Training to Boost Wise Behavior Can Help Those with Schizophrenia

Emerging research suggests training to enhance positive psychological traits, such as wisdom, may promote health and well-being in persons with schizophrenia. Investigators at the University of California San Diego School of Medicine said the new study helps to clarify how wisdom – typically closely linked to improved health and well-being – impacts people with schizophrenia.

Investigators discovered that, on average, persons with schizophrenia (PwS) obtained lower scores on a wisdom assessment than non-psychiatric comparison participants (NPCPs). However, there was considerable variability in levels of wisdom.

Nearly one-third of PwS had scores for wisdom in the “normal” range, and these PwS with higher levels of wisdom displayed fewer psychotic symptoms as well as better cognitive performance and everyday functioning.

The research paper appears in the journal Schizophrenia Research.

“Taken together, our findings argue for the value of assessing wisdom in persons with schizophrenia because increasing wisdom may help improve their social and neuro-cognition, and vice versa,” said senior author Dilip Jeste, M.D., Distinguished Professor of Psychiatry and Neurosciences and director of the Stein Institute for Research on Aging.

“There is a concept of ‘wellness within illness,’” said Jeste. “Our findings support the hypothesis that wisdom and schizophrenia co-exist in a proportion of these patients, specifically those functioning at a higher level. Furthermore, the data suggest that treatments which enhance positive psychological traits, such as wisdom, may promote health and well-being in persons with schizophrenia.

“We have a tendency in medicine to focus attention on remediating symptoms and impairments to the exclusion of individual strengths. A sustained effort to assess and enhance positive traits in a person with severe mental illness, such as their levels of wisdom, happiness and resilience, might do much to improve the quality of their lives.”

In this study, 65 stable adult outpatients with a diagnosis of chronic schizophrenia or schizoaffective disorder and 96 without a psychiatric diagnosis (NPCPs) completed a commonly used, three-dimensional wisdom scale (3D-WS). The assessment tool includes measures of cognitive, reflective, and affective (relating to emotion) wisdom.

While people with schizophrenia had lower average scores on the wisdom scale than NPCPs, those PwS with higher wisdom scores performed better on neurocognitive and functional assessments than those with lower scores. Indeed, level of wisdom positively correlated with performance on multiple neurocognitive tests in PwS; no such relationships were detected in NPCPs.

The researchers also found that the ability to look inward accurately and without bias or to recognize others’ perspectives (the reflective domain of wisdom) was significantly related to the mental health and well-being of PwS. Whereas levels of cognitive and affective wisdom appeared to have no such correlative effect.

“In healthy adults, wisdom seems to reduce the negative effects of adverse life events. It boosts a sense of well-being, life satisfaction and overall health,” said first author Dr. Ryan Van Patten, a postdoctoral scholar in the UC San Diego School of Medicine Department of Psychiatry.

“In persons with schizophrenia, wisdom is also connected to levels of happiness, resilience, and subjective recovery.”

In recent years, there has been increasing empirical evidence that wisdom has a biological basis and can be modified and enhanced through a variety of interventions.

Jeste believes the study supports the idea that therapies which promote wise behavior in persons with schizophrenia can also boost their broader capacity to function in society, more healthfully and with greater happiness and satisfaction.

Source: University of California San Diego/EurekAlert

Parenting Practices Influence Development of Antisocial Behaviors in Children

Emerging research suggests less parental warmth and more harshness in the home environment can affect aggressive trait development among children. The parenting behavior can influence whether a child develops empathy and a moral compass, a set of characteristics known as callous-unemotional (CU) traits.

University of Pennsylvania psychologist Dr. Rebecca Waller and her research team analyzed small differences in parenting among 227 identical twins. The investigators studied the parenting that each twin experienced to determine whether these differences predicted the likelihood of antisocial behaviors emerging.

They learned that the twin who experienced stricter or harsher treatment and less emotional warmth from parents had a greater chance of showing aggression and CU traits. Callous-unemotional traits include limited empathy, a lack of guilt, a shallow affect and antisocial behavior.

The study appears in the Journal of the American Academy of Child and Adolescent Psychiatry.

“Some of the early work on callous-unemotional traits focused on their biological bases, like genetics and the brain, making the argument that these traits develop regardless of what is happening in a child’s environment, that parenting doesn’t matter,” said Waller.

“We felt there must be something we could change in the environment that might prevent a susceptible child from going down the pathway to more severe antisocial behavior.”

The work is the latest in a series of studies from Waller and colleagues using direct observation to assess a variety of aspects of parenting. The initial research, which considered a biological parent and child, confirmed that parental warmth plays a significant role in whether CU traits materialize.

A subsequent adoption study, of parents and children who were not biologically related, provided similar results.

“We couldn’t blame genetics, because these children don’t share genes with their parents,” Waller stated. “But this doesn’t rule out the possibility that something about the child’s genetic characteristics was evoking certain reactions from the adoptive parent.”

In other words, a parent who is warm and positive may have a hard time maintaining those behaviors if the child never reciprocates.

Knowing this led Waller to turn to a study of 6-to-11-year-old participants from a large, ongoing study of identical twins directed by Dr. S. Alexandra Burt at Michigan State University. For 454 children (227 sets of identical twins), parents completed a 50-item questionnaire about the home environment.

They also established their harshness and warmth levels by rating 24 statements such as “I often lose my temper with my child” and “My child knows I love him/her.” The researchers assessed child behavior by asking the mother to report on 35 traits related to aggression and CU traits.

“The study convincingly shows that parenting and not just genes contributes to the development of risky callous-unemotional traits,” said Hyde. “Identical twins have the same DNA, so we can be more certain that the differences in parenting the twins received affect the development of these traits.”

A potential next step is to turn these findings into useable interventions for families trying to prevent a child from developing such traits, or to improve troubling behaviors that have already begun, according to Waller.

“From a real-world standpoint, creating interventions that work practically and are actually able to change behaviors in different types of families is complicated,” concluded Waller. “These results show that small differences in how parents care for their children matters.”

The researchers acknowledge there are some limitations to the study, for example that it skews heavily towards two-parent families, meaning the findings may not be as generalizable to single-parent homes. It also assesses parenting measures and twin behaviors based solely on parenting reports.

Source: Elsevier/EurekAlert

New Method to Classify Schizophrenia Symptoms Should Improve Care

Development of symptoms associated with schizophrenia can dramatically change a person’s life trajectory. This is because negative symptoms in schizophrenia can be so disabling that they interfere with a person’s ability to attend school, begin a fulfilling career, and even live independently.

Symptoms of schizophrenia appear during adolescence or young adulthood with an average age of onset of 18 in men and 25 in women. In the new study, University of Nevada – Las Vegas psychology professor Dr. Daniel Allen and colleagues suggest a new way to classify the negative symptoms of schizophrenia.

The new methodology, published by JAMA Psychiatry, should improve intervention and treatment of the negative symptoms associated with schizophrenia and influence future research. Previous literature suggested that the negative symptoms of schizophrenia should be placed into two categories. Allen and his colleagues suggest that that view is too simplified.

To reflect the complexity of the disease, and to focus on more specific treatments, Allen suggests that the symptoms be placed into five categories. Allen says it is important to understand the symptoms of schizophrenia so we can measure them accurately.

“Correctly measuring these symptoms allows us to judge whether or not the person is improving or getting worse,” Allen said. “Or whether or not we’re developing medications that are actually helpful for the disorder that they have, or not helpful.”

Measuring symptoms in schizophrenia and other mental disorders can be difficult because it is heavily subjective, dependent on what people tell their doctors about the symptoms they are experiencing.

This makes care for the disorder challenging as the effectiveness of clinical care differs from a disease like cancer, where the effectiveness of treatments can be measured against the size of a tumor, and whether it’s shrinking.

Therefore, scientists like Allen believe an increased level of specificity is necessary when assessing people with schizophrenia. He recommends great care be taken to make sure that questions are asked about the kinds of symptoms people with schizophrenia experience — including negative symptoms.

His study, which he wrote with Gregory P. Strauss — his former UNLV student and current assistant professor of psychology at the University of Georgia — highlights the complexity of the disease and its symptoms.

“People with schizophrenia will continue to have these persistent, negative symptoms that interfere with their ability to function, live independently, hold a job, get married, and other important life goals and activities, and we need better treatments for them,” Allen said.

“It’s one of those areas in schizophrenia where there’s a lot of recent research interest in how to develop new medications or behavioral interventions that can remediate these symptoms so people can begin to live normally.”

Experts explain that schizophrenia is a serious mental disorder. Most people associate schizophrenia with unusual or bizarre symptoms, including hearing voices or seeing things that do not exist, delusional beliefs, and disorganized thinking and behavior.

However, other symptoms, referred to by scientists as negative symptoms, represent normal behaviors and abilities that the person has lost. These symptoms usually lead to long-term functional impairment.

Negative symptoms include the inability to experience pleasure, the inability to motivate oneself, the inability to socialize, diminished or total lack of facial expressions, and reduced quantity of speech.

“I think what we hope is that this study, and studies like it, will help us increase our understanding of the kinds of symptoms that people with schizophrenia experience and what kind of treatments are useful in improving those symptoms,” Allen said.

Source: University of Nevada – Las Vegas

Unique Brain Activity May Predict Schizophrenia

While some signs can suggest if a person is at risk for developing schizophrenia, a definitive diagnosis is not determined until the fist psychotic episode occurs. But neuroscientists have now discovered an abnormal brain pattern that is linked to the development of schizophrenia.

Schizophrenia is a brain disorder that produces hallucinations, delusions, and cognitive impairments. The disorder usually becomes evident during adolescence or young adulthood. The new research is expected to fuel studies that test use of cognitive behavioral therapy and neural feedback as early interventions to combat the symptoms of schizophrenia.

In the new study, MIT neuroscientists working with researchers at Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, and the Shanghai Mental Health Center have now identified a pattern of brain activity correlated with development of schizophrenia.

The researchers believe the discovery of the abnormal brain pattern be used as a marker to diagnose schizophrenia earlier.

“You can consider this pattern to be a risk factor. If we use these types of brain measurements, then maybe we can predict a little bit better who will end up developing psychosis, and that may also help tailor interventions,” said Dr. Guusje Collin, lead author of the paper.

The study, which appears in the journal Molecular Psychiatry, was performed at the Shanghai Mental Health Center.

Researchers explain that before an individual experiences a psychotic episode — characterized by sudden changes in behavior and a loss of touch with reality — people can experience milder symptoms such as disordered thinking.

This kind of thinking can lead to behaviors such as jumping from topic to topic at random, or giving answers unrelated to the original question. Previous studies have shown that about 25 percent of people who experience these early symptoms go on to develop schizophrenia.

The researchers followed 158 people between the ages of 13 and 34 who were identified as high-risk because they had experienced early symptoms. The team also included 93 control subjects, who did not have any risk factors.

At the beginning of the study, the researchers used functional magnetic resonance imaging (fMRI) to measure a type of brain activity involving “resting state networks.” Resting state networks consist of brain regions that preferentially connect with and communicate with each other when the brain is not performing any particular cognitive task.

“We were interested in looking at the intrinsic functional architecture of the brain to see if we could detect early aberrant brain connectivity or networks in individuals who are in the clinically high-risk phase of the disorder,” Whitfield-Gabrieli says.

One year after the initial scans, 23 of the high-risk patients had experienced a psychotic episode and were diagnosed with schizophrenia. In those patients’ scans, taken before their diagnosis, the researchers found a distinctive pattern of activity that was different from the healthy control subjects and the at-risk subjects who had not developed psychosis.

The researchers discovered that in most people, a part of the brain known as the superior temporal gyrus — involved in auditory processing — is highly connected to brain regions involved in sensory perception and motor control.

However, in patients who developed psychosis, the superior temporal gyrus became more connected to limbic regions, which are involved in processing emotions. This could help explain why patients with schizophrenia usually experience auditory hallucinations, the researchers say.

Meanwhile, the high-risk subjects who did not develop psychosis showed network connectivity nearly identical to that of the healthy subjects.

Researchers believe this type of distinctive brain activity could be useful as an early indicator of schizophrenia, especially since it is possible that it could be seen in even younger patients.

Source: MIT/EurekAlert

Brain Scan Plus Learning Data May Help ID Psychosis Risk

In a recent study, investigators from the University of Missouri discovered that brain scans, coupled with behavioral data, could provide markers for diagnosing psychosis risk.

Moreover, the researchers discovered that improving how well people at risk for psychosis learn from positive and negative feedback could potentially help mitigate psychotic symptoms.

Psychotic disorders such as schizophrenia and bipolar disorder often involve delusions or hallucinations in which people lose touch with reality.

Researchers hope findings will help mental health professionals to understand how to better treat their patients with psychoses and prevent its onset.

“Around the time Nobel Prize winner John Nash first developed psychosis he turned down an endowed chair at the University of Chicago because he said he believed he was going to become the emperor of Antarctica, despite the population of Antarctica being zero,” said Dr. John G. Kerns, a professor of psychological sciences.

“How a genius like John Nash could develop a delusion has long baffled clinicians and scientists. We wanted to examine whether dysfunction in a brain region called the striatum and a disruption in feedback-based learning were related to risk for psychosis.”

Investigators discovered feedback-based learning helps learners raise their awareness of strengths and weaknesses and identify actions to be taken to improve.

This learning technique is heavily dependent on varying levels of dopamine, a neurotransmitter that sends signals to other nerve cells in a part of the brain called the striatum.

Dopamine in the striatum provides an important teaching signal that increases or decreases the chance that certain thoughts and actions occur again in the future.

In research conducted at the Mizzou Brain Imaging Center and using a feedback-based learning task, Kerns and his team found that people at risk for psychosis are impaired when they need to rely on feedback to learn.

Using functional magnetic resonance imaging (fMRI), the team found that people at risk for psychosis failed to activate the striatum when they received feedback.

“Current research suggests that people like John Nash develop delusions in part because they have problems learning from feedback, like a car driving without a brake,” Kerns said.

“Our research is also consistent with other research that people with psychosis have an increased level of dopamine in the striatum. However, for the first time we have linked psychosis risk to both a behavioral impairment, poor feedback learning, as well as striatum dysfunction.”

It is also hoped that this research will be useful in detecting risk for psychosis, Kerns said.

Measuring dopamine in the striatum is both invasive and expensive and cannot be done in routine clinical assessment.

However, Kerns found that non-invasive measures can be used in everyday clinical practice to effectively detect striatal dysfunction. Ultimately, Kerns believes this research will help professionals both detect risk and prevent psychosis, which could mean decreased suffering for many people and their families.

The study appears in the Schizophrenia Bulletin.

Source: University of Missouri

Self-Diagnosis of Personality Disorders May Be More Accurate Than Expected

New research reveals that when using the same evaluative tools, a professional’s diagnosis of a personality disorder and an individual’s self-evaluation may be relatively similar. In fact, individuals may report more personality disorder pathology than was noted by their therapists. The study suggests concerns about invalid self-reports due to under-reporting have been overstated.

Purdue University researchers believe the findings should lessen concerns that people lack awareness of their own personality pathology. The research findings appear in the Journal of Consulting and Clinical Psychology.

Previous research suggested that clients lack awareness of their own personality pathology due to a perceived gap in agreement of the evaluation of a clinician and the patient’s own self-diagnosis.

However, the new research finds that when using the same evaluation tool set, that gap of agreement significantly decreased, and previous concerns might have been overstated.

“Research settings typically utilize diagnostic procedures that differ considerably from methods used in clinical practice,” said Dr. Douglas Samuel, associate professor of psychological sciences and lead author on the paper.

“As a result, little is known about the reliability and validity of the diagnoses assigned in routine clinical practice.”

For the study, researchers collected dimensional trait ratings from 54 therapist-client dyads within outpatient clinics. Patients provided ratings of dimensional personality disorder traits via the Personality Inventory for DSM-5, an assessment scale created by the American Psychiatric Association.

The assessment is designed to provide a broad indication of problematic personality traits, focusing on five personality trait domains, including negative affect, detachment, antagonism, disinhibition and psychoticism.

Therapists also completed the informant version of the same assessment.

“In contrast with concerns about under-reporting of personality disorder pathology, clients reported a greater pathology than their therapists on almost all traits,” Samuel said.

“These findings alleviate concerns about the validity of self-reports, but also raise questions about how and why clients (and clinicians) provide ratings. Ultimately, more work is necessary to understand how source and methods can be best integrated to arrive at the most effective personality disorders diagnoses.”

Graduate students Takakuni Suzuki, Meredith Bucher and Sarah Griffin are co-authors of the paper.

Researchers explain that although treating clinicians provide the majority of mental health diagnoses, little is known about the validity of their routine diagnoses — including the agreement with clients’ self- reports.

This is particularly notable for personality disorders (PDs) as the literature suggests weak agreement between therapists and clients. Existing research has been limited by a focus on PD categories and brief therapist-report measures.

Moreover, although self-reports of PD have been criticized for under-reporting, very few data have compared them to therapist-report in terms of mean-level.

To evaluate the limitations, researchers collected dimensional trait ratings from 54 therapist-client dyads within outpatient clinics. The clients (52 percent women, 94 percent Caucasian, 39.8 years) provided ratings of dimensional PD traits via the Personality Inventory for DSM-5 (PID-5). Likewise, therapists (72 percent female, 89 percent Caucasian) completed the Informant version of the same measure.

The results show that when employing similar evaluative measures of traits, the results were closer than observed in prior studies. In fact, mean-level comparisons indicated that individuals (clients) reported significantly higher levels of PD pathology than did their therapists.

This effect was most notable for the domain of psychoticism. From these findings, researchers conclude that when using similar evaluative tools, individuals and therapists were in much more agreement over a diagnosis than has been reported in prior studies.

Source: Purdue University