By Jadon R. Webb, Jean Addington, Diana O. Perkins, Carrie E. Bearden, Kristin S. Cadenhead, Tyrone D. Cannon, Barbara A. Cornblatt, Robert K. Heinssen, Larry J. Seidman, Sarah I. Tarbox, Ming T. Tsuang, Elaine F. Walker, Thomas H. McGlashan, and Scott W. Woods | Schizophrenia Bulletin | September 2015

Abstract:

It is not well established whether the incident outcomes of the clinical high-risk (CHR) syndrome for psychosis are diagnostically specific for psychosis or whether CHR patients also are at elevated risk for a variety of nonpsychotic disorders. We collected 2 samples (NAPLS-1, PREDICT) that contained CHR patients and a control group who responded to CHR recruitment efforts but did not meet CHR criteria on interview (help-seeking comparison patients [HSC]). Incident diagnostic outcomes were defined as the occurrence of a SIPS-defined psychosis or a structured interview diagnosis from 1 of 3 nonpsychotic Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) groups (anxiety, bipolar, or nonbipolar mood disorder), when no diagnosis in that group was present at baseline. Logistic regression revealed that the CHR vs HSC effect did not vary significantly across study for any emergent diagnostic outcome; data from the 2 studies were therefore combined. CHR (n = 271) vs HSC (n = 171) emergent outcomes were: psychosis 19.6% vs 1.8%, bipolar disorders 1.1% vs 1.2%, nonbipolar mood disorders 4.4% vs 5.3%, and anxiety disorders 5.2% vs 5.3%. The main effect of CHR vs HSC was statistically significant (OR = 13.8, 95% CI 4.2–45.0, df = 1, P < .001) for emergent psychosis but not for any emergent nonpsychotic disorder. Sensitivity analyses confirmed these findings. Within the CHR group emergent psychosis was significantly more likely than each nonpsychotic DSM-IV emergent disorder, and within the HSC group emergent psychosis was significantly less likely than most emergent nonpsychotic disorders. The CHR syndrome is specific as a marker for research on predictors and mechanisms of developing psychosis.

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By Jadon R. Webb, Jean Addington, Diana O. Perkins, Carrie E. Bearden, Kristin S. Cadenhead, Tyrone D. Cannon, Barbara A. Cornblatt, Robert K. Heinssen, Larry J. Seidman, Sarah I. Tarbox, Ming T. Tsuang, Elaine F. Walker, Thomas H. McGlashan, and Scott W. Woods | JAMA Psychiatry | August 12, 2015

Abstract: 

Importance

Severe neuropsychiatric conditions, such as schizophrenia, affect distributed neural computations. One candidate system profoundly altered in chronic schizophrenia involves the thalamocortical networks. It is widely acknowledged that schizophrenia is a neurodevelopmental disorder that likely affects the brain before onset of clinical symptoms. However, no investigation has tested whether thalamocortical connectivity is altered in individuals at risk for psychosis or whether this pattern is more severe in individuals who later develop full-blown illness.

Objectives

To determine whether baseline thalamocortical connectivity differs between individuals at clinical high risk for psychosis and healthy controls, whether this pattern is more severe in those who later convert to full-blown illness, and whether magnitude of thalamocortical dysconnectivity is associated with baseline prodromal symptom severity.

Design, Setting, and Participants

In this multicenter, 2-year follow-up, case-control study, we examined 397 participants aged 12-35 years of age (243 individuals at clinical high risk of psychosis, of whom 21 converted to full-blown illness, and 154 healthy controls). The baseline scan dates were January 15, 2010, to April 30, 2012.

Main Outcomes and Measures

Whole-brain thalamic functional connectivity maps were generated using individuals’ anatomically defined thalamic seeds, measured using resting-state functional connectivity magnetic resonance imaging.

Results

Using baseline magnetic resonance images, we identified thalamocortical dysconnectivity in the 243 individuals at clinical high risk for psychosis, which was particularly pronounced in the 21 participants who converted to full-blown illness. The pattern involved widespread hypoconnectivity between the thalamus and prefrontal and cerebellar areas, which was more prominent in those who converted to full-blown illness (t₁₇₃ = 3.77, P < .001, Hedge g = 0.88). Conversely, there was marked thalamic hyperconnectivity with sensory motor areas, again most pronounced in those who converted to full-blown illness (t₁₇₃ = 2.85, P < .001, Hedge g = 0.66). Both patterns were significantly correlated with concurrent prodromal symptom severity (r = 0.27, P < 3.6 × 10⁻⁸, Spearman ρ = 0.27, P < 4.75 × 10⁻⁵, 2-tailed).

Conclusions and Relevance

Thalamic dysconnectivity, resembling that seen in schizophrenia, was evident in individuals at clinical high risk for psychosis and more prominently in those who later converted to psychosis. Dysconnectivity correlated with symptom severity, supporting the idea that thalamic connectivity may have prognostic implications for risk of conversion to full-blown illness.

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By Kyle S. Minor, Michelle Friedman-Yakoobian, Y. Jude Leung, Eric C. Meyer, Suzanna V. Zimmet, Brina Caplan, Thomas Monteleone, Caitlin Bryant, Margaret Guyer, Matcheri S. Keshavan, and Larry J. Seidman | Australian and New Zealand Journal of Psychiatry | August 2015

Abstract: 

Objective:

Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREPR, Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement.

Method:

The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREPR (n = 46 with social functioning and 47 with role functioning measures at both time points).

Results:

Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not.

Conclusions:

Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings.

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By Daniel L. Schacter and Kevin P. Madore | Memory Studies | August 2015

Abstract:

Recent studies have shown that imagining or simulating future events relies on many of the same cognitive and neural processes as remembering past events. According to the constructive episodic simulation hypothesis (Schacter and Addis, 2007), such overlap indicates that both remembered past and imagined future events rely heavily on episodic memory: future simulations are built on retrieved details of specific past experiences that are recombined into novel events. An alternative possibility is that commonalities between remembering and imagining reflect the influence of more general, non-episodic factors such as narrative style or communicative goals that shape the expression of both memory and imagination. We consider recent studies that distinguish the contributions of episodic and non-episodic processes in remembering the past and imagining the future by using an episodic specificity induction – brief training in recollecting the details of a past experience – and also extend this approach to the domains of problem solving and creative thinking. We conclude by suggesting that the specificity induction may target a process of scene construction that contributes to episodic memory as well as to imagination, problem solving, and creative thinking.

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By Ian R. Kleckner, Jolie Baumann Wormwood, W. Kyle Simmons, Lisa Feldman Barrett, and Karen S. Quigley | Psychophysiology | August 12, 2015

Abstract: 

Heartbeat detection tasks are often used to measure cardiac interoceptive sensitivity—the ability to detect sensations from one’s heart. However, there is little work to guide decisions on the optimum number of trials to use, which should balance reliability and power against task duration and participant burden. Here, 174 participants completed 100 trials of a widely used heartbeat detection task where participants attempt to detect whether presented tones occurred synchronously or asynchronously with their heartbeats. First, we quantified measurement reliability of the participant’s accuracy derived from differing numbers of trials of the task using a correlation metric; we found that at least 40–60 trials were required to yield sufficient reliability. Next, we quantified power by simulating how the number of trials influenced the ability to detect a correlation between cardiac interoceptive sensitivity and other variables that differ across participants, including a variable measured from our sample (body mass index) as well as simulated variables of varying effect sizes. Using these simulations, we quantified the trade-offs between sample size, effect size, and number of trials in the heartbeat detection task such that a researcher can easily determine any one of these variables at given values of the other two variables. We conclude that using fewer than 40 trials is typically insufficient due to poor reliability and low power in estimating an effect size, although the optimal number of trials can differ by study.

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