such as cooking a meal (Semkovska et al., 2004). Multitasking refers to activities where the person has to: carry out and alternate between different tasks that vary in terms of priority, difficulty and duration; define the tasks’ targets; and where the person is faced with unexpected problems during the realization of these tasks (Burgess, 2000). However, at present, patients’ multitasking capacities have not been adequately examined in the literature due to an absence of suitable assessment strategies. We thus recently developed a computerized real-life activity task designed to take into account the complex and multitasking nature of certain everyday life activities where participants are required to prepare a room for a meeting – the Computerized Meeting Preparation Task (CMPT) Methods: Twenty-one individuals diagnosed with schizophrenia and 20 matched healthy controls completed the CMPT. During the CMPT, participants found themselves in a virtual room that they had to prepare for a meeting while respecting a list of instructions (the placement of the guests, the needed objects, the desired drinks, etc.). Patients were also evaluated with an extensive cognitive battery (assessing executive functions, attention, processing speed and memory), measures of symptomatology and real world functioning. To examine the ecological validity of the CMPT, 14 others patients were recruited and were given the computerized version and a real version of the meeting preparation task. Results: Results demonstrated that performance on the CMPT significantly differentiated patients and healthy controls for the total time to complete task, planning efficiency, and the respect of the instructions. Moreover, these variables were significantly correlated with executive functioning (i.e. cognitive flexibility and planning), suggesting the major implication of these cognitive processes in multitasking activities. Performance on the CMPT also significantly predicted up to 50% of real world functioning. Finally, performances on the computerized version and the real version of the meeting preparation task were highly correlated, suggesting good ecological validity. Discussion: In this study, we created a novel task involving the multitasking nature of real world activities. The results demonstrated that this approach provides a good indication of the real world functioning in patients diagnosed with schizophrenia. Moreover, results suggest a particular implication of executive functioning in multitasking activities. These findings suggest the importance of evaluating multitasking capacities in patients diagnosed with schizophrenia in order to predict real world functioning

A Cross-National Investigation of Hallucination-Like Experiences in 10 Countries: The E-CLECTIC Study

Hallucination-like experiences (HLEs) are typically defined as sensory perceptions in the absence of external stimuli. Multidimensional tools, able to assess different facets of HLEs, are helpful for a better characterization of hallucination proneness and to investigate the cross-national variation in the frequencies of HLEs. The current study set out to establish the validity, factor structure, and measurement invariance of the Launay-Slade Hallucinations Scale-Extended (LSHS-E), a tool to assess HLEs. A total of 4419 respondents from 10 countries were enrolled. Network analyses between the LSHS-E and the 3 dimensions of the Community Assessment of Psychic Experiences (CAPE) were performed to assess convergent and divergent validity of the LSHS-E. Confirmatory factor analysis was used to test its measurement invariance. The best fit was a 4-factor model, which proved invariant by country and clinical status, indicating cross-national stability of the hallucination-proneness construct. Among the different components of hallucination-proneness, auditory-visual HLEs had the strongest association with the positive dimension of the CAPE, compared with the depression and negative dimensions. Participants who reported a diagnosis of a mental disorder scored higher on the 4 LSHS-E factors. Small effect size differences by country were found in the scores of the 4 LSHS-E factors even after taking into account the role of socio-demographic and clinical variables. Due to its good psychometric properties, the LSHS-E is a strong candidate tool for large investigations of HLEs

Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease

Much of the research on visual hallucinations (VHs) has been conducted in the context of eye disease and neurodegenerative conditions, but little is known about these phenomena in psychiatric and nonclinical populations. The purpose of this article is to bring together current knowledge regarding VHs in the psychosis phenotype and contrast this data with the literature drawn from neurodegenerative disorders and eye disease. The evidence challenges the traditional views that VHs are atypical or uncommon in psychosis. The weighted mean for VHs is 27% in schizophrenia, 15% in affective psychosis, and 7.3% in the general community. VHs are linked to a more severe psychopathological profile and less favorable outcome in psychosis and neurodegenerative conditions. VHs typically co-occur with auditory hallucinations, suggesting a common etiological cause. VHs in psychosis are also remarkably complex, negative in content, and are interpreted to have personal relevance. The cognitive mechanisms of VHs in psychosis have rarely been investigated, but existing studies point to source-monitoring deficits and distortions in top-down mechanisms, although evidence for visual processing deficits, which feature strongly in the organic literature, is lacking. Brain imaging studies point to the activation of visual cortex during hallucinations on a background of structural and connectivity changes within wider brain networks. The relationship between VHs in psychosis, eye disease, and neurodegeneration remains unclear, although the pattern of similarities and differences described in this review suggests that comparative studies may have potentially important clinical and theoretical implications. © 2014 The Author