Attachment styles are used to describe patterns of attachment in relationships. Adults with a secure attachment style tend to have good self-esteem, they share their feelings with partners and friends, and have trusting, lasting relationships. Insecure attachment styles include anxious attachment style (also known as ambivalent or preoccupied), which involves reluctance to become close to others, worry about the security of relationships, a reduced sense of autonomy, and increased dependence on others. Avoidant attachment style is another insecure style. It involves problems with intimacy, over-regulation of emotions, and unwillingness to share thoughts and feelings. Fearful attachment style is represented by an inconsistent sense of self and an inability to regulate one’s emotions.

While attachment style in adulthood is thought to be based on early experiences with primary care givers, life’s experiences can also impact on attachment style in adults. Children described as ambivalent or avoidant can become securely attached as adults, while those with a secure attachment in childhood can show insecure attachment patterns in adulthood.

What is the evidence for attachment styles in people with schizophrenia?

Moderate to high quality evidence found the prevalence of insecure attachment styles is higher in people with schizophrenia than in people without a mental illness (76% vs. 38%), with fearful attachment style being the most prevalent in patients (38%) followed by avoidant (23%), then anxious (17%) attachment style. This large effect of more insecure attachment styles in people with schizophrenia compared to controls was similar to that seen in people with depression or bipolar disorder. It was also similar across all three disorders for anxious attachment style. However, for avoidant attachment style, it was small for schizophrenia, medium-sized for bipolar disorder, and large for depression.

Small to medium-sized associations were found between increased general and positive symptoms and increased anxious and avoidant attachment styles. There was a weak association between increased negative symptoms and increased avoidant attachment style, and no significant association between negative symptoms and anxious attachment style. There were also medium-sized associations between decreased social and personal recovery and increased anxious and avoidant attachment styles in patients.

February 2022

Image: ©VectorMine – stock.adobe.com

The post Attachment styles appeared first on NeuRA Library.

Selective attention is the ability to focus on relevant stimuli and ignore irrelevant stimuli. Sustained attention is the ability to maintain a consistent focus. Several tasks have been developed to assess attention performance. Examples include the Continuous Performance Test (CPT), which uses both visual and auditory stimuli and requires participants to respond to targets and ignore distractors. Other examples include the Trail Making Test (TMT), which requires participants to connect, in order, letters and/or numbers as quickly as possible, and the Wisconsin Card Sorting Test (WCST) that tests the ability to display flexibility during changing schedules. The Stroop Colour Word Test (SCWT) presents the name of a colour printed in an ink congruent to the colour name (e.g. blue), or incongruent to the colour name (e.g. blue), and participants are asked to either read the word or name the ink colour. Attention tasks may also measure other cognitive constructs, such as processing speed and memory.

What is the evidence for attention?

Moderate to high quality evidence shows medium to large effects of poorer performance on various attention and vigilance tasks in people with schizophrenia compared to people without schizophrenia. There are small to medium-sized associations between poorer attention and more severe symptoms, poorer community functioning, and poorer social skills. People taking olanzapine or quetiapine showed medium to large improvements on attention tasks after treatment. People taking haloperidol showed small improvements after treatment, and people taking clozapine or risperidone showed no improvement after treatment.

High quality evidence found people at clinical high risk of psychosis and people at familial high risk for psychosis are similarly impaired on attention tasks. Moderate to high quality evidence shows a medium-sized effect of better attention in people at clinical high-risk than people with first-episode psychosis. Those at risk who converted to psychosis were more impaired on attention tasks than those at risk who did not convert to psychosis.

Compared to people with bipolar disorder, moderate to high quality evidence shows people with schizophrenia have slightly poorer performance on attention tasks. There was also poorer performance on attention tasks in people with schizophrenia who were herpes simplex virus positive or had metabolic syndrome than in people with schizophrenia who were herpes simplex virus negative or did not have metabolic syndrome. There was a small effect of greater impairment in attention in smokers vs. non-smokers with schizophrenia, however people with schizophrenia and a substance use disorder performed better on attention tasks than people with schizophrenia and no substance use disorder.

March 2022

Image: ©nelos – stock.adobe.com

The post Attention appeared first on NeuRA Library.

There are two key approaches for identifying people with early signs that may suggest a high risk of developing psychosis or schizophrenia. The first approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing phenomenological (subjective) disturbances. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect an earlier phase in the disease process than the second approach, which identifies at-risk mental states as a combination of; a family history of psychosis (familial risk) plus non-specific symptoms and recent decline in functioning; recent onset Attenuated Psychotic Symptoms with decline in functioning; and Brief Limited Intermittent Psychotic Symptoms.

What is the evidence for cognitive functioning in high-risk groups?

Moderate to high quality evidence found medium-sized effects of poorer verbal learning, reasoning and problem-solving, visual memory, verbal memory, working memory, olfaction, visual learning, and executive functioning in people at clinical high-risk for psychosis compared to controls. There were also small effects of poorer general intelligence, processing speed, attention/vigilance, premorbid intelligence, visuospatial ability, social cognition, and motor functioning in people at clinical high risk for psychosis.

High quality evidence shows people at clinical high risk of psychosis and familial high risk of psychosis are similarly impaired on processing speed, verbal and visual memory, attention and language fluency when compared with controls. People at familial high risk were more impaired on premorbid and current IQ than those at clinical high risk, and those at clinical high risk were more impaired on visuospatial working memory than those at familial high risk.

Moderate quality evidence found medium-sized effects of poorer verbal learning, visual memory, and executive functioning in people at high-risk of psychosis who made the transition to psychosis compared to people at high-risk of psychosis who did not make the transition to psychosis. There were small effects of poorer processing speed, attention/vigilance, and general intelligence in those who transitioned to psychosis, with no differences in working memory, premorbid intelligence, olfaction, or motor functioning.

Moderate quality evidence finds medium-sized effects of better verbal learning, general intelligence, and executive functioning in people at high-risk of psychosis compared to people with first-episode psychosis. There were no differences in premorbid intelligence or processing speed.

High quality evidence finds small improvements in cognition over time in people at ultra-high risk of psychosis and in people with first-episode psychosis.

March 2022

Image: ©ninefotostudio – stock.adobe.com

The post Cognition in high-risk groups appeared first on NeuRA Library.

Cognitive deficits are core features of both schizophrenia and bipolar disorder. Establishing differences in cognition between these disorders may be useful for identifying differences in the underlying illness pathologies, and may provide potential targets for individual treatments.

What is the evidence for cognitive functioning in schizophrenia and bipolar disorder?

Moderate to high quality evidence shows small to medium-sized effects of poorer global cognition, executive functioning, social cognition, processing speed, attention, reasoning and problem solving, learning, and memory in people with schizophrenia (including early onset schizophrenia) compared to bipolar disorder (including paediatric bipolar disorder).

There was a medium-sized effect of poorer pre-illness onset cognitive functioning and a large effect of poorer post-illness onset cognitive functioning in people with schizophrenia compared to controls without a mental illness. In people with bipolar disorder compared to controls without a mental illness, there was a small effect of poorer pre-illness onset cognitive functioning and a medium-sized effect of poorer post-illness onset cognitive functioning. People with schizoaffective disorder showed poorer cognitive performance than people with bipolar disorder, but better cognitive performance than people with schizophrenia.

March 2022

Image: ©iconicbestiary – adobe.stock.com

The post Cognition in schizophrenia and bipolar disorder appeared first on NeuRA Library.

Schizophrenia is characterised by positive, negative and disorganised symptoms. Positive symptoms refer to experiences additional to what would be considered normal experience, such as hallucinations and delusions. Negative symptoms include blunted affect, impoverished thinking, alogia, asociality, avolition, and anhedonia. Alogia is often manifested as poverty of speech, asociality involves reduced social interaction, avolition refers to poor hygiene and reduced motivation, while anhedonia is defined as an inability to experience pleasure. Disorganised symptoms involve bizarre behaviour and disorganised thought and speech. Cognitive deficits are also a core feature of schizophrenia. These deficits may be present in chronic patients, as well as prior to onset of the disorder and during its early and acute stages. Cognitive deficits may be associated with specific symptoms as well as functional impairment.

What is the evidence for cognitive functioning relating to symptom dimensions?

Moderate to high quality evidence shows more severe overall symptoms are associated with poor prospective memory, insight, executive functioning, facial perception, facial emotion recognition, emotion processing and perception, social perception, and Theory of Mind.

More severe positive symptoms are associated with poorer insight, attention/vigilance, reasoning, problem solving, non-emotional recognition, self-recognition, psychomotor speed, executive functioning, Theory of Mind, verbal list learning and digit span performance. More severe negative symptoms are associated with poorer language fluency, IQ, attention, memory, learning, speed of processing, reasoning, executive functioning, insight, social cognition, and olfaction. More severe disorganised symptoms are associated with poorer IQ, attention, executive functioning, speed of processing, reasoning/problem solving, and memory, but not verbal working memory. Thought disorder was associated with poorer semantic priming and verbal fluency.

March 2022

Image: ©carlosgardel – stock.adobe.com

The post Cognitive functioning related to symptoms appeared first on NeuRA Library.

Decision making requires the use of knowledge and experience of a context in order to choose a course of action. The ability to autonomously make decisions is referred to as their decisional capacity. Effective decision-making aims to increase the likelihood of a favourable outcome in the relevant context, selecting responses that avoid unfavourable or harmful outcomes.

An experimental tool used to examine decision-making is the Iowa Gambling Task. On each trial, participants choose a card from one of four decks and receive a monetary gain or loss. Two decks (A, B) are disadvantageous and two decks (C, D) are advantageous. The decks also differ according to the amount of immediate gain, the relative frequency of gains vs. losses and the relative number of net losses. The goal is to maximize monetary outcome through adaptive decision-making across many trials.

Another experimental tool is the MacArthur Competence Assessment Tool, which assesses the ability to understand the relevant information, the ability to reason rationally, the ability to appreciate a situation and its consequences, and the ability to communicate a choice.

What is the evidence for decision making?

High quality evidence found medium to large impairments in understanding, appreciation and reasoning decision-making and a small impairment in expression of a choice decision making. Effect sizes were smaller in studies using enhanced informed consent for people with schizophrenia.

Moderate to high quality evidence found poorer performance on the Iowa Gambling Task, with more A and B deck choices and fewer D deck choices. There were also fewer C deck choices, although this was not significantly different to controls.

Moderate quality evidence found more severe psychotic symptoms and poorer verbal cognitive functioning are associated with reduced decision-making ability about treatment (small to medium-sized effects).

March 2022

Image: ©mantinov – stock.adobe.com

The post Decision making appeared first on NeuRA Library.

Defeatist performance beliefs are over-generalised negative thoughts about one’s ability to successfully perform goal-directed behaviour. This prevents the initiation of and engagement in social and employment opportunities and therefore is considered a possible contributing factor to negative symptoms and poor functional outcomes.

Neurocognitive deficits in memory and attention for example may contribute to unsuccessful goal attainment, which over time can give rise to dysfunctional attitudes, including defeatist performance beliefs. These dysfunctional attitudes, in turn, may lead to a decrease in motivation for future goal-related activities, which may contribute to functional outcome deficits. Reduction in goal-directed behaviour reinforces further disengagement with the social world.

What is the evidence for defeatist performance beliefs?

High quality evidence suggests significant but small relationships between increased defeatist performance beliefs and worse negative symptoms and functional outcomes (e.g. general functioning, quality of life, life skills).

March 2022

Image: ©terovesalainen – stock.adobe.com

The post Defeatist performance beliefs appeared first on NeuRA Library.

Dermatoglyphics, also referred to as epidermal ridges, are the distinct patterns and lines on the hands and fingers. These ridges appear on the hands between weeks 6 and 15 during foetal development, and remain largely unchanged after this period. Alterations in the patterns and counts of dermatoglyphics may be an indication of disruption to foetal development in the early- to mid-gestation period. A triradius occurs where three ridge systems meet at a point, and occurs four times on the palm, at the base of each of the four digits (a, b, c, and d). Dermatoglyphic indices include: fingertip patterns; finger ridge counts, which are the number of ridges between the center of the fingertip patterns and their corresponding triradius; palmar ridge counts, which are the number of ridges on the palm connecting two triradii; fluctuating asymmetries, which are the differences in ridge counts or pattern types between parallel structures on the left and right hands; and the ATD angle, which is the angle formed by lines drawn from the most remote triradius near the base of the palm, to triradii a and d, located close to the index and little fingers respectively.

What is the evidence for dermatoglyphics?

Moderate to high quality evidence found a medium-sized effect of reduced total ridge count and a-b palmar ridge count in people with schizophrenia compared to controls, with no differences in ATD angle, fingertip pattern asymmetry or ridge count asymmetry.

February 2022

Image: ©peopleimages – stock.adobe.com

The post Dermatoglyphics appeared first on NeuRA Library.

Key features of the symptoms of disorganisation include disorganised speech and behaviour, as well as inappropriate affect. Severely disorganised speech is difficult to follow, being incoherent, irrelevant and/or illogical. These symptoms are sometimes referred to as positive formal thought disorder. Disorganised speech may also be deprived of content, which is sometimes referred to as negative formal thought disorder symptoms. Disorganised behaviour includes bizarre or inappropriate behaviour, actions or gestures. Inappropriate (incongruous) affect involves exhibiting incorrect emotional responses for a given context.

Symptoms of disorganisation have been identified as risk factors for poor illness outcome, and have a significant negative effect on a person’s day-to-day functioning and quality of life. There is evidence to suggest that disorganisation symptoms may be associated with impaired cognitive performance.

What is the evidence regarding disorganised symptoms?

Moderate to high quality evidence found small to medium-sized associations between positive and negative formal thought disorder and poor cognition in the areas of memory, attention, processing speed, planning, semantic processing, social cognition, and social functioning. Positive formal thought disorder was particularly associated with poor inhibition and syntactic comprehension, while negative formal thought disorder was particularly associated with poor fluency. There was also a medium-sized association between poor insight (overall unawareness of having a mental disorder) and increased disorganised symptoms.

There was a small to medium-sized effect of more formal thought disorder symptoms in people with schizophrenia than in people with bipolar disorder. This effect was significant only in non-acute, stable patients.

High quality evidence shows significant concordance of disorganisation symptoms in siblings with schizophrenia. Low quality evidence suggests unclear concordance in twins with schizophrenia.

February 2022

Image: ©carlosgardel – stock.adobe.com

The post Disorganised symptoms appeared first on NeuRA Library.

Dissociation is described as disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, or behaviour. Common dissociative experiences include mild forms of absorption, such as daydreaming. Less common and more severe dissociative experiences include amnesia, derealisation, depersonalisation, and fragmentation of identity. Dissociative features may play a role in the pathology of schizophrenia.

What is the evidence for dissociation?

Moderate to high quality evidence found more dissociation in people with schizophrenia than controls without schizophrenia. In those with schizophrenia, there was a medium-sized association between exposure to childhood adversity and more dissociation. There were also medium to strong associations between increased dissociation and increased psychotic symptoms.

Moderate to low quality evidence found less dissociation in people with schizophrenia than in people with dissociative disorders, post-traumatic stress disorder, borderline personality disorder, or conversion disorder.

February 2022

Image: ©Nomad_Soul – stock.adobe.com

The post Dissociation appeared first on NeuRA Library.