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.

Read the full paper here.

Larry Seidman et al | Schizophrenia Research | February 11, 2015

Abstract:

Background:
Although many endophenotypes for schizophrenia have been studied individually, few studies have examined the extent to which common neurocognitive and neurophysiological measures reflect shared versus unique endophenotypic factors. It may be possible to distill individual endophenotypes into composite measures that reflect dissociable, genetically informative elements.

Methods:
The first phase of the Consortium on the Genetics of Schizophrenia (COGS-1) is a multisite family study that collected neurocognitive and neurophysiological data between 2003 and 2008. For these analyses, participants included schizophrenia probands (n = 83), their nonpsychotic siblings (n = 151), and community comparison subjects (n = 209) with complete data on a battery of 12 neurocognitive tests (assessing domains of working memory, declarative memory, vigilance, spatial ability, abstract reasoning, facial emotion processing, and motor speed) and 3 neurophysiological tasks reflecting inhibitory processing (P50 gating, prepulse inhibition and antisaccade tasks). Factor analyses were conducted on the measures for each subject group and across the entire sample. Heritability analyses of factors were performed using SOLAR.

Results:
Analyses yielded 5 distinct factors: 1) Episodic Memory, 2) Working Memory, 3) Perceptual Vigilance, 4) Visual Abstraction, and 5) Inhibitory Processing. Neurophysiological measures had low associations with these factors. The factor structure of endophenotypes was largely comparable across probands, siblings and controls. Significant heritability estimates for the factors ranged from 22% (Episodic Memory) to 39% (Visual Abstraction).

Conclusions:
Neurocognitive measures reflect a meaningful amount of shared variance whereas the neurophysiological measures reflect largely unique contributions as endophenotypes for schizophrenia. Composite endophenotype measures may inform our neurobiological and genetic understanding of schizophrenia.

Read the full paper here.

A delusional episode, or a personality disorder distinguished by lack of empathy, remorse, and inhibition? Psychosis and psychopathy are two distinct diagnoses whose risk of violence is often confused or conflated.

On Thursday, February 19, 2015, CLBB presented a McLean Hospital Grand Rounds titled “Psychosis vs. Psychopathy: Navigating the Risk of Violence in the Clinical and Courtroom.” Clinical and legal experts used case-study to distinguish the on-set, pathophysiology, symptoms and effective interventions for each diagnosis, and characterize the risk of violence.

This Grand Rounds presented case studies and discussion by Joseph Stoklosa, MD, medical director for McLean’s schizophrenia and bipolar program; Judge Roanne Sragow, first justice for the Cambridge District Court; Larry Seidman, MD, neuropsychologist and expert on early psychosis; and CLBB co-director Bruce Price, MD, McLean Chief of Neurology. CLBB co-director Judith Edersheim, JD, MD, forensic psychiatrist, served as moderator.

The Grand Rounds took place from 12-1pm in Pierce Hall, inside the Service Building, at McLean Hospital.

Watch video of the entire “Psychosis vs. Psychopathy” event below, or explore past events on juvenile justice, pain, memory, and criminal responsibility, on CLBB’s Vimeo channel.

The 17th annual Conference on the Contemporary Applications of Psychological Assessment will be held Thursday, November 6 – Saturday, November 8, 2014 at the Massachusetts School of Professional Psychology.

The pre-conference institute, “Current controversies in assessment and treatment of ADHD,” on November 6, will feature CLBB faculty Larry Seidman, PhD.

The Conference, titled, “Violence risk and threat assessment: An historic and dynamic perspective,” will be held November 7 & 8. Robert Kinscherff, PhD, Esq., CLBB faculty, is a course director.

The conference is presented by The Department of Psychology, Massachusetts Mental Health Center Academic Division of Public Psychiatry of the Department of Psychiatry of the Beth Israel Deaconess Medical Center; The University of Massachusetts Boston, Department of Psychology; The Massachusetts School of Professional Psychology; and The Society for Personality Assessment.

For details and to register, see the conference website and brochure.