Deficits In People Research Articles

Pain Catastrophizing Mediates and Moderates the Link Between Acute Pain and Working Memory

The bidirectional relationship between pain and working memory (WM) deficits is well-documented but poorly understood. Pain catastrophizing—exaggerated, negative cognitive and emotional responses toward pain—may contribute to WM deficits by occupying finite, shared cognitive resources. The present study assessed the role of pain catastrophizing as both a state-level process and trait-level disposition in the link between acute pain and WM. Healthy, young adults were randomized to an experimentally-induced ischemic pain or control task, during which they completed verbal and non-verbal WM tests. Participants also completed measures of state- and trait-level pain catastrophizing. Simple mediation analyses indicated that participants in the pain group (vs. control) engaged in more state-level catastrophizing about pain, which led to worse verbal and non-verbal WM. Moderated mediation analyses indicated that the indirect (mediation) effect of state-level pain catastrophizing was moderated by trait-level pain catastrophizing for both verbal and non-verbal WM. Participants in the pain group who reported a greater trait-level tendency to catastrophize about pain experienced greater state-level catastrophizing about pain during the ischemic task, which led to worse verbal and non-verbal WM performance. These results provide evidence for pain catastrophizing as an important mechanism and moderating factor of WM deficits in acute pain. Future research should replicate these results in chronic pain samples, investigate other potential mechanisms (e.g., sleep disturbances), and determine if interventions that target pain catastrophizing directly can ameliorate cognitive deficits in people with pain. PerspectiveThis article presents a laboratory study examining the relationships among pain, pain catastrophizing, and working memory in healthy participants. The results shed new light on these relationships and raise the possibility that interventions that reduce catastrophizing may lead to improved cognitive function among people with pain.

Alcohol consumption and neurocognitive deficits in people with well-treated HIV in Switzerland.

BackgroundHazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy.MethodsThe Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively.ResultsMost participants (96.2%) had undetectable viral loads and 64% were aged >50 years old. Hazardous alcohol consumption was observed in 49.4% of participants and binge drinking in 4.2%. While alcohol consumption frequency and quantity were not associated with NCI, the practice of binge drinking was significantly associated with impaired motor skills and overall neurocognitive function in both binary (odds ratio, OR ≥2.0, P <0.05) and continuous (mean z-score difference -0.2 to -0.4, P ≤0.01) outcomes. A significant U-shaped distribution of AUDIT-C score was also observed for motor skills and overall neurocognitive function.ConclusionsIn this cohort of PWH with well-controlled HIV infection, NCI was associated with the practice of binge drinking rather than alcohol consumption frequency or quantity. Longitudinal analysis of alcohol consumption and NCI in this population is currently underway.

Plasma Levels of Neuron- and Astrocyte-Derived Exosomal Amyloid Beta1-42, Amyloid Beta1-40, and Phosphorylated Tau Levels in Schizophrenia Patients and Non-psychiatric Comparison Subjects: Relationships With Cognitive Functioning and Psychopathology.

Introduction: Cognitive deficits in people with schizophrenia (PWS) are a major predictor of disability and functioning, yet the underlying pathophysiology remains unclear. A possible role of amyloid and tau biomarkers (hallmarks of Alzheimer's disease) is still speculative in schizophrenia. Exosomes or extracellular vesicles, involved with cell-to-cell communication and waste removal, can be used to assay brain-based proteins from peripheral blood. To our knowledge, this is the first study of exosomal amyloid and tau protein levels in PWS.Methods: This cross-sectional study included 60 PWS and 60 age- and sex-comparable non-psychiatric comparison subjects (NCs), age range 26–65 years. Assessments of global cognitive screening, executive functioning, psychopathology, and physical measures were conducted. Exosomes were extracted and precipitated from fasting plasma and identified as neuron-derived exosomes (NDEs) or astrocyte-derived exosomes (ADEs). Human-specific ELISAs were used to assay levels of amyloid-beta 1-42 (Aβ42), amyloid-beta 1-40 (Aβ40), and phosphorylated T181 tau (P-T181-tau). Plasma assays for aging biomarkers (C-reactive protein and F2-isoprostanes) were also performed.Results: ADE-Aβ42 levels were higher in PWS compared to NCs, though the other exosomal markers were similar between the two groups. Higher ADE-P-T181-tau levels were associated with worse executive functioning. Among PWS, higher ADE-P-T181-tau levels were associated with less severe negative symptoms and increased F2-isoprostane levels. Astrocyte-derived Aβ marker levels were sensitive and specific in differentiating between diagnostic groups. Among PWS, Aβ40 levels differed most by exosomal origin.Discussion: Exosomal markers may provide novel insights into brain-based processes (e.g., aging, oxidative stress) from peripheral blood samples.

Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study.

BackgroundThe development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction.ObjectiveThe goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV.MethodsTests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect.ResultsThe group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group).ConclusionsThe results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.

The Role of Mental Imagery in Parkinson's Disease Rehabilitation.

Parkinson’s disease (PD) is a disabling neurodegenerative disease whose manifestations span motor, sensorimotor, and sensory domains. While current therapies for PD include pharmacological, invasive, and physical interventions, there is a constant need for developing additional approaches for optimizing rehabilitation gains. Mental imagery is an emerging field in neurorehabilitation and has the potential to serve as an adjunct therapy to enhance patient function. Yet, the literature on this topic is sparse. The current paper reviews the motor, sensorimotor, and sensory domains impacted by PD using gait, balance, and pain as examples, respectively. Then, mental imagery and its potential for PD motor and non-motor rehabilitation is discussed, with an emphasis on its suitability for addressing gait, balance, and pain deficits in people with PD. Lastly, future research directions are suggested.

Cognitive Abilities, Debt, Roads and their Impact on Deaths in Traffic in Brazil

Abstract Deaths in traffic represent a global and multicausal problem. We verified, through a linear regression model, that cognitive abilities (CA) and population indebtedness (PI) predict, together, 56% of the variation of death rates in the traffic (DT) of the twenty-seven states of Brazil. CA’s are related to a greater control of the attention and, possibly, to a greater compliance with norms for preventing traffic accidents, has a greater impact than PI on DT, since PI associates to only one deficit of people's attention resources. The decrease of PI and the improvement of CA can decrease DT.

Comparison of attention process training and activity-based attention training after acquired brain injury: A randomized controlled study.

ObjectivesTo compare the effects of 2 interventions for attention deficits in people with acquired brain injury, Attention Process Training (APT) and Activity-based Attention Training (ABAT), on activity and participation.DesignRandomized controlled study.PatientsThe study included 51 patients in outpatient rehabilitation 4–12 months after stroke or traumatic brain injury.MethodsIntervention: 20 h of attention training.MeasurementsAssessment of Work Performance (AWP), Work Ability Index (WAI), Canadian Occupational Performance Measure (COPM), and Rating Scale of Attentional Behavior (RSAB).ResultsBetween-group comparisons showed significantly improved process skills after APT: Mental Energy (p = 0.000, ES = 1.84), Knowledge (p = 0.003, ES = 1.78), Temporal Organization (p = 0.000, ES=1.43) and Adaptation (p = 0.001, ES = 1.59). For within-group comparisons significant improvement was found between pre- and post-measures for both groups on COPM Performance (APT: p = 0.001, ES=1.85; ABAT: p = 0.001, ES = 1.84) and Satisfaction (APT: p = 0.000, ES=1.92; ABAT: p = 0.000, ES = 2.40) and RSAB Total Score (ABAT: p = 0.027, ES = 0.81; APT: p = 0.007, ES = 1.03).ConclusionWe found significant differences favouring APT before ABAT for process skills (AWP). There were no discernible differences in global measures of activity between the 2 approaches: both groups improved significantly, as indicated by ES. The results of this study highlight the complexities of influencing behaviour on the level of body functions while measuring effects on activity.LAY ABSTRACTThe focus of this study is on training of attention deficits after acquired brain injury. The study compared 2 training methods; one directly training attention (Attention Process Training; APT) and another training attention in daily activities (Activity-based Attention Training; ABAT). The APT group improved somewhat more in work performance skills regarding organization of tasks, maintaining focus and adjusting to changes, compared with the ABAT group. The APT group rated an improvement from poor to moderate work ability, while the ABAT group maintained poor work ability. Self-assessed work ability was not estimated “excellent” for any participant at any assessment point. Both groups demonstrated medium to large improvements in performance ratings for daily activities and for satisfaction in performance. Their attention improved, as observed by physiotherapists/occupational therapists during training.

Art Training in Dementia: A Randomized Controlled Trial.

ObjectivesThe present study explores the effect of visual art training on people with dementia, utilizing a randomized control trial design, in order to investigate the effects of an 8-week visual art training program on cognition. In particular, the study examines overall cognition, delayed recall, and working memory, which show deficits in people with dementia.MethodFifty-three individuals with dementia were randomly assigned into either an art training (n = 27) or usual-activity waitlist control group (n = 26). Overall cognition and delayed recall were assessed with the Montreal Cognitive Assessment (MoCA), and working memory was assessed with the Backward Digit Span task.ResultsThere were no group differences in overall cognition, or working memory, while a difference in delayed recall was undetermined, based on post-test—pre-test difference scores. Groups were comparable at baseline on all measures.ConclusionThe measures of cognition, delayed recall, and working memory used in this study were not affected by an 8-week visual art training program.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT03175822.

Reliability and Replicability of Implicit and Explicit Reinforcement Learning Paradigms in People With Psychotic Disorders.

Motivational deficits in people with psychosis may be a result of impairments in reinforcement learning (RL). Therefore, behavioral paradigms that can accurately measure these impairments and their change over time are essential. We examined the reliability and replicability of 2 RL paradigms (1 implicit and 1 explicit, each with positive and negative reinforcement components) given at 2 time points to healthy controls (n = 75), and people with bipolar disorder (n = 62), schizoaffective disorder (n = 60), and schizophrenia (n = 68). Internal consistency was acceptable (mean α = 0.78 ± 0.15), but test-retest reliability was fair to low (mean intraclass correlation = 0.33 ± 0.25) for both implicit and explicit RL. There were no clear effects of practice for these tasks. Largely, performance on these tasks shows intact implicit and impaired explicit RL in psychosis. Symptom presentation did not relate to performance in any robust way. Our findings replicate previous literature showing spared implicit RL and impaired explicit reinforcement in psychosis. This suggests typical basal ganglia dopamine release, but atypical recruitment of the orbitofrontal and dorsolateral prefrontal cortices. However, we found that these tasks have only fair to low test-retest reliability and thus may not be useful for assessing change over time in clinical trials.

Quantifying balance deficit in people with ankle fracture six months after surgical intervention through the Y-Balance test

BackgroundAnkle fractures are among the most common traumatic fractures and have a great socio-economic impact. Consequences of an ankle fracture requiring surgical treatment (e.g. pain, reduced ankle range of motion (ROM), muscle weakness, etc.) lead to balance deterioration, which has a profound impact on activities of daily living. However, to the best of the authors' knowledge, no reliable clinical tests are available to monitor balance in patients after ankle surgery. ObjectivesTo quantify single-leg dynamic balance in patients with bimalleolar ankle fracture through the Y-Balance test (YBT). The second objective was to analyze the impact of ankle dorsiflexion ROM and hip strength on balance to optimize balance rehabilitation programs. DesignCross-sectional study. Methods22 participants, who had undergone surgery after bimalleolar ankle fractures, were assessed for ankle ROM, hip strength, and dynamic balance six-months after the surgical intervention. The within-session reliability of YBT was calculated through the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). Student's t-tests were used to assess leg differences. A multiple regression analysis was performed to evaluate the role of ankle dorsiflexion ROM and hip abductor and adductor strength in predicting balance performance. ResultsYBT showed high-to-excellent within-session relative reliability (Healthy leg: 0.85 ≤ ICC≤0.96; Operated leg: 0.84 ≤ ICC≤0.96). SEM values were below 3.3 %. The operated leg showed significant lower YBT scores for anterior reach direction (−9.0 %; g=−0.70) and composite score (-4.5 %; g=−0.34). Multiple regression analysis showed that both, ankle dorsiflexion and hip abductor and adductor strength explained 66 % of the variance in the YBT anterior direction of the operated leg. ConclusionsThe YBT is a reliable tool that allows the quantification of single-leg dynamic balance impairments from 6-months after surgery in patients with bimalleolar ankle fracture. Between-leg YBT differences in the anterior direction can be used as reference scores (3.3 %) for balance restoration. Balance rehabilitation programs should focus on improving ankle functionality and reducing hip muscle weakness with specific hip strength exercises and balance exercises with similar demands to the reaching tasks of the YBT to promote a faster recovery.

Reading skills deficits in people with mental illness: A systematic review and meta-analysis.

Good reading skills are important for appropriate functioning in everyday life, scholastic performance, and acquiring a higher socioeconomic status. We conducted the first systematic review and meta-analysis to quantify possible deficits in specific reading skills in people with a variety of mental illnesses, including personality disorders (PDs). We performed a systematic search of multiple databases from inception until February 2020 and conducted random-effects meta-analyses. The search yielded 34 studies with standardized assessments of reading skills in people with one or more mental illnesses. Of these, 19 studies provided data for the meta-analysis. Most studies (k=27; meta-analysis, k=17) were in people with schizophrenia and revealed large deficits in phonological processing (Hedge's g=-0.88, p<0.00001), comprehension (Hedge's g=-0.96, p <0.00001) and reading rate (Hedge's g=-1.22, p=0.002), relative to healthy controls; the single-word reading was less affected (Hedge's g=-0.70, p <0.00001). A few studies in affective disorders and nonforensic PDs suggested weaker deficits (for all, Hedge's g <-0.60). In forensic populations with PDs, there was evidence of marked phonological processing (Hedge's g=-0.85, p<0.0001) and comprehension deficits (Hedge's g=-0.95, p=0.0003). People with schizophrenia, and possibly forensic PD populations, demonstrate a range of reading skills deficits. Future studies are needed to establish how these deficits directly compare to those seen in developmental or acquired dyslexia and to explore the potential of dyslexia interventions to improve reading skills in these populations.

Impaired central drive to plantarflexors and minimal ankle proprioceptive deficit in people with multiple sclerosis

BackgroundA common and disruptive symptom of multiple sclerosis is difficulty in walking. Deficits in ankle proprioception and in plantarflexor muscle function may contribute to these mobility issues. In this study, ankle proprioceptive ability and plantarflexor performance of people with multiple sclerosis (PwMS) were compared to healthy controls to determine whether multiple sclerosis causes impairments in these systems. MethodsPwMS (n = 30, median EDSS 4.0, IQR 2) were compared to age- and sex-matched healthy controls (n = 30) across tests of ankle proprioception and plantarflexor muscle performance. Proprioceptive tests: detection of passive movement, reaction time and ankle joint position sense. Plantarflexor performance: strength, fatigue, recovery and voluntary activation (level of neural drive) of the plantarflexor muscles, assessed through brief and sustained fatiguing (2 min) isometric maximal voluntary contractions with nerve stimulation to evoke superimposed and resting muscle twitches. ResultsPwMS had unimpaired movement detection and joint position sense but had a slower reaction time to respond with plantarflexion to an imposed ankle movement (between group difference = 0.11 [95% CI; 0.05 to 0.17] s). During brief, maximal contractions PwMS produced lower torque (difference = -25.1 [-42.0 to -8.2] Nm) with reduced voluntary activation (difference = -14.6 [-25.1 to -4.1]%) but no impairment of the muscle itself (resting twitch torque difference = 0.3 [-2.8 to 2.2] Nm). At the end of the fatiguing contraction, neural drive decreased for PwMS (-19.5 [-27.1 to -11.9]%, p <0.0001) but not for controls (-2.5 [-6.9 to 1.8]%, p = 0.242). Fatigue did not affect the resting twitch size for controls (-1.3 [-2.7 to -0.03] Nm, p = 0.134) or PwMS (-0.1 [-1.1 to 1.0] Nm, p = 0.90). ConclusionsPwMS showed no deficit in their ability to sense ankle position or imposed movements but were slow when a motor response was required. Their plantarflexor muscles produced similar torque with electrical stimulation but voluntary strength was impaired. Both groups experienced overall fatigue following the 2-minute maximal voluntary contraction but PwMS also had significantly reduced neural drive indicating central fatigue. PwMS showed mainly central deficits in motor output at the ankle with little impairment of proprioceptive acuity.

Motor and cognitive dontributions of dual-task walking deficits in people with Parkinson's disease

Objective: To examine the relationship between dual-task walking deficits and motor or cognitive functions in people with Parkinson's disease (PD), and to clarify factors that influence the magnitude of dual-task walking deficits.

Responsiveness of Objective vs. Clinical Balance Domain Outcomes for Exercise Intervention in Parkinson's Disease.

Background: Balance deficits in people with Parkinson's disease (PD) are often not helped by pharmacological or surgical treatment. Although balance exercise intervention has been shown to improve clinical measures of balance, the efficacy of exercise on different, objective balance domains is still unknown.Objective: To compare the sensitivity to change in objective and clinical measures of several different domains of balance and gait following an Agility Boot Camp with Cognitive Challenges (ABC-C) intervention.Methods: In this cross-over, randomized design, 86 individuals with PD participated in 6-week (3×/week) ABC-C exercise classes and 6-week education classes, consisting of 3–6 individuals. Blinded examiners tested people in their practical off state. Objective outcome measures from wearable sensors quantified four domains of balance: sway in standing balance, anticipatory postural adjustments (APAs) during step initiation, postural responses to the push-and-release test, and a 2-min natural speed walk with and without a cognitive task. Clinical outcome measures included the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, the Mini Balance Evaluation Systems Test (Mini-BESTest), the Activities of Balance Confidence (ABC), and the Parkinson's Disease Questionnaire (PDQ-39). The standardized response means (SRM) of the differences between before and after each intervention compared responsiveness of outcomes to intervention. A linear mixed model compared effects of exercise with the active control—education intervention.Results: The most responsive outcome measures to exercise intervention with an SRM > 0.5 were objective measures of gait and APAs, specifically arm range of motion, gait speed during a dual-task walk, trunk coronal range of motion, foot strike angle, and first-step length at step initiation. The most responsive clinical outcome measure was the patient-reported PDQ-39 activities daily living subscore, but all clinical measures had SRMs <0.5.Conclusions: The objective measures were more sensitive to change after exercise intervention compared to the clinical measures. Spatiotemporal parameters of gait, including gait speed with a dual task, and APAs were the most sensitive objective measures, and perceived functional independence was the most sensitive clinical measure to change after the ABC-C exercise intervention. Future exercise intervention to improve gait and balance in PD should include objective outcome measures.

Intensive aphasia therapy improves low mood in fluent post-stroke aphasia: Evidence from a case-controlled study

ABSTRACT Introduction: Depressive symptoms are a major drawback of aphasia, negatively impacting on functional outcomes. In a previous study, Intensive Language-Action Therapy (ILAT) was effective in improving depression and low mood in persons with chronic non-fluent aphasia. We present a proof-of-concept case–control study that evaluates language and mood outcomes amongst persons with fluent post-stroke aphasia. Participants: Thirteen Spanish speaking persons with fluent aphasia due to chronic stroke lesions in the left hemisphere participated in the study. Intervention: Five participants (intervention group) received ILAT for 3 h/day during two consecutive weeks, for an overall of 30 h, and 8 participants (control group) entered a waiting-list no-treatment arm. Results: The main finding was that participants receiving active treatment showed significant improvements on depression and aphasia severity scores, whereas no significant changes were found in the control group. Conclusions: The implementation of ILAT was efficient in improving clinical language deficits in people with fluent aphasia and contributes to improvement in mood after therapy. Trial registration: EUDRACT (2008-008481-12)

Relating Parkinson freezing and balance domains: A structural equation modeling approach

BackgroundPeople with PD who exhibit freezing of gait (FOG) also exhibit poor balance compared to those who do not freeze. However, balance is a broad construct that can be subdivided into subdomains that include dynamic balance (gait), anticipatory postural adjustments (APAs) & gait initiation, postural sway in stance, and automatic postural responses (e.g., reactive stepping). Few studies have provided a robust investigation on how each of these domains is impacted by FOG, and no studies have compared balance across groups while rigorously controlling for disease severity. MethodsStructural equation modeling was used to evaluate the relationships between FOG and balance domains constructed as latent variables and controlling for disease severity. Domains included: dynamic balance (gait), APAs, postural sway, and reactive stepping. Models were run relating domains to both the presence and severity of FOG. ResultsLatent variables reflecting domains of Gait and APAs, but not postural sway or reactive stepping, were significantly related to the severity of FOG. Models for presence of FOG showed the same results, as Gait and APAs, but not postural sway or reactive stepping, were related to presence of FOG. ConclusionThese results are consistent with hypotheses that balance deficits in people with PD who freeze are most pronounced in gait and anticipatory postural adjustments. Reactive stepping and postural sway domains are less effected in PD patients who freeze compared to those who do not. These findings suggest that rehabilitative strategies focused on gait and APAs may be most effective for people with PD who freeze.

Reduced Dorsal Visual Oscillatory Activity During Working Memory Maintenance in the First-Episode Schizophrenia Spectrum.

Cognitive deficits in people with schizophrenia are among the hardest to treat and strongly predict functional outcome. The ability to maintain sensory precepts in memory over a short delay is impacted early in the progression of schizophrenia and has been linked to reliable neurophysiological markers. Yet, little is known about the mechanisms of these deficits. Here, we investigated possible neurophysiological mechanisms of impaired visual short-term memory (vSTM, aka working memory maintenance) in the first-episode schizophrenia spectrum (FESz) using magnetoencephalography (MEG). Twenty-eight FESz and 25 matched controls performed a lateralized change detection task where they were cued to selectively attend and remember colors of circles presented in either the left or right peripheral visual field over a 1 s delay. Contralateral alpha suppression (CAS) during the delay period was used to assess selective attention to cued visual hemifields held in vSTM. Delay-period CAS was compared between FESz and controls and between trials presenting one vs three items per visual hemifield. CAS in dorsal visual cortex was reduced in FESz compared to controls in high-load trials, but not low-load trials. Group differences in CAS were found beginning 100 ms after the disappearance of the memory set, suggesting deficits were not due to the initial deployment of attention to the cued visual hemifield prior to stimulus presentation. CAS was not greater for high-load vs low-load trials in FESz subjects, although this effect was prominent in controls. Further, lateralized gamma (34–40 Hz) power emerged in dorsal visual cortex prior to the onset of CAS in controls but not FESz. Gamma power in this cluster differed between groups at both high and low load. CAS deficits observed in FESz were correlated with change detection accuracy, working memory function, estimated IQ, and negative symptoms. Our results implicate deficits in CAS in trials requiring broad, but not narrow, focus of attention to spatially distributed objects maintained in vSTM in FESz, possibly due to reduced ability to broadly distribute visuospatial attention (alpha) or disruption of object-location binding (gamma) during encoding/consolidation. This early pathophysiology may shed light upon mechanisms of emerging working memory deficits that are intrinsic to schizophrenia.

Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care.

Cognitive remediation is an evidence-based intervention targeting the common and disabling cognitive deficits in people with psychosis. Findings from efficacy studies and meta-analyses show that cognitive remediation produces medium to large effects on cognition in both chronic and first episode patients. However, clinical availability of this treatment remains scarce, reflecting a major gap between science and practice. Here we describe the development of a cognitive remediation programme in an outpatient first episode psychosis clinical service, and preliminary feasibility and acceptability outcomes. Based on evidence from efficacy trials and assessment within the clinic of perceived benefits and barriers, we developed a CR programme that involved both internet-based computer training exercises and a weekly in-person therapy group. Outcomes were assessed based on data from three consecutive 12-week group series. Feasibility outcomes included adoption, fill, cost, and utilization; tolerability outcomes were based on user survey and focus group feedback. We found evidence of feasibility including good adoption, fill, utilization, and cost. We also found good tolerability and satisfaction based on feedback from a user survey and focus groups, with more than 80% of respondents reporting high overall satisfaction with the programme and subjective cognitive and functional improvements. The present report provides preliminary evidence that cognitive remediation can be translated into real world clinical practice for first episode psychosis. Systematic evaluation of implementation and dissemination of cognitive remediation is needed, and has the potential to improve access to cognitive health interventions for people with psychosis.

The 'telegraphic schizophrenic manner': Psychosis and a (non)sense of time.

This paper reads Vonnegut’s Slaughterhouse-Five and Piercy’s Woman on the Edge of Time as stories of deictic temporal crises. It critically examines the texts, exploring their representations of mental time travel (MTT), and places them into dialectic with health sciences research on autonoesis and episodic memory deficits in people with lived experience of mental health disorders, particularly psychosis or ‘schizophrenia’. The paper uses this dialectic to interrogate how atypical MTT is diagnostically and clinically rendered as pathological, and indicative of psychosis in particular. Similarly, it mines these fictional representations for the insights they might provide in attempting to understand the phenomenological reality of temporal disruptions for people with lived experience of psychosis. The paper moves on to incorporate first-person accounts from people with lived experience, and uses these to refine a Deleuzean static synthesis of time constructed around the traumatic Event and the Dedekind ‘cut’. The paper concludes with some suggestions as to how the literary texts offer possible insights into the experience of people living with ‘psychotic’ temporal disruptions, and in particular how to re-invest their deictic relations to establish functioning fixity and stability of the self in time.

The Effect of Autistic Traits on Social Orienting in Typically Developing Individuals.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by wide ranging and heterogeneous changes in social and cognitive abilities, including deficits in orienting attention during early processing of stimuli. Investigators have found that there is a continuum of autism-like traits in the general population, suggesting that these autistic traits may be examined in the absence of clinically diagnosed autism. To provide evidence for the continuum of autistic traits in terms of social attention and to provide insights into social attention deficits in people with autism, the current study was conducted to examine the effect of autistic traits of typically developing individuals on social orienting using a spatial cueing paradigm. The typically developing individuals who participated in this study were divided into high autistic traits (HA) and low autistic traits groups using the Autism Quotient scale. All participants completed a spatial cueing task in which social cues (gaze) and non-social cues (arrow) were presented under different cue predictability conditions (predictive vs. non-predictive) with different SOAs (100 ms vs. 400 ms). The results showed that compared to low autistic individuals, high autistic individuals had less benefit from non-predictive social cues but greater benefit from non-social ones, providing evidence that such spatial attention impairment in high autistic individuals is specific to the social domain. Interestingly, the smaller benefit from non-predictive social cues in high autistic individuals was shown only in the 400 ms condition, not in the 100 ms condition, suggesting that their difficulties in orienting to non-predictive social cues may be caused by a deficiency in spontaneously effortful control processing.