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Find video protocols related to scientific articles indexed in Pubmed.
Brave new worlds-review and update on virtual reality assessment and treatment in psychosis.
Schizophr Bull
PUBLISHED: 09-05-2014
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In recent years, virtual reality (VR) research on psychotic disorders has been initiated. Several studies showed that VR can elicit paranoid thoughts about virtual characters (avatars), both in patients with psychotic disorders and healthy individuals. Real life symptoms and VR experiences were correlated, lending further support to its validity. Neurocognitive deficits and difficulties in social behavior were found in schizophrenia patients, not only in abstract tasks but also using naturalistic virtual environments that are more relevant to daily life, such as a city or encounters with avatars. VR treatments are conceivable for most dimensions of psychotic disorders. There is a small but expanding literature on interventions for delusions, hallucinations, neurocognition, social cognition, and social skills; preliminary results are promising. VR applications for assessment and treatment of psychotic disorders are in their infancy, but appear to have a great potential for increasing our understanding of psychosis and expanding the therapeutic toolbox.
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Psychological therapies for auditory hallucinations (voices): current status and key directions for future research.
Schizophr Bull
PUBLISHED: 06-18-2014
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This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation.
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Psychotic symptoms, cognition and affect as predictors of psychosocial problems and functional change in first-episode psychosis.
Schizophr. Res.
PUBLISHED: 06-16-2014
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To enable further understanding of how cognitive deficits and psychopathology impact psychosocial functioning in first-episode psychosis patients, we investigated how psychopathology and cognitive deficits are associated with psychosocial problems at baseline, and how these predict psychosocial functioning at 12 months follow-up. Also, we tested whether the effect of baseline psychopathology on psychosocial functioning decreases between baseline and 12 months and the effect of baseline cognition increases.
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Controlling a stream of paranoia evoking events in a virtual reality environment.
Stud Health Technol Inform
PUBLISHED: 05-31-2014
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Although virtual reality exposure has been reported as a method to induce paranoid thought, little is known about mechanisms to control specific virtual stressors. This paper reports on a study that examines the effect of controlling the stream of potential paranoia evoking events in a virtual restaurant world. A 2-by-2 experiment with a non-clinical group (n = 24) was conducted with as two within-subject factors: (1) the cycle time (short/long) for when the computer considers activation of a paranoia evoking event and (2) the probability that a paranoia-evoking event (low/high) would be triggered at the completion of a cycle. The results showed a significant main effect for the probability factor and two-way interaction effect with the cycle time factor on the number of paranoid comments participants made and their self-reported anxiety.
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Identifying gene-environment interactions in schizophrenia: contemporary challenges for integrated, large-scale investigations.
, Jim van Os, Bart P Rutten, Inez Myin-Germeys, Philippe Delespaul, Wolfgang Viechtbauer, Catherine van Zelst, Richard Bruggeman, Ulrich Reininghaus, Craig Morgan, Robin M Murray, Marta Di Forti, Philip McGuire, Lucia R Valmaggia, Matthew J Kempton, Charlotte Gayer-Anderson, Kathryn Hubbard, Stephanie Beards, Simona A Stilo, Adanna Onyejiaka, François Bourque, Gemma Modinos, Stefania Tognin, Maria Calem, Michael C O'Donovan, Michael J Owen, Peter Holmans, Nigel Williams, Nicholas Craddock, Alexander Richards, Isla Humphreys, Andreas Meyer-Lindenberg, F Markus Leweke, Heike Tost, Ceren Akdeniz, Cathrin Rohleder, J Malte Bumb, Emanuel Schwarz, Koksal Alptekin, Alp Üçok, Meram Can Saka, E Cem Atbaşoğlu, Sinan Guloksuz, Güvem Gümüş-Akay, Burçin Cihan, Hasan Karadag, Haldan Soygür, Eylem Şahin Cankurtaran, Semra Ulusoy, Berna Akdede, Tolga Binbay, Ahmet Ayer, Handan Noyan, Gülşah Karadayı, Elçin Akturan, Halis Ulas, Celso Arango, Mara Parellada, Miguel Bernardo, Julio Sanjuan, Julio Bobes, Manuel Arrojo, Jose Luis Santos, Pedro Cuadrado, José Juan Rodríguez Solano, Angel Carracedo, Enrique García Bernardo, Laura Roldán, Gonzalo Lopez, Bibiana Cabrera, Sabrina Cruz, Eva Ma Díaz Mesa, María Pouso, Estela Jiménez, Teresa Sanchez, Marta Rapado, Emiliano González, Covadonga Martínez, Emilio Sanchez, Ma Soledad Olmeda, Lieuwe de Haan, Eva Velthorst, Mark van der Gaag, Jean-Paul Selten, Daniella van Dam, Elsje van der Ven, Floor van der Meer, Elles Messchaert, Tamar Kraan, Nadine Burger, Marion Leboyer, Andrei Szoke, Franck Schürhoff, Pierre-Michel Llorca, Stéphane Jamain, Andrea Tortelli, Flora Frijda, Jeanne Vilain, Anne-Marie Galliot, Grégoire Baudin, Aziz Ferchiou, Jean-Romain Richard, Ewa Bulzacka, Thomas Charpeaud, Anne-Marie Tronche, Marc De Hert, Ruud van Winkel, Jeroen Decoster, Catherine Derom, Evert Thiery, Nikos C Stefanis, Gabriele Sachs, Harald Aschauer, Iris Lasser, Bernadette Winklbaur, Monika Schlögelhofer, Anita Riecher-Rossler, Stefan Borgwardt, Anna Walter, Fabienne Harrisberger, Renata Smieskova, Charlotte Rapp, Sarah Ittig, Fabienne Soguel-dit-Piquard, Erich Studerus, Joachim Klosterkötter, Stephan Ruhrmann, Julia Paruch, Dominika Julkowski, Desiree Hilboll, Pak C Sham, Stacey S Cherny, Eric Y H Chen, Desmond D Campbell, Miaoxin Li, Carlos María Romeo-Casabona, Aitziber Emaldi Cirión, Asier Urruela Mora, Peter Jones, James Kirkbride, Mary Cannon, Dan Rujescu, Ilaria Tarricone, Domenico Berardi, Elena Bonora, Marco Seri, Thomas Marcacci, Luigi Chiri, Federico Chierzi, Viviana Storbini, Mauro Braca, Maria Gabriella Minenna, Ivonne Donegani, Angelo Fioritti, Daniele La Barbera, Caterina Erika La Cascia, Alice Mulè, Lucia Sideli, Rachele Sartorio, Laura Ferraro, Giada Tripoli, Fabio Seminerio, Anna Maria Marinaro, Patrick McGorry, Barnaby Nelson, G Paul Amminger, Christos Pantelis, Paulo R Menezes, Cristina M Del-Ben, Silvia H Gallo Tenan, Rosana Shuhama, Mirella Ruggeri, Sarah Tosato, Antonio Lasalvia, Chiara Bonetto, Elisa Ira, Merete Nordentoft, Marie-Odile Krebs, Neus Barrantes-Vidal, Paula Cristóbal, Thomas R Kwapil, Elisa Brietzke, Rodrigo A Bressan, Ary Gadelha, Nadja P Maric, Sanja Andric, Marina Mihaljevic, Tijana Mirjanic.
Schizophr Bull
PUBLISHED: 05-24-2014
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Recent years have seen considerable progress in epidemiological and molecular genetic research into environmental and genetic factors in schizophrenia, but methodological uncertainties remain with regard to validating environmental exposures, and the population risk conferred by individual molecular genetic variants is small. There are now also a limited number of studies that have investigated molecular genetic candidate gene-environment interactions (G × E), however, so far, thorough replication of findings is rare and G × E research still faces several conceptual and methodological challenges. In this article, we aim to review these recent developments and illustrate how integrated, large-scale investigations may overcome contemporary challenges in G × E research, drawing on the example of a large, international, multi-center study into the identification and translational application of G × E in schizophrenia. While such investigations are now well underway, new challenges emerge for G × E research from late-breaking evidence that genetic variation and environmental exposures are, to a significant degree, shared across a range of psychiatric disorders, with potential overlap in phenotype.
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The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis.
Schizophr. Res.
PUBLISHED: 03-16-2014
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There is no meta-analysis of cognitive behavioural therapy for delusions and hallucinations separately. The aim of this meta-analysis is to evaluate the end-of-treatment effects of individually tailored case-formulation cognitive behavioural therapy on delusions and auditory hallucinations using symptom-specific outcome measures. A systematic search of the trial literature was conducted in MEDLINE, PSYCHINFO and EMBASE. Eighteen studies were selected with symptom specific outcome measures. Hedges' g was computed and outcomes were pooled meta-analytically using the random-effects model. Our main analyses were with the selected studies with CBT using individually tailored case-formulation that aimed to reduce hallucinations and delusions. The statistically significant effect-sizes were 0.36 with delusions and 0.44 with hallucinations, which are modest and in line with other recent meta-analyses. Contrasted with active treatment, CBT for delusions lost statistical significance (0.33), but the effect-size for CBT for hallucinations increased (0.49). Blinded studies reduced effect-size in delusions (0.24) and gained some in hallucinations (0.46). There was no heterogeneity in hallucinations and moderate heterogeneity in delusion trials. We conclude that CBT is effective in treating auditory hallucinations. CBT for delusions is also effective, but the results must be interpreted with caution, because of heterogeneity and the non-significant effect-sizes when compared with active treatment.
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Psychological interventions for psychosis: a meta-analysis of comparative outcome studies.
Am J Psychiatry
PUBLISHED: 02-15-2014
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Meta-analyses have demonstrated the efficacy of various interventions for psychosis, and a small number of studies have compared such interventions. The aim of this study was to provide further insight into the relative efficacy of psychological interventions for psychosis.
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A manual-based individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT.
BMC Psychiatry
PUBLISHED: 01-06-2014
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Metacognitive dysfunction has been widely recognized as a feature of schizophrenia. As it is linked with deficits in several aspects of daily life functioning, improvement of metacognition may lead to improvement in functioning. Individual psychotherapy might be a useful form of treatment to improve metacognition in patients with schizophrenia; multiple case reports and a pilot study show promising results. The present study aims to measure the effectiveness of an individual, manual-based therapy (Metacognitive Reflection and Insight Therapy, MERIT) in improving metacognition in patients with schizophrenia. We also want to examine if improvement in metacognitive abilities is correlated with improvements in aspects of daily life functioning namely social functioning, experience of symptoms, quality of life, depression, work readiness, insight and experience of stigma.
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Effect of crisis plans on admissions and emergency visits: a randomized controlled trial.
PLoS ONE
PUBLISHED: 01-01-2014
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To establish whether patients with a crisis plan had fewer voluntary or involuntary admissions, or fewer outpatient emergency visits, than patients without such a plan.
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Criminal victimisation in people with severe mental illness: a multi-site prevalence and incidence survey in the Netherlands.
PLoS ONE
PUBLISHED: 01-01-2014
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Although crime victimisation is as prevalent in psychiatric patients as crime perpetration (and possibly more so), few European figures for it are available. We therefore assessed its one-year prevalence and incident rates in Dutch severely mentally ill outpatients, and compared the results with victimisation rates in the general population.
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Bridging the science-to-service gap in schizophrenia care in the Netherlands: the Schizophrenia Quality Improvement Collaborative.
Int J Qual Health Care
PUBLISHED: 10-31-2013
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/st> Many patients with schizophrenia are not treated in line with evidence-based guidelines. This study examines the large-scale implementation of the National Multidisciplinary Guideline for schizophrenia in the Netherlands.
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Virtual Reality Experiments Linking Social Environment and Psychosis: A Pilot Study.
Cyberpsychol Behav Soc Netw
PUBLISHED: 08-31-2013
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Abstract Initial studies with healthy subjects and individuals with high risk for psychosis have suggested that virtual reality (VR) environments may be used to investigate social and psychological mechanisms of psychosis. One small study reported that VR can safely be used in individuals with current persecutory delusions. The present pilot study investigated the feasibility and potential negative side effects of exposure to different virtual social risk environments in patients with first episode psychosis and in healthy controls. Seventeen patients with first episode psychosis (FEP) and 24 healthy control subjects (HC) participated in four virtual experiments during which they walked for 3.5-4 minutes in a virtual café, looking for avatars with digits on their clothing. The level of paranoid thoughts, as well as psychological, physiological, and behavioral correlates of paranoid thoughts, were measured in different virtual social risk environments, manipulating two factors: population density and ethnicity of avatars. FEP and HC frequently had paranoid thoughts about avatars. Paranoia in the real world correlated strongly with paranoid thoughts about avatars in virtual environments (Spearmans ?=0.67 and 0.54 in FEP and HC respectively, p<0.01). FEP kept a smaller distance to avatars than HC. In FEP, but not in HC, galvanic skin response was significantly stronger in virtual environments with avatars of other ethnicity than in the own ethnicity condition. These results suggest that VR is an acceptable and sufficiently realistic method to use in patients with first episode psychosis. VR research may help to increase our understanding of the social and psychological mechanisms of psychosis and to develop new treatment applications.
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Priming to induce paranoid thought in a non clinical population.
Stud Health Technol Inform
PUBLISHED: 06-25-2013
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Freeman et al. reported that a substantial minority of the general population has paranoid thoughts while exposed in a virtual environment. This suggested that in a development phase of a virtual reality exposure system for paranoid patients initially a non-clinical sample could be used to evaluate the systems ability to induce paranoid thoughts. To increase the efficiency of such an evaluation, this paper takes the position that when appropriately primed a larger group of a non-clinical sample will display paranoid thoughts. A 2-by-2 experiment was conducted with priming for insecurity and vigilance as a within-subject factor and prior-paranoid thoughts (low or high) as a between-subjects factor. Before exposure into the virtual world, participants (n=24) were shown a video and read a text about violence or about mountain animals. While exposed, participants were asked to comment freely on their virtual environment. The results of the experiment confirmed that exposure in a virtual environment could induce paranoid thought. In addition, priming with an aim to create a feeling of insecurity and vigilance increased paranoid comments in the non-clinical group that otherwise would less often exhibit ideas of persecution.
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Symptom changes in five dimensions of the Positive and Negative Syndrome Scale in refractory psychosis.
Eur Arch Psychiatry Clin Neurosci
PUBLISHED: 04-30-2013
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Refractory psychosis units currently have little information regarding which symptoms profiles should be expected to respond to treatment. In the current study, we provide this information using structural equation modeling of Positive and Negative Syndrome Scale (PANSS) ratings at admission and discharge on a sample of 610 patients admitted to a treatment refractory psychosis program at a Canadian tertiary care unit between 1990 and 2011. The hypothesized five-dimensional structure of the PANSS fit the data well at both admission and discharge, and the latent variable scores are reported as a function of symptom dimension and diagnostic category. The results suggest that, overall, positive symptoms (POS) responded to treatment better than all other symptoms dimensions, but for the schizoaffective and bipolar groups, greater response on POS was observed relative to the schizophrenia and major depression groups. The major depression group showed the most improvement on negative symptoms and emotional distress, and the bipolar group showed the most improvement on disorganization. Schizophrenia was distinct from schizoaffective disorder in showing reduced treatment response on all symptom dimensions. These results can assist refractory psychosis units by providing information on how PANSS symptom dimensions respond to treatment and how this depends on diagnostic category.
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A multi-site single blind clinical study to compare the effects of prolonged exposure, eye movement desensitization and reprocessing and waiting list on patients with a current diagnosis of psychosis and co morbid post traumatic stress disorder: study pro
Trials
PUBLISHED: 04-30-2013
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Trauma contributes to psychosis and in psychotic disorders post-traumatic stress disorder (PTSD) is often a comorbid disorder. A problem is that PTSD is underdiagnosed and undertreated in people with psychotic disorders. This studys primary goal is to examine the efficacy and safety of prolonged exposure and eye movement desensitization and reprocessing (EMDR) for PTSD in patients with both psychotic disorders and PTSD, as compared to a waiting list. Secondly, the effects of both treatments are determined on (a) symptoms of psychosis, in particular verbal hallucinations, (b) depression and social performance, and (c) economic costs. Thirdly, goals concern links between trauma exposure and psychotic symptomatology and the prevalence of exposure to traumatic events, and of PTSD. Fourthly predictors, moderators, and mediators for treatment success will be explored. These include cognitions and experiences concerning treatment harm, credibility and burden in both participants and therapists.
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The Cognitive Biases Questionnaire for Psychosis (CBQ-P) and the Davos Assessment of Cognitive Biases (DACOBS): validation in a Flemish sample of psychotic patients and healthy controls.
Schizophr. Res.
PUBLISHED: 04-27-2013
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A large body of research has demonstrated the importance of cognitive biases in the development and maintenance of psychosis. Self-report scales for routine clinical practice have been developed only recently. Two new instruments on cognitive biases are evaluated: the Cognitive Biases Questionnaire for Psychosis and the Davos Assessment of Cognitive Biases Scale.
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[Prevention of psychotic disorders; is the time ripe for intervention?].
Ned Tijdschr Geneeskd
PUBLISHED: 03-01-2013
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A growing number of research papers focus on the identification of young individuals meeting ultra-high risk criteria for developing a first episode of psychosis. Intervention in this early phase might possibly prevent or postpone the development of a full-blown psychosis. Different detection and treatment strategies within this target group are being discussed. This is illustrated using three cases. The first is a 20-year-old female with subclinical psychotic symptoms and recent functional decline; however, as her symptoms only presented following drug abuse, she was not considered to be at ultra-high risk for developing a first episode of psychosis. The second case involves a 17-year-old student who did meet at-risk criteria; after seeking help for subclinical psychotic symptoms and increasing social withdrawal behaviour his symptoms decreased with help of CBT. The third case, an 18-year-old male, illustrates that specialized investigation into high-risk symptoms of psychosis are sometimes needed to reveal frank psychotic symptoms.
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Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups.
Schizophr. Res.
PUBLISHED: 02-28-2013
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Over the last decade many studies were conducted to assess the feasibility of early detection of people at risk of developing psychosis and intervention to prevent or delay a first psychotic episode. Most of these studies were small and underpowered. A meta-analysis can demonstrate the effectiveness of the efforts to prevent or postpone a first episode of psychosis. A search conducted according the PRISMA guideline identified 10 studies reporting 12-month follow-up data on transition to psychosis, and 5 studies with follow-ups varying from 24 to 48 months. Both random and fixed effects meta-analyses were conducted. The quality of the studies varied from poor to excellent. Overall the risk reduction at 12 months was 54% (RR=0.463; 95% CI=0.33-0.64) with a Number Needed to Treat (NNT) of 9 (95% CI=6-15). Although the interventions differed, there was only mild heterogeneity and publication bias was small. All sub-analyses demonstrated effectiveness. Also 24 to 48-month follow-ups were associated with a risk reduction of 37% (RR=.635; 95% CI=0.44-0.92) and a NNT of 12 (95% CI=7-59). Sensitivity analysis excluding the methodologically weakest study showed that the findings were robust. Early detection and intervention in people at ultra-high risk of developing psychosis can be successful to prevent or delay a first psychosis. Antipsychotic medication showed efficacy, but more trials are needed. Omega-3 fatty acid needs replication. Integrated psychological interventions need replication with more methodologically sound studies. The findings regarding CBT appear robust, but the 95% confidence interval is still wide.
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Two subdomains of negative symptoms in psychotic disorders: established and confirmed in two large cohorts.
J Psychiatr Res
PUBLISHED: 01-29-2013
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Negative symptoms of schizophrenia are normally grouped into a single category. However, the diversity of such symptoms suggests that they are actually made up of more than one dimension. The DSM-V proposes two negative symptom domains, namely expressive deficits and avolition/asociality. We investigated whether the negative symptoms do indeed have two dimensions. An exploratory factor analysis was carried out based on interviews with the PANSS (664 patients). We restricted our analysis to items that had been described as negative symptoms in previous factor analyses. The symptom structure was then tested for stability by performing a confirmatory factor analysis on PANSS interviews from a separate cohort (2172 patients). Exploratory factor analysis yielded a two-factor structure of negative symptoms. The first factor consisted of PANSS items Flat affect, Poor rapport, Lack of spontaneity, Mannerisms and posturing, Motor retardation, and Avolition. The second factor consisted of Emotional withdrawal, Passive/apathetic social withdrawal, and Active social avoidance. The first factor could be related to expressive deficits, reflecting a loss of initiative, and the second factor to social amotivation, related to community interaction. This factor structure supports the DSM-V classification and may be relevant for pathophysiology and treatment of schizophrenia and other psychotic disorders.
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The distribution of self-reported psychotic-like experiences in non-psychotic help-seeking mental health patients in the general population; a factor mixture analysis.
Soc Psychiatry Psychiatr Epidemiol
PUBLISHED: 01-28-2013
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Factor mixture analysis (FMA) and item response mixture models in the general population have shown that the psychosis phenotype has four classes. This study attempted to replicate this finding in help-seeking people accessing mental health services for symptoms of non-psychotic mental disorders.
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Cognitive Behavioral Therapy for negative symptoms (CBT-n) in psychotic disorders: a pilot study.
J Behav Ther Exp Psychiatry
PUBLISHED: 01-21-2013
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The treatment of negative symptoms in schizophrenia is a major challenge for mental health care. One randomized controlled trial found that cognitive therapy for low-functioning patients reduced avolition and improved functioning, using an average of 50.5 treatment sessions over the course of 18 months. The aim of our current pilot study was to evaluate whether 20 sessions of Cognitive Behavioral Therapy for negative symptoms (CBT-n) would reduce negative symptoms within 6 months. Also, we wanted to test the cognitive model of negative symptoms by analyzing whether a reduction in dysfunctional beliefs mediated the effects on negative symptoms.
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Development of the Davos assessment of cognitive biases scale (DACOBS).
Schizophr. Res.
PUBLISHED: 01-15-2013
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Cognitive problems and biases play an important role in the development and continuation of psychosis. A self-report measure of these deficits and processes was developed (Davos Assessment of Cognitive Biases Scale: DACOBS) and is evaluated in this study.
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Depression and social anxiety in help-seeking patients with an ultra-high risk for developing psychosis.
Psychiatry Res
PUBLISHED: 01-07-2013
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Knowledge on associations between ultra-high risk (UHR) for developing psychosis and on non-psychotic psychopathology in help-seeking populations is limited with respect to differences between male and female patients. The present study tests the hypothesis that both social anxiety and depression are highly prevalent in an UHR population, particularly among women. From February 2008 to February 2010 baseline data were collected from help-seeking subjects (14-35 years) who were included in the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Two recruiting strategies were used: a two-stage screening strategy in a population of consecutive help-seeking and distressed subjects of secondary mental health services, and a referral strategy. This study included 201 patients with a mean age of 22.7 years. Of these, 102 (51%) were female, 58% of the patients met the criteria for clinical depression on the Beck Depression Inventory and 42% met the criteria for clinical social phobia on the Social Interaction Anxiety Scale. Women showed more depression and social anxiety than men. The results support the hypothesis that UHR is associated with depression and social anxiety, particularly in women. Screening a help-seeking population with depression and anxiety may be effective in detecting patients at UHR for developing psychosis.
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Initial evaluation of the effects of competitive memory training (COMET) on depression in schizophrenia-spectrum patients with persistent auditory verbal hallucinations: a randomized controlled trial.
Br J Clin Psychol
PUBLISHED: 10-04-2011
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This study investigates whether depression can be ameliorated by weakening the associations between auditory verbal hallucinations and easily activated networks with negative self-evaluations, by strengthening the access to competing memories of positive self-esteem. Design.? A randomized controlled clinical trial comparing competitive memory training (COMET) with treatment as usual (TAU) in schizophrenia patients with persistent auditory hallucinations.
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Why do patients with schizophrenia who have poor insight still take antipsychotics? Memory deficits as moderators between adherence belief and behavior.
J Psychiatr Pract
PUBLISHED: 09-20-2011
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While lack of insight is often predictive of antipsychotic nonadherence, some inconsistency in the literature remains unexplained. Verbal memory deficits may moderate the association between insight and adherence. Based on cross-sectional data, outpatients treated with antipsychotics for a psychotic disorder were divided into those with good (n=53) and poor (n=59) memory. Poor insight predicted nonadherence only among the subgroup with relatively good memory (r=0.43; P<0.01), but had no effect in the subgroup with worse memory (r=0.08; ns). Structural equation modelling revealed significant moderation (?=4.72; df=1; P<0.05), which means that a significantly better model fit was found by allowing the analysis to differentiate between the two memory groups. Thus, poor insight was only associated with poor medication adherence among patients with relatively good memory. We speculate that memory deficits commonly associated with schizophrenia may partly explain why poor insight does not always lead to poor medication adherence.
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REFLEX, a social-cognitive group treatment to improve insight in schizophrenia: study protocol of a multi-center RCT.
BMC Psychiatry
PUBLISHED: 06-30-2011
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Insight is impaired in a majority of people with schizophrenia. Impaired insight is associated with poorer outcomes of the disorder. Based on existing literature, we developed a model that explains which processes may possibly play a role in impaired insight. This model was the starting point of the development of REFLEX: a brief psychosocial intervention to improve insight in schizophrenia. REFLEX is a 12-sessions group training, consisting of three modules of four sessions each. Modules in this intervention are: "coping with stigma", "you and your personal narrative", and "you in the present".
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Virtual reality to study responses to social environmental stressors in individuals with and without psychosis.
Stud Health Technol Inform
PUBLISHED: 06-21-2011
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A Virtual Reality (VR) environment was created to study psychotic symptoms in patients and non-patients. Participants task was to find five virtual characters that each had a small number label on his or her chest. The density and ethnic appearance of the virtual characters in the bar was controlled. For a non-patient group (N=24), results showed a significant main effect for density on participants physiological responses, their behavior, reported level of discomfort, and their ability to remember place and location of the numbered avatars. The avatars ethnicity had a significant effect on non-patients physiological responses. Comparison between two patients and non-patient group showed differences in physiological responses, behavior and reported level of discomfort.
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Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial.
Behav Res Ther
PUBLISHED: 05-20-2011
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Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ? 65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.
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Pathways to psychosis: help-seeking behavior in the prodromal phase.
Schizophr. Res.
PUBLISHED: 05-13-2011
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Knowledge of pathways to care by help-seeking patients prior to the onset of psychosis may help to improve the identification of at-risk patients. This study explored the history of help-seeking behavior in secondary mental health care services prior to the onset of the first episode of psychosis.
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Treating trauma in psychosis with EMDR: a pilot study.
J Behav Ther Exp Psychiatry
PUBLISHED: 05-12-2011
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Initial studies have shown that posttraumatic stress disorder (PTSD) can be effectivelytreated in patients with a psychotic disorder. These studies however used adapted treatment protocols, avoided direct exposure to trauma related stimuli or preceded treatment with stabilizing techniques making treatment considerably longer in duration.
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Recovery style predicts remission at one-year follow-up in outpatients with schizophrenia spectrum disorders.
J. Nerv. Ment. Dis.
PUBLISHED: 05-06-2011
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Although people with schizophrenia use various coping strategies, it is largely unknown how their coping style contributes to remission of the illness. The concept of recovery style-either by sealing over or integrating-reflects an important distinction. We wanted to examine whether recovery style predicts remission at a 1-year follow-up. We examined the recovery style, insight, therapeutic alliance, and symptoms in 103 patients with psychotic disorders. To assess the remission status, the symptoms were measured at 6 and 12 months. Logistic regression analyses were used. Results showed that scoring an extra category toward integration (six categories exist) increased the odds of remission 1.84-fold (95% confidence interval, 1.11 to 3.03). Insight and therapeutic alliance were not predictive. Although remission was also predicted by positive symptom levels at baseline, this did not influence the effect of recovery style. In conclusion, independently of symptom levels, insight, or therapeutic alliance, an integrating recovery style increases the odds of remission at a 1-year follow-up.
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Factor analysis of the scale of prodromal symptoms: differentiating between negative and depression symptoms.
Psychopathology
PUBLISHED: 01-17-2011
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This study examines the ability of the Scale of Prodromal Symptoms (SOPS) to differentiate between negative and depression symptoms in a young help-seeking ultrahigh risk (UHR) group.
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Cognitive-behavioural therapy for persistent and recurrent psychosis in people with schizophrenia-spectrum disorder: cost-effectiveness analysis.
Br J Psychiatry
PUBLISHED: 01-05-2011
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Evidence on cost-effectiveness is important to make well-informed decisions regarding care delivery.
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A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an At Risk Mental State for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial.
Trials
PUBLISHED: 03-22-2010
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Psychotic disorders are a serious mental health problem. Intervention before the onset of psychosis might result in delaying the onset, reducing the impact or even preventing the first episode of psychosis. This study explores the effectiveness of cognitive behavioural therapy (CBT) in targeting cognitive biases that are involved in the formation of delusions in persons with an ultra-high risk for developing psychosis. A single blind randomised controlled trial compares CBT with treatment as usual in preventing or delaying the onset of psychosis.
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Prescription of antipsychotic medication to patients at ultra high risk of developing psychosis.
Int Clin Psychopharmacol
PUBLISHED: 06-13-2009
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Little is known about medication prescription in a naturalistic setting to patients at ultra high risk (UHR) of developing psychosis. Antipsychotic medication prescription to UHR patients is not recommended in clinical practice guidelines based on the current evidence. The aim of this study is to investigate medication prescription to UHR patients in the Netherlands. The frequency of antipsychotic medication prescription to UHR patients (n=72) was compared with the frequency of antipsychotic medication prescription to patients who were diagnosed with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition psychotic disorder at first diagnostic evaluation (n=90). Within the UHR group, frequency of antipsychotic medication prescription at baseline was compared between UHR patients who did make the transition to psychosis (n=18) and UHR patients who did not (n=54). No significant differences were found in antipsychotic medication prescription to UHR patients and to patients who turned out to have a florid psychosis: 51% in the psychotic group and 58% in the UHR group used no medication. Thirty-four percent in the psychotic group and 21% in the UHR group used antipsychotic medication. There was also no difference in medication prescription between UHR patients who did and did not make the transition to psychosis. More research should be aimed at developing and implementing clinical practice guidelines for the treatment of UHR patients.
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Metacognitive beliefs, beliefs about voices and affective symptoms in patients with severe auditory verbal hallucinations.
Br J Clin Psychol
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This study explores associations between metacognitive beliefs and beliefs about voices in patients with severe auditory verbal hallucinations, and their hypothesized relationship with levels of depression and anxiety. Furthermore, it was hypothesized that metacognitive beliefs are better able to explain differences in levels of depression and anxiety, than beliefs about voices.
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Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial.
Schizophr Bull
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Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains inconclusive.
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Symptomatic and functional remission and its associations with quality of life in patients with psychotic disorder in Assertive Community Treatment teams.
Compr Psychiatry
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The aims of the present study were (1) to determine the proportion and characteristics of patients treated in Assertive Community Treatment teams who achieve symptomatic remission (SR) and/or functional remission (FR) and (2) to explore the association between both types of remission and (3) their bearing on quality of life (QoL).
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Cognitive deficits and ethnicity: a cohort study of early psychosis patients in The Netherlands.
Soc Psychiatry Psychiatr Epidemiol
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Incidence rates of psychotic disorders are higher in immigrant groups compared to native populations. This increased risk may partly be explained by misdiagnosis. Neurocognitive deficits are a core feature of psychotic disorders, but little is known about the relationship between migration and cognition in psychotic disorders. We examined whether immigrant patients have cognitive deficits similar to non-immigrant patients, in order to investigate the plausibility of misdiagnosis as explanation for increased incidence rates.
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The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population.
Schizophr Bull
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In order to bring about implementation of routine screening for psychosis risk, a brief version of the Prodromal Questionnaire (PQ; Loewy et al., 2005) was developed and tested in a general help-seeking population. We assessed a consecutive patient sample of 3533 young adults who were help-seeking for nonpsychotic disorders at the secondary mental health services in The Hague with the PQ. We performed logistic regression analyses and CHi-squared Automatic Interaction Detector decision tree analysis to shorten the original 92 items. Receiver operating characteristic curves were used to examine the psychometric properties of the PQ-16. In the general help-seeking population, a cutoff score of 6 or more positively answered items on the 16-item version of the PQ produced correct classification of Comprehensive Assessment of At-Risk Mental State (Yung et al., 2005) psychosis risk/clinical psychosis in 44% of the cases, distinguishing Comprehensive Assessment of At-Risk Mental States (CAARMS) diagnosis from no CAARMS diagnosis with high sensitivity (87%) and specificity (87%). These results were comparable to the PQ-92. The PQ-16 is a good self-report screen for use in secondary mental health care services to select subjects for interviewing for psychosis risk. The low number of items makes it quite appropriate for screening large help-seeking populations, thus enhancing the feasibility of detection and treatment of ultra high-risk patients in routine mental health services.
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The treatment of hallucinations in schizophrenia spectrum disorders.
Schizophr Bull
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This article reviews the treatment of hallucinations in schizophrenia. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. Only 8% of first-episode patients still experience mild to moderate hallucinations after continuing medication for 1 year. Olanzapine, amisulpride, ziprasidone, and quetiapine are equally effective against hallucinations, but haloperidol may be slightly inferior. If the drug of first choice provides inadequate improvement, it is probably best to switch medication after 2-4 weeks of treatment. Clozapine is the drug of choice for patients who are resistant to 2 antipsychotic agents. Blood levels should be above 350-450 ?g/ml for maximal effect. For relapse prevention, medication should be continued in the same dose. Depot medication should be considered for all patients because nonadherence is high. Cognitive-behavioral therapy (CBT) can be applied as an augmentation to antipsychotic medication. The success of CBT depends on the reduction of catastrophic appraisals, thereby reducing the concurrent anxiety and distress. CBT aims at reducing the emotional distress associated with auditory hallucinations and develops new coping strategies. Transcranial magnetic stimulation (TMS) is capable of reducing the frequency and severity of auditory hallucinations. Several meta-analyses found significantly better symptom reduction for low-frequency repetitive TMS as compared with placebo. Consequently, TMS currently has the status of a potentially useful treatment method for auditory hallucinations, but only in combination with state of the art antipsychotic treatment. Electroconvulsive therapy (ECT) is considered a last resort for treatment-resistant psychosis. Although several studies showed clinical improvement, a specific reduction in hallucination severity has never been demonstrated.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.