A cross-sectional study on the association between executive functions and social disabilities in people with a psychotic disorder

BackgroundExecutive function difficulties may be prevalent in people with PTSD, and they might negatively affect their behavior and daily functioning. However, knowledge about the implications of executive function deficits on daily functioning and the assessments that reflect functional limitations is limited. This study aimed to measure how executive function difficulties affect daily functioning in PTSD using ecologically valid assessments that imitate daily activities.MethodsThe participants were 66 individuals aged 18–65 years: 26 diagnosed with PTSD and 40 healthy controls. All participants completed a socio-demographic questionnaire, the Clinician-Administered PTSD Scale, and the Behavior Rating Inventory of Executive Functions—BRIEF-A, a self-reported tool to assess the impact of executive functions on daily activities. The participants also performed a virtual shopping activity to assess executive functions while performing in a daily activity using the Virtual Action Planning Supermarket (VAP-S 2), a novel, ecologically valid, performance-based tool.ResultsDifficulties in executive functions were significantly more prevalent in PTSD patients: the BRIEF-A reflected how executive function difficulties manifested in behavioral dysregulation, restricting daily functioning. The VAP-S 2 revealed difficulties in executive functions, expressed as higher impulsivity, lower strategy use, and decreased performance efficiency while shopping in the virtual supermarket. Correlations were found between BRIEF-A and VAP-S 2: more collisions and lower inhibition in VAP-S 2 were correlated with worse BRIEF-A scores. Difficulties in executive functions correlated with PTSD severity.ConclusionsExecutive function difficulties in PTSD may correlate with PTSD severity and restrict daily functioning. Therefore, executive functions in PTSD should be evaluated using ecologically valid assessments to illuminate the implications of real-life activities. VAP-S 2 uniquely enables an objective assessment of executive functions in real-life scenarios for PTSD, complementing self-report and enhancing the ecological validity of findings. It is recommended to combine self-reports that reflect the person’s authentic perspective with performance-based assessments, such as the VAP-S 2, to focus intervention on people’s real-life context and, by that, improve their function and well-being.

BackgroundSocial functioning impairment is one of the core features for schizophrenia diagnosis and are also present in other psychotic spectrum disorders, being determinant for disability. This impairment has multiple domains, which are linked but separate. Previous research has shown that social functioning is multiply determined by neurocognition, social cognition and symptoms, being social cognition the domain that accounts for more of the variance in daily functioning. However, cognitive rigidity in interpersonal perception has received less attention and much variance remains unexplained. The aim of this study was to test the role of interpersonal cognitive rigidity, as measured with the Repertory Grid Technique (RGT) in social functioning in psychosis.MethodsSample of 40 out-patients with a psychotic spectrum diagnosis from the network of mental health services of Parc Sanitari Sant Joan de Déu (Barcelona, Spain). Cross-sectional study, assessment was carried out by a predoctoral researcher (GMH), using a sociodemographic questionnaire, the Social Functioning Scale (SFS), the Hinting Task (Theory of Mind, ToM), the Beck Cognitive Insight Scale (BCIS), and the RGT (to measure interpersonal cognitive rigidity, two indices were selected: Percentage of Variance Accounted for the First Factor, PVAFF, and Polarization). Pearson correlations and multiple regression analysis were performed.ResultsResults showed that social engagement/withdrawal was explained by PVAFF, accounting for 16% of the variance. Independence-competence was explained by polarization, explaining 14.6% of the variance and by sex, which accounted for 11.1% of the variance. Independence-performance was explained by theory of mind, explaining 22.5% of variance. Employment/occupation was explained by years of illness accounting for 21.6% of variance, and by polarization (beta=-0.318, p=0.026) which explained 10% of variance. Finally, the total score of the SFS was explained by polarization, explaining 14.4% of variance, and sex, which accounted for 12.6% of variance. For prosocial activities and interpersonal communication, none of the variables entered for the linear regression analysis.DiscussionDespite ToM and cognitive insight are common variables reported in the research literature, in our study the cognitive rigidity measures of the RGT, based on the patients’ own terms (personal constructs) in rating their significant others, were better predictors of social functioning. These findings support the importance and utility of an idiographic instrument like the RGT to investigate cognitive processes related to social perception and their impact on functioning. Regarding PVAFF, a higher tendency to perceive the interpersonal world from a unidimensional manner predicted a worse outcome in social relationships/withdrawal. Regarding interpersonal polarized thinking, it was the best cognitive predictor of social functioning measures. Our results suggest that a dichotomous thinking style in interpersonal perception might also be relevant for elucidating the dysfunction in social adjustment domains. These findings are still preliminary, and form part of an ongoing study.

Objective To understand the clinical symptoms and treatment method of acute schizophrenia,to explore the effect of antipsychotic drugs on the social function recovery in acute phase schizophrenia patients.Methods In our hospital from 2010 June to 2013 June,we treated 45 cases of the acute phase of schizophrenia patients as the research object.By using the method of random with the intention we divided them into three groups,15 cases in each group.Among them,group A was treated with anti psychotic drugs typical,group B was treated with atypical antipsychotic drugs for treatment,group C used paliperidone extended-release tablets for treatment,and then used the personal and social performance scale (PSP) and positive and negative symptom scale (PANSS) on the treatment of three groups of patients before treatment,4 weeks,12 weeks and 24 weeks after treatment,we evaluated the social function,then carried on the contrast analysis.Results After the analysis,we compared three groups of patients before and after treatment,the PANSS score had significant statistical difference (P ＜ 0.01),and in group C patients after 4 weeks,the PANSS scores (with the exception of positive symptom score) were significantly lower than those in group A and group B,showing a significant statistical difference (P ＜ 0.05),and 12 weeks and 24 weeks later,in group B and C,the PANSS scores (with the exception of positive symptom score) were significantly lower than those of group A,showing significant statistical difference (P ＜ 0.05); the three groups before and after treatment PSP scores showed significant statistical difference (P ＜ 0.01),but for PSP score,the treatment group A after treatment for 12 weeks and 24 weeks ago there was no significant statistical difference (P ＞ 0.05),the group C at 4 weeks after treatment PSP score was significantly higher than that of group A and B group,after treatment for 12 weeks and 24 weeks in the group B the PSP score was higher than that in group A,group C,PSP scores were significantly higher than that in group B,showing significant statistical difference (P ＜ 0.05).Conclusions Antipsychotic drugs can improve the social function of acute phase patients with schizophrenia,but from the effects of view,atypical antipsychotics are better than typical antipsychotic drugs,especially with paliperidone extended-release tablets optimal.But the influencing factors during the acute phase of the social function of schizophrenia patients recovery is relatively complex,so the drug of choice for patients with acute schizophrenia for the social function recovery has very big impact,therefore,clinical attention should be emphasized. Key words: Schizophrenia; Acute period; Antipsychotic drugs; Social function; Recovery; Influence

Executive and social functioning difficulty is well established in pediatric brain tumor survivors. Few studies have compared posterior fossa (PF) tumor survivors in comparison to their peers. The relationship between attention, processing speed, working memory, fatigue, and executive and social functioning was investigated to better understand the factors that impact executive and social functioning in PF tumor populations. Sixteen medulloblastomas, 9 low-grade astrocytomas (LGAs), and 17 healthy controls recruited from 4 sites completed measures of working memory and processing speed, and self-reported fatigue. One parent completed questionnaires on executive and social functioning. There were no significant differences among all 3 groups on parent-reported executive and social functioning; of note, parents of LGA survivors expressed greater concerns regarding behavioral and cognitive regulation than did parents of medulloblastoma survivors and healthy controls. Parent-reported attention was related to parent-reported emotion, behavior, and cognitive regulation. Worse self-reported fatigue was associated with greater emotional dysregulation for the 2 PF tumor groups. Parents of PF tumor survivors described their children as performing similarly to their peers in most facets of executive and social functioning. While LGA survivors are traditionally thought to have more favorable outcomes, our finding of parent-reported executive functioning concerns to be worse for this group highlights the importance of long-term follow-up for all PF tumor survivors. Additionally, significant effects of attention on aspects of executive functioning in PF tumor survivors may inform current clinical practice and the future development of more effective interventions.

More than a decade ago, Whitley and Drake suggested a dimensional structure for the concept of recovery in psychotic disorder patients. This perspective of multiple objective and subjective dimensions of recovery (e.g. symptomatic, personal and functional recovery) opened a wide range of topics of practical relevance for mental health services. Future research was encouraged to address the question whether progress in one dimension of recovery is predicated by progress in another. However, a recent systematic review of personal recovery in people with a psychotic disorder observed that studies on other than clinical factors as determinants of personal recovery are scarce, as are studies of changes in dimensions of recovery over time. Thus, in spite of a long standing interest in recovery in people with severe mental illness by consumers, clinicians, and policy makers, the field is still faced with a triple fold challenge: (1) to combine different perspectives, (2) to get longitudinal information (including the course of recovery when patients are not in mental health care anymore), and (3) to develop interventions aimed at improving personal and functional recovery from psychosis. In a ten years longitudinal cohort study in the Netherlands, we aim to meet these challenges by focussing on the interrelation of dimensions of recovery and modelling the process of recovery across time.

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on social function and life quality of schizophrenia in long-term hospitalization. Methods Sixty patients met with ICD-10 for schizophrenia in long-term hospitalization were enrolled in this study. The group was divided randomly into research (n=40) and control (n=40) groups. They were given rTMS or sham stimulation, respectively. The treatment was given 20 times, and the course of treatment was 4 weeks. The research and control groups were assessed with measured the scale of social function in psychosis inpatients and personal and social function scale and schizophrenia quality of life scale before and after 4 weeks treatment. Each test result of all groups before and after treatment was compared with each other, respectively. Results Compared to rTMS before treatment, the study group scale of social function in psychosis inpatients (SSPI) total score, factor Ⅰ, Ⅱ and personal and social function scale (PSP) scores were significantly increased (P 0.05); the study group Schizophrenia Quality of Life Scale (SQLS) total score, psychological and social power, the energy scale scores were significantly reduced (P 0.05). No significant change was found in the scores of project SSPI, PSP and SQLS in control group before and after treatment (P>0.05); the difference of each parameter between two groups after treatment were statistically significant (P<0.05). Conclusions Repetitive transcranial magnetic stimulation could improve on social function and life quality of schizophrenia in long-term hospitalization, rTMS could provide a new way for the individual rehabilitation of schizophrenia in long-term hospitalization. Key words: Transcranial magnetic stimulation; Schizophrenia/TH/RH; Social behavior; Quality of life

Functional abilities as reflected through temporal handwriting measures among adolescents with neuro-developmental disabilities

BackgroundProblems in social functioning (e.g., unemployment, social isolation), are common in people with a psychotic disorder. Social cognition is a treatment target to improve social functioning, as it is a proximal predictor of social functioning. Social Cognition Training (SCT) improves social cognition, but may not generalize (enduringly) to social functioning, perhaps due to insufficient opportunity to practice in daily-life social situations. Using virtual reality (VR) for SCT could address this problem, as VR is customizable, accessible, and interactive. We will test the effect of a VR SCT, ‘DiSCoVR’, on social cognition and social functioning in a randomized controlled trial (RCT).MethodsIn total 100 people with a psychotic disorder and deficits in social cognition will be recruited for this multicenter randomized controlled trial (RCT). Participants will be randomized to VR SCT (DiSCoVR) or VR relaxation training (VRelax; active control). DiSCoVR is a 16-session individual SCT, consisting of three modules: 1) emotion perception (recognizing facial emotions in a virtual shopping street); 2) social perception and theory of mind (observing social interactions between virtual characters and assessing their behavior, emotions and thoughts); and 3) application of higher-order social cognition in social interaction (role-playing personalized situations in VR). People receiving VRelax complete sixteen individual sessions, in which they receive psycho-education about stress, identify personal stressors, learn relaxation techniques, and explore relaxing immersive virtual environments.Assessments will be performed at baseline, post-treatment, and 3-month follow-up. Primary outcomes are emotion perception (Ekman 60 Faces), social perception and theory of mind (The Awareness of Social Inference Test). Secondary outcomes include social functioning (Personal and Social Performance Scale), experiences and social interactions in daily life (experience sampling of emotions, social participation and subjective experience of social situations), psychiatric symptoms (e.g., depression, perceived stress, anxiety, positive and negative symptoms) and self-esteem.DiscussionTo our knowledge, this will be the first RCT testing the efficacy of VR SCT. It will also investigate generalization to daily life social situations, the durability of treatment effects, and moderators and mediators of treatment success.Trial registrationOn December 5, 2017, this trial was registered prospectively in the Dutch Trial Register as NTR6863.

ObjectiveIn patients with psychotic disorders, insecure attachment styles and impaired social functioning are highly prevalent. Our aim was to explore the multi-cross-sectional and longitudinal associations between attachment style and social functioning. MethodsThis study was performed in a subsample of 119 patients with non-affective psychotic disorders, 128 unaffected siblings and 66 healthy controls within the Genetic Risk and Outcome of Psychosis (GROUP) Study. Attachment style (using the Psychosis Attachment Measure) and three social functioning domains, namely withdrawal, interpersonal behaviour and pro-social activities as measured with the Social Functioning Scale (SFS) were assessed on two moments in time. Generalized linear mixed models and linear regression models were used. Bonferroni correction for multiple testing was applied. ResultsIn the patient group, a significant negative association was found between avoidant attachment and pro-social functioning. In the sibling and control group, we found significant negative associations between avoidant attachment and the social functioning domains withdrawal and interpersonal behaviour. We also found a significant negative association between anxious attachment and the social functioning domain withdrawal in siblings. Higher levels of insecure anxious attachment at baseline predicted a reduction of the social functioning domain interpersonal behaviour in siblings over a period of three years on a trend level. ConclusionsFindings indicate that levels of insecure attachment are elevated in patients with psychotic disorders and have a negative association with social functioning in both patients, siblings and controls. These findings warrant specific attention for attachment style in the treatment of patients with psychotic disorders and individuals with an increased vulnerability for developing psychosis.

Deficits in self-regulation and executive functions (EFs) frequently characterize children/adolescents with emotional regulation disorders and restrict their daily function and quality of life (QOL). These deficits are mainly manifested by neuropsychological measures in laboratory settings. This study aimed to compare self-regulation and EFs by ecological measures to reflect the implications in daily life between children with emotional regulation disorders and healthy controls and examine the relations between self-regulation, EFs and QOL in the study group. the participants were 49 children aged 8-18: 25 children/adolescents with emotional regulation disorders and 24 healthy children. The parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL), the Behavior Rating Inventory of Executive Functions (BRIEF) and the Pediatric Quality of Life Inventory (Peds-QL). The study group had greater self-regulation difficulties (internalization and externalization problems), executive dysfunctions (EFdys) (including metacognition difficulties) and a lower QOL. Their internalization and externalization problems correlated with reduced EFs and QOL. Internalization predicted the physical and emotional QOLs, while metacognition predicted social and school-related QOLs. Deficits in self-regulation and EFs are prevalent in children/adolescents with emotional disorders and restrict their daily function and QOL. Therefore, they should be routinely evaluated by ecological instruments to reflect daily restrictions.

The cultural background and age shape the cognitive and social development of children. This study aimed to compare perceptual, executive, and social functioning in two age groups of preschoolers from Germany and Iran. One hundred sixty-five children (83 Iranian and 82 German) participated in the study, with 87 children aged three years and 78 children aged four years. The participants completed a series of tasks to assess different cognitive functions, including the theory of mind as a measure of social cognition, picture mental rotation test to evaluate spatial ability, and several tests including digit span, Corsi block tapping, day-night, grass-snow, dimensional change card sort, and active and passive vocabulary tests to assess executive functions. The findings revealed that German children performed better than their Iranian peers regarding spatial ability and theory of mind. Additionally, German children outperformed Iranian children in working memory, cognitive flexibility, and verbal fluency, while Iranian children demonstrated better inhibitory control. Furthermore, the correlational analysis indicated that in German children, executive function correlated with the theory of mind, whereas in Iranian children, executive function was associated with perceptual functions. Age impacted the results. These results highlight the role of cultural factors in shaping cognitive functioning and emphasize the need to consider cultural influences when examining cognitive development in different populations.

ABSTRACTThis study address three questions: (a) Do interned adolescents exhibit general or specific deficits in the core executive functions, as compared to an age-matched control group? (b) Do interned adolescents report more executive problems in everyday life, as compared to an age-matched control group? And (c) are performance-based measures of executive functions related to self-reported executive problems? Thirty-one interned youths and 40 non-interned controls participated in the study. To this end, we measured the three constituents (inhibition, shifting, and updating) of the Unity/Diversity model of executive functioning, as well as the participants’ self-reported everyday executive functioning using the Behavior Rating Inventory of Executive Functions scale. The interned group performed less well compared to the control group on the majority of performance-based tasks but did not show more pronounced deficits in any one executive function, reflective of a more general deficit. Compared to the controls, the interned adolescents also reported more dysfunction in executive behaviors related to the ability to inhibit action, behavioral flexibility, working memory, and the ability to follow through with tasks. Overall, correlations between self-report and performance-based measures were weak. These findings suggest that performance-based and self-report measures may assess different, albeit important, aspects of executive functioning.

The reliability of the Personal and Social Performance scale – informing its training and use

a) Objectives: This study analyses the characteristics and prevalence of psychotic disorders in patients with substance use, that needed medical and psychiatric care in a Dual Pathology Department during a 3 years period. b) Background and aims: The strong comorbidity between substance use and psychotic disorders has been deeply studied in recent literature. The aim of this study is to analyse the characteristics of the psychotic episode (primary or drug-induced), the predominant substance of use and the age of onset of consumption, as well as some sociodemographic characteristics in these patients. c) Materials and methods After a bibliographic review of recent literature, we realize a descriptive study of psychotic disorders and substance use from a total of 531 hospitalized patients during a 3 years period, using SPSS for Windows 20.0 database for statistic results. d) Results: In this study we can observe a predominant percentage of males with an average age of 36 years old, around 50% psychotic disorders out of total number of patients with a predominant type of primary psychosis and a high prevalence of cocaine (18% of total patients), alcohol (16%) and cannabis (8%) use and also an early age of onset of problematic consumption (15 years old for alcohol, 16 years old for cannabis and 21 years old for cocaine). e) Conclusions: The result of this study approach the current literature data about psychotic disorders and substance use and underlines the importance of a correct and early diagnosis in patients with a serious mental illness.

Difficulty with social interactions is a characteristic of schizophrenia. The authors used functional magnetic resonance imaging (fMRI) to investigate brain activation changes during a social cognition paradigm in patients with schizophrenia during and after an acute episode and their association with social and executive function. In a longitudinal study design, 14 patients with schizophrenia experiencing an acute episode had an fMRI scan. They returned for a follow-up scan after clinical improvement. Fourteen healthy comparison subjects were also scanned twice with approximately the same time interval between scans as in the patient group. The authors employed a social cognition fMRI paradigm involving empathic and forgivability judgments. Schizophrenia symptoms, social functioning and illness insight scales, and the Wisconsin Card Sorting Test were used to examine whether improvement on these measures was associated with recovery of brain activation in response to the social cognition paradigm. After recovery from the acute episode, patients exhibited increased activation in the left medial prefrontal cortex, which was, in turn, significantly correlated with improved insight and social functioning. Decreased symptom severity and improved performance on the Wisconsin Card Sorting Test were not significantly associated with increased left medial prefrontal cortex activation. This is the first study to the authors' knowledge to use a social cognition paradigm to reveal improved left medial prefrontal cortex activation in schizophrenia after recovery from an acute episode. These results suggest that restored left medial prefrontal cortex activation may mediate improvement of insight and social functioning in patients with schizophrenia.