Non-psychiatric Control Group Research Articles

Overweight and obesity in patients with bipolar disorder or schizophrenia compared with a non-psychiatric sample

Multiple studies suggest an association of overweight and obesity with bipolar disorder (BD) and schizophrenia. The goal of this paper was to determine the magnitude of this association and its relationship with previous course-of-illness and other variables of clinical interest. The prevalence of overweight and obesity was compared among patients with BD (n=108), patients with schizophrenia (n=250) and a non-psychiatric control group (n=290). Moreover, within each group we analyzed the variables associated with overweight [including obesity, i.e., body mass index (BMI) ≥25] and obesity (BMI≥30) adjusting for a possible confounding effect of sex, age and educational level by logistic regression. In comparison with the non-psychiatric sample, a strong association of both BMI≥25 and obesity was observed with BD and schizophrenia (adjusted odds ratios between 3.4 and 4.6; P-values <0.001). Overweight was significantly associated with male sex and increasing age in both control and BD groups; and with female sex among schizophrenia patients. Moreover, for BD patients, earlier onset of first BD symptoms, presence of a non-psychiatric illness, current use of mood-stabilizing medication, and being a non-smoker were significantly associated with overweight; and male sex and the presence of a non-psychiatric illness, with obesity. Within the schizophrenia patients, obesity was significantly associated with female sex, intermediate age range and lower PANSS score. Among patients with BD or schizophrenia, the chronic course of their illness and their current treatment with psychotropic medication might be more relevant for becoming overweight or obese than the specific psychiatric illness.

A Prospective, Naturalistic, Blinded Study of Early Neurobehavioral Outcomes for Infants Following Prenatal Antidepressant Exposure

This study examined the potential effects of antidepressant exposure in pregnancy on early infant neurobehavioral outcomes. In this prospective, naturalistic study, neurobehavioral assessments using the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were completed by blinded raters between March 2001 and August 2005 on 64 infants who were born to mothers in 1 of 3 categories: (1) women with a history of DSM-IV-diagnosed major depressive disorder (MDD) who were treated with antidepressants during pregnancy, (2) women with a history of DSM-IV-diagnosed MDD who discontinued or chose not to be treated with antidepressants during pregnancy, and (3) a nonpsychiatric control group. Summary scores for the BNBAS were obtained within the first week of life and at 6 to 8 weeks of age. No significant differences were observed between groups at either the first week after delivery or at 6 to 8 weeks of age on any of the summary scores for the 7 major clusters of the BNBAS. Antidepressant exposure during pregnancy does not appear to have major adverse effects on indices of early infant neurobehavioral development during the first 2 months of life as assessed by the BNBAS. While this finding is encouraging, further studies with larger samples and longer follow-up are needed.

Social skill and social cognition in adolescents at genetic risk for psychosis

Adolescents at genetic high risk (GHR) for schizophrenia have shown social skill impairments and there is some evidence to suggest they have Theory of Mind (ToM) deficits; however no research has used a standardized, performance-based behavioral measure to assess social functioning in this population nor evaluated ToM with a well-validated measure. We evaluated the psychometric properties of a new, theoretically-derived assessment of social functioning in GHR adolescents: the “High-Risk Social Challenge” task (HiSoC). The second aim was to explore whether GHR adolescents would show social skill and ToM deficits as compared to a non-psychiatric control (NPC) group. The present study evaluated social functioning with the HiSoC and ToM with the Eyes Test in 23 GHR adolescents and 31 NPCs. The HiSoC demonstrated high levels of reliability and validity. The GHR adolescents showed social skill impairments, but not ToM deficits. The results suggest that the HiSoC is a potentially useful new measure of social functioning in GHR adolescents. Furthermore, the findings add to the current body of literature that indicates that social skill impairments are related to schizophrenia vulnerability.

Psychophysiological and Self-Report Components of Disgust in Body Dysmorphic Disorder: The Effects of Repeated Exposure

Body dysmorphic disorder (BDD) is a severe and debilitating psychiatric condition. While approaches to treatment relying on cognitive-behavior therapy modeled using exposure methods has shown promise, intervention is highly reliant on alleviating anxiety and depression. However, anecdotal evidence and clinical observations suggest that BDD sufferers experience disgust at their perceived physical imperfections. The present study examined the change in disgust reactivity, using psychophysiological and self-report measures, when individuals diagnosed with BDD were exposed to a mirror staring task over five 1-minute trials. Two groups completed the experiment, a BDD group (n = 6) and a non-psychiatric community control group (n = 6). Results revealed that the BDD group had higher baseline disgust reactivity, and showed significant decreases in disgust, as assessed with heart rate and hand temperature, compared to community controls. Individuals with BDD also reported significantly higher levels of disgust and...

Executive functioning in schizophrenia: A thorough examination of performance on the Hayling Sentence Completion Test compared to psychiatric and non-psychiatric controls

Background The current study examined executive functioning in schizophrenia by assessing response initiation and suppression in a group of schizophrenia patients, and drawing comparisons with psychiatric and non-psychiatric control groups. Method The Hayling Sentence Completion Test was used as a measure of executive functioning and was completed by 39 schizophrenia patients, 40 bipolar disorder patients and 44 healthy control participants. Outcome measures included response initiation and response suppression latency and error rate. Results The schizophrenia group was significantly impaired on all measures of the Hayling Sentence Completion Test when compared to healthy control participants, and only on some of the measures when compared to the bipolar disorder group. The bipolar disorder group did not differ in performance compared to the healthy control group. Overall schizophrenia patients showed longer response initiation and response suppression latencies, and an increased error rate. Performance of the schizophrenia patients was associated with higher ratings of cognitive disorganisation. Performance was not related to age, gender, predicted IQ or any other clinical characteristics. Conclusions Schizophrenia patients show a slowing in baseline response initiation and slowed suppression of an inappropriate response. Considering the bipolar disorder patients demonstrated intact performance, altered executive functioning in schizophrenia appears relatively specific to the disorder rather than reflecting other characteristics common to mental illness. Investigations examining which neurocognitive domains are impaired in schizophrenia provide direct implications for treatment options tailored to an individual's cognitive strengths and weaknesses.

Perceptions of hostility by persons with and without persecutory delusions

Introduction. Current models of paranoia propose that ambiguous situations, in which cues regarding the intentions of others are lacking, may be perceived as hostile by persons with persecutory delusions (PD). Thus, a social-cognitive bias for the perception of hostility may be present. In this study, the Ambiguous Intentions Hostility Questionnaire (AIHQ) was used to present situations that are ambiguous regarding the intentions of others. It was predicted that on the AIHQ, persons with PD would show greater levels of perceived hostility, blame, and aggression than both psychiatric and nonpsychiatric controls. Methods. The sample comprised 32 persons with PD, 28 persons without PD (psychiatric controls), and 50 healthy participants (nonpsychiatric controls). Participants completed the AIHQ along with measures of paranoia, attributional style, depression, anxiety, self-esteem, and public self-consciousness. Results. As predicted, the group with PD showed greater perceptions of hostility, blame, and aggression scores for ambiguous situations on the AIHQ. Also, the AIHQ Hostility bias score was predictive of paranoid ideation. Conclusions. Persons with PD showed a social-cognitive bias for perceiving hostility in ambiguous situations. The bias appears to be specific as it was not found in the psychiatric or nonpsychiatric control groups. Suggestions for future research are discussed.

Contributions of spectral frequency analyses to the study of P50 ERP amplitude and suppression in bipolar disorder with or without a history of psychosis

The present study investigated event-related brain potential (ERP) indices of auditory processing and sensory gating in bipolar disorder and subgroups of bipolar patients with or without a history of psychosis using the P50 dual-click procedure. Auditory-evoked activity in two discrete frequency bands also was explored to distinguish between sensory registration and selective attention deficits. Thirty-one individuals with bipolar disorder and 28 non-psychiatric controls were compared on ERP indices of auditory processing using a dual-click procedure. In addition to conventional P50 ERP peak-picking techniques, quantitative frequency analyses were applied to the ERP data to isolate stages of information processing associated with sensory registration (20-50 Hz; gamma band) and selective attention (0-20 Hz; low-frequency band). Compared to the non-psychiatric control group, patients with bipolar disorder exhibited reduced S1 response magnitudes for the conventional P50 peak-picking and low-frequency response analyses. A bipolar subgroup effect suggested that the attenuated S1 magnitudes from the P50 peak-picking and low-frequency analyses were largely attributable to patients without a history of psychosis. The analysis of distinct frequency bands of the auditory-evoked response elicited during the dual-click procedure allowed further specification of the nature of auditory sensory processing and gating deficits in bipolar disorder with or without a history of psychosis. The observed S1 effects in the low-frequency band suggest selective attention deficits in bipolar patients, especially those patients without a history of psychosis, which may reflect a diminished capacity to selectively attend to salient stimuli as opposed to impairments of inhibitory sensory processes.

Dysfunctional Attitudes and Cognitive Schemas in Bipolar Manic and Unipolar Depressed Outpatients

Dysfunctional thought patterns are presumed to underlie cognitive biases in mood disorder patients. However, few studies have compared dysfunctional thought patterns in bipolar manic and unipolar depressed patients. Cognitive schemas and dysfunctional attitudes were evaluated using the cognitive checklist for mania and Dysfunctional Attitudes Scale (DAS) in 34 bipolar manic, 35 unipolar depressed, and 29 nonpsychiatric control subjects. Unipolar depressed subjects had significantly higher total DAS scores and subfactor scores as compared with nonpsychiatric controls, whereas bipolar patients had intermediate scores between both groups. Significant correlations emerged between cognitive checklist for mania total and subcomponent scores and the DAS (total, performance subfactor, and approval subfactor scales) for the bipolar, but not the unipolar or nonpsychiatric control groups. Core beliefs among bipolar patients appear negativistic during manic phases, potentially reflecting an overcompensation for depression. The findings support clinical approaches targeting depressive cognitions regardless of the presence of manic symptoms.

Impaired theory of mind in first-episode schizophrenia: comparison with community, university and depressed controls

First order theory of mind, as measured by the ‘Reading the Mind in the Eyes Test’ Revised, is impaired in schizophrenia. However, no study has investigated whether this occurs in first-episode schizophrenia. Also, it is unclear whether such a deficit is specific to schizophrenia, and whether convenience control samples, particularly undergraduate university students, represent valid comparison groups. This study investigated theory of mind ability, measured by the ‘Reading the Mind in the Eyes Test’ Revised, in a group of first-episode schizophrenia outpatients ( n = 13) and three control groups: outpatients with non-psychotic major depression ( n = 14), individuals from the general community ( n = 16) and from an undergraduate university course ( n = 27). The schizophrenia group exhibited significant theory of mind impairments compared to both non-psychiatric control groups but not the depression group. Unexpectedly, the depression group was not significantly impaired compared to the community control group, and the university control group exhibited superior theory of mind ability relative to all three groups. The findings indicate theory of mind deficits in first episode schizophrenia and support the implementation of theory of mind interventions in first-episode schizophrenia treatment programs. Results also indicate that community rather than university control groups represent more valid comparison groups in first-episode schizophrenia research.

Menarche, puberty, and first sexual activities in eating‐disordered patients as compared with a psychiatric and a nonpsychiatric control group

To examine chronology and experience of menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group. We interviewed 150 females, namely 50 patients with anorexia or bulimia nervosa (ED), 50 patients with polysubstance dependence (PSD-CO), and 50 healthy controls (HE-CO) (defined by DSM-IV) on chronology and their experience of menarche, puberty, and first sexual activities adjusted for childhood sexual abuse. ED women were similar to HE-CO in age at menarche and most sexual milestones, but differed significantly from PSD-CO women, who were "early starters." Regarding their experience of menarche, pubertal body changes, and first sexual activities, however, ED women rated these variables significantly more negatively than did either of the comparison groups. These significant differences remained after adjusting for sexual abuse. These findings suggest a negative body attitude in ED patients already at pubertal age, namely years before onset of the disorder. Prospective data are needed.

Elevated social Internet use and schizotypal personality disorder in adolescents

IntroductionIn the past decade, the use of the Internet as a forum for communication has exponentially increased, and research indicates that excessive use is associated with psychiatric symptoms. The present study examined the rate of Internet use in adolescents with personality disorders, with a focus on schizotypal personality disorder (SPD), which is characterized by marked interpersonal deficits. Because the Internet provides an easily accessible forum for anonymous social interaction and constitutes an environment where communication is less likely to be hampered by interpersonal deficits, it was hypothesized that SPD youth will spend significantly more time engaging in social activities on the Internet than controls. MethodsSelf-reports of daily Internet use in adolescents with SPD (n=19), a control group with other personality disorders (n=22) and a non-psychiatric control group (n=28) were collected. ResultsAnalyses revealed that the SPD participants reported significantly less social interaction with ‘real-life’ friends, but used the Internet for social interaction significantly more frequently than controls. Chat room participation, cooperative Internet gaming, and to a lesser degree, e-mail use, were positively correlated with ratings of SPD symptom severity and Beck Depression Inventory scores. DiscussionFindings are discussed in light of the potential benefits and risks associated with Internet use by socially isolated SPD youth.

Elevated serum levels of C-reactive protein are associated with mania symptoms in outpatients with bipolar disorder

Objectives We investigated the association between serum levels of C-reactive protein (CRP), a marker of inflammation, and the severity of psychopathology in outpatients with bipolar disorder. We also compared the levels of CRP in the bipolar disorder individuals with those of a non-psychiatric control group. Methods We measured the level of CRP in N = 122 outpatients with bipolar disorder and N = 165 control individuals and evaluated the symptom severity of the bipolar disorder patients with the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (Ham-D). Results Within the bipolar disorder sample, CRP was significantly associated with the YMRS score ( r = .306, p < .006), age of onset, gender, and race. CRP was not significantly associated with the Ham-D score or other clinical or demographic variables. In a multivariate analysis of covariance, CRP was the only independent predictor of YMRS score ( F = 11.7, p = .0009). The CRP levels of the n = 41 individuals with YMRS > 6 were significantly greater than the levels of the n = 81 individuals with YMRS ≤ 6 ( F = 7.94, < .006). The CRP levels of the group with YMRS > 6 were also significantly greater than the levels of the control group ( p = .033) while the CRP levels of the group with YMRS ≤ 6 did not differ from that of controls ( p > .05). Conclusions Our results suggest that outpatients with bipolar disorder with mania symptoms have increased levels of CRP as compared to those without mania symptoms and compared to individuals without psychiatric disorders. The long-term consequences of CRP in bipolar disorder should be the subject of future studies.

Early Maladaptive Schemas and Social Phobia

The present study compares core beliefs between a group of patients with social phobia (n = 62), other anxiety disorders (n = 41) and a group of non-psychiatric controls (n = 55). Participants completed measures to assess social anxiety and the Young’s Schema Questionnaire (123-items version) that is designed to assess 15 early maladaptive schemas (EMSs). Results suggest that the schematic structure of patients with social phobia differs from the one of patients with other anxiety disorders and from normal controls’. Patients with social phobia show higher levels of EMSs particularly in the area of disconnection/rejection than patients with other anxiety disorders. Regression analysis identified the EMSs of mistrust/abuse, social undesirability/defectiveness, entitlement, emotional deprivation, unrelenting standards and shame, as the ones that explain most of the variance in our sample subject’s anxiety that they felt in social situations and on fear of negative evaluation.

The course of cognitive functioning in first episode psychosis: Changes over time and impact on outcome

This three year longitudinal study examined the cognitive performance of 247 individuals who recently presented with a first episode of psychosis. Using a comprehensive battery of cognitive tests, we assessed cognition at baseline, 1 year and 2-year follow-ups. Assessments also included positive and negative symptoms, depression, social outcome and substance use. There were several significant improvements in cognition over the two-year period which were usually matched by improvements in a matched non-psychiatric control group. Regression analyses demonstrated that after controlling for symptoms cognitive impairment accounted for 4–6% of the variance in social functioning. Our results suggest that impaired cognition exists in the very early stages of a psychotic illness and that there is no decline over time. Secondly, our results suggest that, although related, poor social functioning deficits may be independent of cognitive impairment. Finally there are implications for improved methodology in the assessment of both cognitive and social functioning.

Analogical reasoning in schizophrenic delusions

Purpose. – Reasoning ability has often been argued to be impaired in people with schizophrenic delusions, although evidence for this is far from convincing. This experiment examined the analogical reasoning abilities of several groups of patients, including non-deluded and deluded schizophrenics, to test the hypothesis that performance by the deluded schizophrenic group would be impaired. Subjects/materials. – Eleven deluded schizophrenics, 10 depressed subjects, seven non-deluded schizophrenics and 16 matched non-psychiatric controls, who were matched on a number of key variables, were asked to solve an analogical reasoning task. Results. – Performance by the deluded schizophrenic group was certainly impaired when compared with the depressed and non-psychiatric control groups though less convincingly so when compared with the non-deluded schizophrenic group. The impairment shown by the deluded schizophrenic group seemed to occur at the initial stage of the reasoning task. Discussion. – The particular type of impairment shown by the deluded subjects was assessed in relation to other cognitive problems already researched and the implications of these problems on reasoning tasks and theories of delusions was discussed.

The validity of the brief version of the Fear of Negative Evaluation Scale

The Fear of Negative Evaluation Scale [FNE; J. Consult. Clin. Psychol. 33 (1969) 448] is a commonly used measure of social anxiety. A brief version of the scale (FNEB) is available for convenient administration. Despite being widely advocated for use, the psychometric properties of the FNEB have not been evaluated with clinically anxious samples. The present study addressed the reliability and validity of the FNEB in a clinical sample of individuals with either social phobia ( n=82) or panic disorder ( n=99) presenting for treatment. Factor analysis supported the construct validity of the FNEB. The validity of the FNEB was further demonstrated through significant correlations with social avoidance and depression, and non-significant correlations with agoraphobic avoidance and demographic variables. The scale obtained excellent inter-item reliability ( α=.97) and 2-week test-retest reliability ( r=.94). Discriminant function analysis also supported validity of the FNEB. For example, individuals with social phobia scored significantly higher on the FNEB than those with panic disorder and a group of non-psychiatric community controls ( n=30). The FNEB was sensitive to pre- to post-CBT changes in both social anxiety and panic disorder, and changes on the FNEB correlated significantly with other measures of treatment responsiveness, such as reductions in somatic arousal, depression and other anxiety symptomatology. These research findings strongly support the validity of the FNEB and its clinical utility as an outcome measure in social anxiety treatment.

Problem-solving in suicide attempters

Recent research studies on the psychological processes underlying suicidal behaviour have highlighted deficits in social problem-solving ability, and suggest that suicide attempters may, in addition, be passive problem-solvers. The aim of this study was to examine problem-solving in suicide attempters (including passivity) and to see whether the deficits are mood-dependent. Two groups, a suicide attempter group and a non-suicidal psychiatric control group completed measures of depression, hopelessness, suicidal ideation and social problem-solving ability shortly after admission, and again 6 weeks later. In addition, a non-psychiatric control group provided baseline data at a single time point. The suicide attempter group displayed poorer problem-solving ability than matched psychiatric controls and this difference persisted despite change in mood. However, although suicidal patients were more passive in their problem-solving style than non-psychiatric controls, they were not significantly more passive than psychiatric controls. Problem-solving did not change with improving mood. Although passivity is not unique to suicidal patients, in combination with the smaller number and less effective alternatives generated, it may increase vulnerability.

Premorbid function and early development in early onset schizophrenia

Adolescents at genetic high risk (GHR) for schizophrenia have shown social skill impairments and there is some evidence to suggest they have Theory of Mind (ToM) deficits; however no research has used a standardized, performance-based behavioral measure to assess social functioning in this population nor evaluated ToM with a well-validated measure. We evaluated the psychometric properties of a new, theoretically-derived assessment of social functioning in GHR adolescents: the “High-Risk Social Challenge” task (HiSoC). The second aim was to explore whether GHR adolescents would show social skill and ToM deficits as compared to a non-psychiatric control (NPC) group. The present study evaluated social functioning with the HiSoC and ToM with the Eyes Test in 23 GHR adolescents and 31 NPCs. The HiSoC demonstrated high levels of reliability and validity. The GHR adolescents showed social skill impairments, but not ToM deficits. The results suggest that the HiSoC is a potentially useful new measure of social functioning in GHR adolescents. Furthermore, the findings add to the current body of literature that indicates that social skill impairments are related to schizophrenia vulnerability.

Respiratory sinus arrhythmia as a predictor of outcome in major depressive disorder

Background: Respiratory sinus arrhythmia (RSA) is a noninvasive measure of parasympathetic tone that has been related to emotion regulatory capacity. While some previous work indicates that clinically depressed persons exhibit lower levels of RSA than do normal controls, there is nevertheless considerable between-subject variation in RSA among depressed persons. The current study evaluated the significance of variation in RSA among depressed persons by examining whether levels of RSA predicted concurrent symptomatology and the course of depressive illness. Methods: The RSA levels of 55 diagnosed depressed individuals were assessed during a paced breathing procedure at Time 1. Six months later (Time 2), participants were interviewed again to determine whether or not each had fully recovered from depression. Multinomial regression analyses were conducted to examine whether RSA predicted Time 2 clinical status. Results: Although RSA levels were not related to overall depression severity, they were associated with specific symptoms of depression: RSA was positively associated with the report of sadness and negatively associated with the report of suicidality. More strikingly, however, higher levels of RSA at Time 1 predicted non-recovery from depression at Time 2, even when statistically controlling for initial depression severity, age and medication use. Limitations: Treatment and medication use were not controlled during the follow-up period and a group of nonpsychiatric controls was not included in this study. Conclusions: A relatively high level of RSA among depressed individuals predicts a more pernicious course of illness than do lower RSA levels.

Computerized perceptual analysis of patients with body dysmorphic disorder: a pilot study.

Many factors influence the development of body image, one of which is the perception we have of our body. Perception can refer to actual visual input or the interpretation of vision; in other words, cognitive appraisal. The goal of this preliminary study is to determine if three groups (body dysmorphic disorder, obsessive-compulsive disorder, and a non-psychiatric control group) differed in the perception of their faces. Thirty individuals, 10 in each group, were asked to make changes to a computerized image of their face. In addition, affective and perceptual tests were administered. The groups did not differ on affective and perceptual organizational measures, although the obsessive-compulsive disorder group reported a higher level of anxiety than the body dysmorphic disorder group. Imaging software showed that facial features were modified by patients with body dysmorphic disorder and obsessive-compulsive disorder in about 50% of cases. No modifications were made in the control group. Future studies need to investigate the possible causes of these differences.