Do adjunctive art therapies reduce symptomatology in schizophrenia? A meta-analysis

©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.BACKGROUND: Art therapies are advocated by national bodies, such as the United Kingdom's National Institute for Health and Care Excellence, to alleviate the negative symptoms associated with schizophrenia. The last decade has however, seen several new larger well-controlled trials published suggesting an update is timely.AIM: To asses randomised controlled trials (RCT) of art therapies for reducing the symptoms of schizophrenia - particularly negative symptoms.METHODS: Searches of PubMed and Scopus were conducted until May 2019 for RCTs examining the impact of art therapies on psychosis (positive, negative and total) symptoms in people diagnosed with schizophrenia. Study quality was assessed using the Cochrane risk of bias tool. Random effects meta-analyses were used to derive overall effect sizes. Moderator analyses were conducted using both meta-regression and categorical comparisons.RESULTS: We identified 133 articles, of which 9 RCTs involving 948 participants (475 assigned to art therapies and 473 controls) met our inclusion criteria. Using random effects models, we calculated pooled effect sizes (Hedges g) for end-of-trial symptomatic outcomes. Effect sizes both for total symptoms [ g = -0.27, 95% confidence interval (CI) -0.60 to 0.05, k = 6] and for positive symptoms ( g = -0.10, 95%CI -0.35 to 0.15, k = 6) were non-significant; however, we did find significant reduction of negative symptoms ( g = -0.42, 95%CI -0.70 to -0.14, k = 9). Meta-regression revealed that negative symptom reduction was larger in trials with a greater proportion of women and in trials with younger patients. Crucially, the negative symptom reduction following art therapies was limited to lower quality trials and did not emerge in trials that used blind assessment of outcomes. CONCLUSION: This review presents a comprehensive meta-analysis of art therapies in schizophrenia in terms of both studies included and participant numbers. We found that art therapies did not significantly reduce total or positive symptoms. A "small" therapeutic effect was found for negative symptoms, but we show that the effect is not present in blind trials and may be subject to publication bias.Peer reviewe

Category deficits and paradoxical dissociations in Alzheimer's disease and Herpes Simplex Hencephalitis

Most studies examining category specificity are single-case studies of patients with living or non living deficits. Nevertheless, no explicit or agreed criteria exist for establishing category-specific deficits in single-cases regarding the type of analyses, whether to compare with healthy controls, the number of tasks, or the type of tasks. We examined to groups of patients with neurological pathology frequently accompained with impaired semantic memory (19 patients with Alzheimer disease and 15 with Herpes Simplex Encephalitis). Category knowledge was examined using three tasks (picture naming, naming-to-description and features verification). Both patients groups were compared with aged- and education- matched healthy controls. The profile of each patients was examined for consistency across tasks and across different analyses; however both prove to be inconsistent. One striking findings was the presence of a paradoxical dissociation ( i.e., patients who were impaired on living things on one task and non living things on another task). The findings have significant implication for how we determine category effects and, more generall for the methods use to document double dissociation across individual cases in this literature

Commentary : Does Cognitive Behavior Therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis

Peer reviewedFinal Published versio

Are women better than men at multi-tasking?

Background: There seems to be a common belief that women are better in multi-tasking than men, but there is practically no scientific research on this topic. Here, we tested whether women have better multi-tasking skills than men.<p></p> Methods: In Experiment 1, we compared performance of 120 women and 120 men in a computer-based task-switching paradigm. In Experiment 2, we compared a different group of 47 women and 47 men on "paper-and-pencil" multi-tasking tests.<p></p> Results: In Experiment 1, both men and women performed more slowly when two tasks were rapidly interleaved than when the two tasks were performed separately. Importantly, this slow down was significantly larger in the male participants (Cohen’s d = 0.27). In an everyday multi-tasking scenario (Experiment 2), men and women did not differ significantly at solving simple arithmetic problems, searching for restaurants on a map, or answering general knowledge questions on the phone, but women were significantly better at devising strategies for locating a lost key (Cohen’s d = 0.49).<p></p> Conclusions: Women outperform men in these multi-tasking paradigms, but the near lack of empirical studies on gender differences in multitasking should caution against making strong generalisations. Instead, we hope that other researchers will aim to replicate and elaborate on our findings.<p></p&gt

Cognitive Behavioural Therapy for schizophrenia - outcomes for functioning, distress and quality of life : A meta-analysis

Background: The effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. However, it has been suggested that the effects of CBTp in areas other than psychotic symptoms are at least as important and potentially benefit from the intervention. Method: We meta-analysed RCTs investigating the effectiveness of CBTp for functioning, distress and quality of life in individuals diagnosed with schizophrenia and related disorders. Data from 36 randomised controlled trials (RCTs) met our inclusion criteria- 27 assessing functioning (1579 participants); 8 for distress (465 participants); and 10 for quality of life (592 participants). Results: The pooled effect size for functioning was small but significant for the end-of-trial (0.25: 95% CI: 0.14 to 0.33); however, this became non-significant at follow-up (0.10 [95%CI -0.07 to 0.26]). Although a small benefit of CBT was evident for reducing distress (0.37: 95%CI 0.05 to 0.69), this became nonsignificant when adjusted for possible publication bias (0.18: 95%CI -0.12 to 0.48). Finally, CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19). Conclusions: CBTp has a small therapeutic effect on functioning at end-of-trial, although this benefit is not evident at follow-up. Although CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted. We found no evidence that CBTp increases quality of life post-intervention.Peer reviewedFinal Published versio

The relationship between cognitive phenotypes of compulsivity and impulsivity and clinical variables in obsessive-compulsive disorder: A systematic review and Meta-analysis

© 2024 The Authors. Published by Elsevier Inc. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background This systematic review and meta-analysis explored the relationship between cognitive phenotypes of compulsivity and impulsivity and clinical variables in obsessive-compulsive disorder (OCD). Methods We searched Pubmed, Scopus, Cochrane Library and PsychINFO databases until February 2023 for studies comparing patients with OCD and healthy controls on cognitive tests of compulsivity and impulsivity. The study followed PRISMA guidelines and was pre-registered on PROSPERO (CRD42021299017). Results Meta-analyses of 112 studies involving 8313 participants (4289 patients with OCD and 4024 healthy controls) identified significant impairments in compulsivity (g = −0.58, [95%CI -0.68, −0.47]; k = 76) and impulsivity (g = −0.48, [95%CI -0.57, −0.38]; k = 63); no significant difference between impairments. Medication use and comorbid psychiatric disorders were not significantly related to impairments. No associations were revealed with OCD severity, depression/anxiety, or illness duration. Conclusion Cognitive phenotypes of compulsivity and impulsivity in patients with OCD appear to be orthogonal to clinical variables, including severity of OCD symptomatology. Their clinical impact is poorly understood and may require different clinical assessment tools and interventions.Peer reviewe

Strange face illusions: A systematic review and quality analysis

© 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Background Strange face illusions describe a range of visual apparitions that occur when an observer gazes at their image reflected in a mirror or at another person’s face in a dimly lit room. The illusory effects range from mild alterations in colour, or contrast, to the perception of distorted facial features, or new strange faces. The current review critically evaluates studies investigating strange face illusions, their methodological quality, and existing interpretations. Method Searches conducted using Scopus, PubMed, ScienceDirect and the grey literature until June 2022 identified 21 studies (N = 1,132; healthy participants n = 1,042; clinical participants n = 90) meeting the inclusion criteria (i.e., providing new empirical evidence relating to strange face illusions). The total sample had a mean age of 28.3 years (SD = 10.31) and two thirds (67 %) of participants tested to date are female. Results are reported using the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines. The review was preregistered at the Open Science Framework (OSF: https://osf.io/ek48d). Results Pooling data across studies, illusory new strange faces are experienced by 58% (95%CI 48 to 68) of nonclinical participants. Study quality as assessed by the Appraisal Tool for Cross-Sectional Studies (AXIS) revealed that 3/21 (14.28%) studies were rated as high, 9/21 (42.86%) as moderate and 9/21 (42.86%) as low quality. Whilst the items relating specifically to reporting quality scored quite highly, those relating to study design and possible biases were lower and more variable. Overall, study quality accounted for 87% of the variance in reporting rates for strange faces, with higher quality being associated with lower illusion rates. The prevalence of illusions was also significantly greater in samples that were older, had higher proportions of female participants and for the interpersonal dyad (IGDT) compared to the mirror gaze paradigm (MGT). The moderating impact of study quality persisted in a multiple meta-regression involving participant age, paradigm type (IGDT vs MGT) and level of feature distortion. Our review point to the importance of reduced light levels, face stimuli and prolonged eye fixation for strange face illusions to emerge. Conclusion Strange face illusions reliably occur in both mirror-gazing and interpersonal gazing dyad paradigms. Further research of higher quality is required to establish the prevalence and particularly, the mechanisms underpinning strange face illusions.Peer reviewe

Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis

This article is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Abstract: Background: Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth. Method: Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up. Results: A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials. Conclusions: The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias.Peer reviewe

Cognitive dysfunction in body dysmorphic disorder: new implications for nosological systems and neurobiological models.

UNLABELLED: Introduction Body dysmorphic disorder (BDD) is a debilitating disorder, characterized by obsessions and compulsions relating specifically to perceived appearance, and which has been newly classified within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Obsessive-Compulsive and Related Disorders grouping. Until now, little research has been conducted into the cognitive profile of this disorder. METHODS: Participants with BDD (n=12) and participants without BDD (n=16) were tested using a computerized neurocognitive battery investigating attentional set-shifting (Intra/Extra Dimensional Set Shift Task), decision-making (Cambridge Gamble Task), motor response-inhibition (Stop-Signal Reaction Time Task), and affective processing (Affective Go-No Go Task). The groups were matched for age, IQ, and education. RESULTS: In comparison to controls, patients with BDD showed significantly impaired attentional set-shifting, abnormal decision-making, impaired response inhibition, and greater omission and commission errors on the emotional processing task. CONCLUSION: Despite the modest sample size, our results showed that individuals with BDD performed poorly compared to healthy controls on tests of cognitive flexibility, reward and motor impulsivity, and affective processing. Results from separate studies in OCD patients suggest similar cognitive dysfunction. Therefore, these findings are consistent with the reclassification of BDD alongside OCD. These data also hint at additional areas of decision-making abnormalities that might contribute specifically to the psychopathology of BDD.Academy of Medical SciencesThis is the author accepted manuscript. The final version is available from Cambridge University Press via https://doi.org/10.1017/S109285291600046

Individual obsessive-compulsive traits are associated with poorer adjustment to the easing of COVID-19 restrictions.

BACKGROUND: As COVID-19 restrictions ease, the public are expected to relinquish previously enforced safety behaviors and resume a more normal lifestyle. Despite these aims, our recent survey of 438 adults from the general population, during a temporary release of lockdown in the United Kingdom (July-November 2020), showed that 25% of the public find re-adjustment problematic. This was especially the case in those with a history of mental disorder and obsessive-compulsive (OC) traits and symptoms, including rigidity as measured by a neurocognitive test of attentional flexibility. To aid in identifying those most at risk, we performed a secondary analysis on the data to determine which specific OC traits were related to specific aspects of behavioral adjustment. METHODS: Correlational and multiple regression analyses were performed to determine associations between the eight individual personality traits constituting DSM-5 Obsessive-Compulsive Personality Disorder (OCPD), as measured by the self-rated Compulsive Personality Assessment Scale (CPAS) and a range of self-rated Post-Pandemic Adjustment Questionnaire items. RESULTS: Three items on the Post-Pandemic Adjustment Questionnaire correlated with individual CPAS items: 'General difficulties adjusting' correlated with perfectionism, preoccupation with details, over-conscientiousness and need for control; 'social avoidance' correlated with perfectionism and preoccupation with details; and 'disinfecting behaviors' correlated with preoccupation with details and miserliness (Pearson's r - all p < .001). Intriguingly, none of the adjustment items correlated significantly with self-rated rigidity. CONCLUSIONS: Several OCPD traits predict post-pandemic adjustment difficulties, but perfectionism and preoccupation-with-details showed the most robust correlations. These traits constitute a platform for the development of new screening and interventional strategies aimed at restoring public mental health and wellbeing. Cognitive rigidity may be more reliably evaluated using an objective form of assessment