Outcome In Schizophrenia Research Articles

Quality of life in patients with schizophrenia: A 2-year cohort study in primary mental health care in rural China.

ObjectiveQuality of life (QoL) has been always an important way to evaluate the outcomes of schizophrenia, but there have been few previous longitudinal studies and few in middle-income countries. This study aimed to explore the QoL in Chinese patients with schizophrenia treated in primary mental health care and the risk factors of QoL over time.MethodsPatients with schizophrenia treated in primary mental health care in rural/regional areas in Luoding, Guangdong, PR China, were evaluated with an extended questionnaire including the Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and 2-year follow-up. Bivariate and multivariate analyses were conducted including Generalized Estimated Equation analyses (GEE).ResultsFour hundred and ninety-one patients with schizophrenia in primary care completed the 2-year follow up evaluation. The QoL physical, environmental, and social relationships domains showed improvement after the 2-year period, but the psychological domain did not. GEE results showed that earlier age of onset, older age, being employed, being unmarried, the thicker waist circumference, less use of clozapine or other SGAs, fewer hospitalizations, more frequent insomnia, more severe depressive and negative symptoms as well as worse treatment insight were independently associated with poor QoL in patients with schizophrenia.ConclusionAccording to our results, to improve the quality of life of patients with schizophrenia in primary care, we should pay more attention to the treatment of depression, negative and insomnia symptoms of schizophrenia, the choice and dosage of antipsychotic medication and improvement in the treatment compliance. The combined use of educational and behavioral strategies may improve treatment adherence.

Homocysteine Levels and Clinical Outcomes in Schizophrenia—A Pilot Randomized Controlled Trial

Objectives: To find out the relation between homocysteine levels in peripheral blood and the effectiveness as well as the safety of haloperidol and olanzapine in schizophrenia treatment. Materials and Methods: A prospective randomized parallel-group open-label interventional clinical trial was conducted on 40 mild to moderate schizophrenia patients. To compare the efficacy of olanzapine and haloperidol Brief Psychiatric Rating Scale (BPRS) score was used. Homocysteine levels of peripheral blood and Abnormal Involuntary Movement Scale scores were evaluated. Results: BPRS score improved in both groups on day 14 and day 28. But significantly more with olanzapine ( P value =.001). The olanzapine group showed a higher reduction (13.91±0.47 to 9.74±0.5) in homocysteine levels than the haloperidol group. Also, the BPRS scores negatively correlated ( r = –0.66) to homocysteine levels. Conclusion: Therefore, our study shows that peripheral blood homocysteine levels can be used to predict and assess the treatment outcome in schizophrenia patients. Biomarker driven approach in schizophrenia will allow the patients to be treated promptly with the right drug. In this light, personalized treatment holds great potential in the future.

Reluctance in Clinicians to Start Clozapine Treatment: A Heavy Toll in Clinical Outcome in Schizophrenia

Objective: Purpose of our study is to determine the frequency of treatment with clozapine among patients with treatment resistance schizophrenia. Study Design: Cross sectional study Place and Duration: Sughra Shafi Medical Complex Narowal. April 2020-October 2020 Methods: Total 23 patients of both genders had age 25-50 years were presented. All the patients had treatment-resistance schizophrenia and admitted to hospital for treatment.Only 4 patients were on clozapine while 19 patients were on other Antipsychotics. Patients were enrolled after taking informed written consent for detailed demographics. SPSS 22.0 was used to analyze all data. Results:Among 23 patients, 17 (73.9%) were males and 6 (26.1%) cases were females.Mean age of the the patients was 34.16±8.30 years and had mean BMI 24.2±6.37 kg/m2. Majority patients 15 (65.2%) had poor socio-economic status and 13 (56.5%) cases had urban residency. Only 4 (17.4%) patients received clozapine treatment. Psychiatristswere hesitating to provide clozapine among 19 (82.6%) cases. Reasons for hesitance to prescribe clozapine included concerns about major adverse effects and patients' lack of adherence, as well as difficulties in finding appropriate patients, service fragmentation, and a lack of familiarity with the drug. Conclusion:Clozapine continues to be under prescribed for individuals with treatment-resistant schizophrenia owing to several hurdles relating to the physician, the system of care, and technology. In order to overcome these obstacles, it is suggested that prescriber expertise and training be enhanced, integrated care be implemented, and technology be used to provide continuous, real-time monitoring of blood tests. Keywords:Treatment-resistance Schizophrenia, Clozapine, Complications, Antipsychotics

Psychiatric hospitalisation before and after commencing long-acting injectable antipsychotic medication: a mirror-image study.

Treatment adherence is an important predictor of outcomes in schizophrenia, related disorders and bipolar disorder, and may be improved by the use of long acting injectable (LAI) antipsychotic medication. Past research on the efficacy of LAIs is mixed with randomised controlled trials showing similar benefits to oral medication, and naturalistic studies showing advantages to LAIs. Psychiatric hospital bed-nights and admissions were compared before and after commencement of an LAI, using a retrospective cohort study with a mirror-image design. Total bed-nights and hospital admissions for each patient were compared for the same time period before and after commencing the LAI. Subgroup analyses were also conducted. Mean bed-nights decreased from 47.1 pre-LAI to 14.3 post-LAI, and median bed-nights from 24.5 to 0.0. Mean hospital admissions decreased from 1.7 pre-LAI to 0.7 post-LAI, and median admissions from 1.0 to 0.0. In our cohort, LAI treatment was associated with a significant reduction in bed-nights and total admissions to psychiatric hospitals. The findings of the current study are consistent with the results of previous naturalistic studies of LAI treatment for patients with psychotic disorders and bipolar disorder.

Improving Outcomes in Schizophrenia—A Case for Initiation of Long-Acting Antipsychotics in Early-Phase Illness

Improving Outcomes in Schizophrenia—A Case for Initiation of Long-Acting Antipsychotics in Early-Phase Illness

The impact of parent history of severe mental illness on schizophrenia outcomes: results from the real-world FACE-SZ cohort.

Parent history of severe mental illness (PHSMI) may have long-term consequences in adult offspring due to genetic and early environmental factors in preliminary studies. To compare the outcomes associated in subjects with PHSMI to those in patients without PHSMI. The participants with schizophrenia and schizoaffective disorders were recruited in the ongoing FACE-SZ cohort at a national level (10 expert centers) and evaluated with a 1-day-long standardized battery of clinician-rated scales and patient-reported outcomes. PHSMI was defined as history of schizophrenia or bipolar disorders in at least one parent and was included as explanatory variable in multivariate models. Of the 724 included patients, 78 (10.7%) subjects were classified in the PHSMI group. In multivariate analyses, PHSMI patients had a better insight into schizophrenia and the need for treatment and reported more often childhood trauma history compared to patients without PHSMI. More specifically, those with paternal history of SMI reported more severe outcomes (increased childhood physical and emotional abuses, comorbid major depression and psychiatric hospitalizations). PHSMI is associated with increased risk of childhood trauma, major depressive disorder and psychiatric hospitalization and better insight in individuals with schizophrenia. Specific public health prevention programs for parents with SMI should be developed to help protect children from pejorative psychiatric outcomes. PHSMI may also explain in part the association between better insight and increased depression in schizophrenia.

Efficacy of Transcranial Direct Current Stimulation to Improve Insight in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Impaired insight into the illness and its consequences is associated with poor outcomes in schizophrenia. While transcranial direct current stimulation (tDCS) may represent a potentially effective treatment strategy to relieve various symptoms of schizophrenia, its impact on insight remains unclear. To investigate whether tDCS would modulate insight in patients with schizophrenia, we undertook a meta-analysis based on results from previous RCTs that investigated the clinical efficacy of tDCS. We hypothesize that repeated sessions of tDCS will be associated with insight improvement among patients. PubMed and ScienceDirect databases were systematically searched to identify RCTs that delivered at least 10 tDCS sessions in patients with schizophrenia. The primary outcome was the change in insight score, assessed by the Positive and Negative Syndrome Scale (PANSS) item G12 following active tDCS sessions as opposed to sham stimulation. Effect sizes were calculated for all studies and pooled using a random-effects model. Meta-regression and subgroup analyses were conducted. Thirteen studies (587 patients with schizophrenia) were included. A significant pooled effect size (g) of -0.46 (95% CI [-0.78; -0.14]) in favor of active tDCS was observed. Age and G12 score at baseline were identified as significant moderators, while change in total PANSS score was not significant. Ten sessions of active tDCS with either frontotemporoparietal or bifrontal montage may improve insight into the illness in patients with schizophrenia. The effect of this treatment could contribute to the beneficial outcomes observed in patients following stimulation.

Impaired verbal memory function is related to anterior cingulate glutamate levels in schizophrenia: findings from the STRATA study

Impaired cognition is associated with lower quality of life and poor outcomes in schizophrenia. Brain glutamate may contribute to both clinical outcomes and cognition, but these relationships are not well-understood. We studied a multicentre cohort of 85 participants with non-affective psychosis using proton magnetic resonance spectroscopy. Glutamate neurometabolites were measured in the anterior cingulate cortex (ACC). Cognition was assessed using the Brief Assessment for Cognition in Schizophrenia (BACS). Patients were categorised as antipsychotic responders or non-responders based on treatment history and current symptom severity. Inverted U-shaped associations between glutamate or Glx (glutamate + glutamine) with BACS subscale and total scores were examined with regression analyses. We then tested for an interaction effect of the antipsychotic response group on the relationship between glutamate and cognition. ACC glutamate and Glx had a positive linear association with verbal memory after adjusting for age, sex and chlorpromazine equivalent dose (glutamate, β = 3.73, 95% CI = 1.26–6.20, P = 0.004; Glx, β = 3.38, 95% CI = 0.84–5.91, P = 0.01). This association did not differ between good and poor antipsychotic response groups. ACC glutamate was also positively associated with total BACS score (β = 3.12, 95% CI = 0.01–6.23, P = 0.046), but this was not significant after controlling for antipsychotic dose. Lower glutamatergic metabolites in the ACC were associated with worse verbal memory, and this relationship was independent of antipsychotic response. Further research on relationships between glutamate and cognition in antipsychotic responsive and non-responsive illness could aid the stratification of patient groups for targeted treatment interventions.

Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study).

BackgroundAlthough clinically effective treatment is available for schizophrenia, recovery often is still hampered by persistent poor psychosocial functioning, which in turn is limited by impairments in neurocognition, social cognition, and social behavioral skills. Although cognitive remediation has shown general efficacy in improving cognition and social functioning, effects still need to be improved and replicated in appropriately powered, methodologically rigorous randomized controlled trials (RCTs). Existing evidence indicates that effects can most likely be optimized by combining treatment approaches to simultaneously address both social cognitive and social behavioral processes.ObjectivesTo assess whether Integrated Social Cognitive and Behavioral Skill Therapy (ISST) is more efficacious in improving functional outcome in schizophrenia than the active control treatment Neurocognitive Remediation Therapy (NCRT).MethodsThe present study is a multicenter, prospective, rater-blinded, two-arm RCT being conducted at six academic study sites in Germany. A sample of 180 at least partly remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST is a compensatory, strategy-based program that targets social cognitive processes and social behavioral skills. NCRT comprises mainly drill and practice-oriented neurocognitive training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause discontinuation over the 12-month study period; psychosocial functioning, quality of life, neurocognitive and social cognitive performance, and clinical symptoms are assessed as secondary outcomes at baseline before randomization (V1), at the end of the six-month treatment period (V6), and at the six-month follow-up (V12).DiscussionThis RCT is part of the German Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) research network, which aims at using innovative treatments to enhance prevention and recovery in patients with schizophrenia. Because this study is one of the largest and methodologically most rigorous RCTs on the efficacy of cognitive remediation approaches in schizophrenia, it will not only help to identify the optimal treatment options for improving psychosocial functioning and thus recovery in patients but also allow conclusions to be drawn about factors influencing and mediating the effects of cognitive remediation in these patients.Trial RegistrationClinicalTrials.gov NCT 02678858, German Study Register DRKS 00010033

Association of polygenic risk for schizophrenia with fast sleep spindle density depends on pro-cognitive variants

Cognitive impairment is a common feature in schizophrenia and the strongest prognostic factor for long-term outcome. Identifying a trait associated with the genetic background for cognitive outcome in schizophrenia may aid in a deeper understanding of clinical disease subtypes. Fast sleep spindles may represent such a biomarker as they are strongly genetically determined, associated with cognitive functioning and impaired in schizophrenia and unaffected relatives. We measured fast sleep spindle density in 150 healthy adults and investigated its association with a genome-wide polygenic score for schizophrenia (SCZ-PGS). The association between SCZ-PGS and fast spindle density was further characterized by stratifying it to the genetic background of intelligence. SCZ-PGS was positively associated with fast spindle density. This association mainly depended on pro-cognitive genetic variants. Our results strengthen the evidence for a genetic background of spindle abnormalities in schizophrenia. Spindle density might represent an easily accessible marker for a favourable cognitive outcome which should be further investigated in clinical samples.

Schizophrenia Polygenic Risk and Experiences of Childhood Adversity: A Systematic Review and Meta-analysis.

Schizophrenia has been robustly associated with multiple genetic and environmental risk factors. Childhood adversity is one of the most widely replicated environmental risk factors for schizophrenia, but it is unclear if schizophrenia genetic risk alleles contribute to this association. In this systematic review and meta-analysis, we assessed the evidence for gene-environment correlation (genes influence likelihood of environmental exposure) between schizophrenia polygenic risk score (PRS) and reported childhood adversity. We also assessed the evidence for a gene-environment interaction (genes influence sensitivity to environmental exposure) in relation to the outcome of schizophrenia and/or psychosis. This study was registered on PROSPERO (CRD42020182812). Following PRISMA guidelines, a search for relevant literature was conducted using Cochrane, MEDLINE, PsycINFO, Web of Science, and Scopus databases until February 2022. All studies that examined the association between schizophrenia PRS and childhood adversity were included. Seventeen of 650 identified studies met the inclusion criteria and were assessed against the Newcastle-Ottawa Scale for quality. The meta-analysis found evidence for gene-environment correlation between schizophrenia PRS and childhood adversity (r = .02; 95% CI = 0.01, 0.03; P = .001), but the effect was small and therefore likely to explain only a small proportion of the association between childhood adversity and psychosis. The 4 studies that investigated a gene-environment interaction between schizophrenia PRS and childhood adversity in increasing risk of psychosis reported inconsistent results. These findings suggest that a gene-environment correlation could explain a small proportion of the relationship between reported childhood adversity and psychosis.

Decreased Resting-state fMRI Local Coherence in Schizophrenia Patients with Poor Long-term Outcome

IntroductionSchizophrenia is heterogeneous in terms of symptoms and outcome, but neurobiology of this heterogeneity is not well-studied. Local correlation analysis of fMRI data provides a measure of local coherence, i.e., average correlation between BOLD-signal in a voxel and its neighbours. Local correlation is a promising approach, and it seems important to find links between local brain coherence and schizophrenia outcome.ObjectivesWe aimed to compare brain local coherence between schizophrenia patients with varied long-term outcomes and healthy controls (HC).MethodsPatients with chronic schizophrenia spectrum disorders (37 males, mean age 41.5±5.5) and HC (17 males, mean age 38±7.7) underwent resting-state fMRI (3T). Cluster analysis based on PANSS and PSP allowed us to allocate patients into two subgroups (N = 13/24). The second subgroup had significantly more marked negative and general psychopathology symptoms and worse functioning than the first subgroup. Local coherence in the brain was compared between clinical subgroups and HC (ANOVA, p<.001 voxelwise, p[FDR]<.05 clusterwise).ResultsLocal coherence in the paracingulate gyri bilaterally ({-2; 58; 14}; 2712 mm3) differentiated the groups. Post hoc analysis revealed decreased local coherence in the subgroup with poorer outcome compared to HC, along with the absence of differences between the subgroup with better outcome and HC. There were no differences between clinical subgroups.ConclusionsHypoactivity of the cingulate cortex is related to negative symptoms (Bersani et al., 2014). Their severity, in turn, is strongly associated with outcome. Thus, local coherence in the cingulate cortex may be one of the factors which underlie outcome heterogeneity.DisclosureNo significant relationships.

Cognitive-Behavioral Therapy in Intensive Case Management: A Multimethod Quantitative-Qualitative Study.

Cognitive-behavioral therapy (CBT) has been shown to improve clinical outcomes in schizophrenia and severe and persistent mental illness, but access to it remains limited. One potential way to improve access to CBT is to provide it through intensive case management (ICM) teams. A 90-week quality improvement study was designed to assess if CBT could be implemented in ICM teams. Self-selected ICM clinicians (N=8) implemented CBT with their patients (N=40). These clinicians attended weekly seminars (36 h total) and group supervision (1.5 h/wk). Patient outcomes for this group were compared with those of other clinicians who did not attend the seminars [treatment as usual (TAU) clinicians (N=4)] and their patient population (N=49). Prescore and postscore on the Clinical Global Impressions scale and a quality-of-life scale (Montreal Life Skill Survey) were analyzed for completers in both groups (Clinical Global Impressions scores were analyzed for 25 patients in the CBT group and 29 patients in the TAU group). Weekly session reports by clinicians in the CBT group measured CBT interventions, session focus, and satisfaction with CBT. Qualitative data were obtained from clinicians in the CBT group. After 90 weeks, patients in the CBT group had fewer negative symptoms compared with patients in the TAU group. Our qualitative data describe 2 trajectories of patients: those who improved with CBT and those who did not, and they suggest factors that may impact patient trajectories in CBT. This study suggests that CBT can be used effectively in ICM teams working with patients suffering from severe and persistent mental illness.

Prognostication of Functional Outcomes of Schizophrenia Using a Multigene Panel

Prognostication of Functional Outcomes of Schizophrenia Using a Multigene Panel

P539. First-Episode Predictors of Long-Term Outcome in Schizophrenia

In most cases, schizophrenia goes along with progressive cognitive and psychosocial deficits that lead to grave consequences in a majority of cases. Disease trajectories can vary considerably between affected individuals, which raises a need for early predictors of long-term outcome as a major step towards personalized treatment strategies.

Overview Of Schizophrenia: A Review Article

Schizophrenia is a chronic brain condition that affects roughly 1% of the world's population and causes delusions, hallucinations, disorganized speech, mental difficulties, and a lack of motivation while it is active. Despite the fact that treatment, especially drug therapy, has been widely used for nearly a century, there is no evidence that it has improved the majority of people with schizophrenia. Current adverse effects may be better if we view schizophrenia as a developmental disorder with psychosis as a stage of delayed illness. This ‘rethinking’ of schizophrenia as a neurodevelopment disorder, very different from the way we thought about illness in the last century, has great potential for prevention and treatment over the next two decades. Conclusion: Most people with schizophrenia benefit from a combination of antimicrobials and non-pharmacologic treatments designed for their specific needs. The provision of low-dose antipsychotic drugs, monitoring and resolving side effects, and providing clozapine if patients continue to have psychiatric symptoms are the norm for medical treatment. Several promising ways to improve outcomes in schizophrenia are being investigated, including glutamate-N-methyld-aspartate (NMDA) cascade drugs, which can help patients with chronic disease reduce persistent psychiatric symptoms, symptoms, and dementia.

Nicotine use in individuals with schizophrenia and its relation with clinical severity

Background: Schizophrenia is a major psychiatric disorder with diverse clinical presentations and comorbidities. Comorbid nicotine use worsens the clinical symptomatology, predisposes the individuals to other chronic illnesses, and is associated with poorer outcomes in schizophrenia. It is thus clinically essential to assess the presence of tobacco use, the severity of nicotine dependence, and its correlation with psychopathology in patients with schizophrenia. Aims and Objectives: (i) To describe the pattern of tobacco use and severity of nicotine dependence in schizophrenia patients. (ii) To compare the socio-demographic variables and symptom severity of schizophrenia between tobacco users and non-users. (iii) To determine the correlation between the severity of nicotine dependence and clinical and nicotine related variables in patients of schizophrenia. Materials and Methods: It was a cross-sectional observational study conducted in a tertiary care level psychiatric hospital in the northeast of India. The study included 100 male schizophrenia patients. Fagerstrom Test for Nicotine Dependence (FTND) and FTND - Smokeless Tobacco, and the Positive and Negative Syndrome Scale five-factor model was used for assessment of the severity of nicotine dependence and symptoms of Schizophrenia, respectively. Results: 70% of the study sample used some form of tobacco. The severity of nicotine dependence was significantly higher in patients using both forms of tobacco. Tobacco use was significantly associated with lower educational status, employment status, and positive symptoms of Schizophrenia. Finally, the severity of nicotine dependence was significantly correlated with the severity of positive and emotional symptoms of schizophrenia. Conclusion: Higher positive and emotional symptoms of schizophrenia predicted severity of nicotine use. Study needs to be replicated in larger population of patients suffering from schizophrenia.

Hospital admissions and clinical implications in schizophrenia and bipolar patients

This study aims to understand the long-term outcomes of schizophrenia and bipolar disorder, with a specific focus on hospital admissions and criteria for involuntary hospitalization. Conducted at the “Prof. Dr. Alexandru Obregia” Clinical Psychiatry Hospital, Bucharest, between September 2022 and January 2023, our research analyzed data from 93 patients diagnosed with either schizophrenia or bipolar disorder. We employed descriptive and inferential statistical methods, including Analysis of Variance (ANOVA), to examine differences in age, income, disease duration, hospital admissions, involuntary hospitalization days, and Clinical Global Impressions (CGI) scores. Descriptive statistics revealed that patients with bipolar disorder were older and had slightly higher education levels than those with schizophrenia. Schizophrenia patients reported higher incomes. Both groups exhibited similar disease durations, indicative of chronic disease courses. ANOVA results showed significant differences in the number of hospital admissions between the two groups (p = 0.028 when equal variances were not assumed), with schizophrenia patients experiencing more frequent hospitalizations. However, there were no significant differences in involuntary hospitalization days. Interestingly, CGI scores suggested higher perceived illness severity in bipolar disorder, although the results did not reach conventional statistical significance (p = 0.056 when variances were not assumed).

Shape features of working memory-related deep-brain regions differentiate high and low community functioning in schizophrenia

We have previously shown that schizophrenia (SCZ) participants with high community functioning demonstrate better verbal working memory (vWM) performance relative to those with low community functioning. In the present study, we investigated whether neuroanatomical differences in regions supporting vWM also exist between schizophrenia groups that vary on community functioning. Utilizing magnetic resonance imaging, shape features of deep-brain nuclei known to be involved in vWM were calculated in samples of high functioning (HF-SCZ, n = 23) and low functioning schizophrenia participants (LF-SCZ, n = 18), as well as in a group of healthy control participants (CON, n = 45). Large deformation diffeomorphic metric mapping was employed to characterize surface anatomy of the caudate nucleus, globus pallidus, hippocampus, and thalamus. Statistical analyses involved linear mixed-effects models and vertex-wise contrast mapping to assess between-group differences in structural shape features, and Pearson correlations to evaluate relationships between shape metrics and vWM performance. We found significant between-group main effects in deep-brain surface anatomy across all structures. Post-hoc comparisons revealed HF-SCZ and LF-SCZ groups significantly differed on both caudate and hippocampal shape, however, significant correlations with vWM were only observed in hippocampal shape for both SCZ groups. Specifically, more abnormal hippocampal deformation was associated with lower vWM suggesting hippocampal shape is both a neural substrate for vWM deficits and a potential biomarker to predict or monitor the efficacy of cognitive rehabilitation. These findings add to a growing body of literature related to functional outcomes in schizophrenia by demonstrating unique shape patterns across the spectrum of community functioning in SCZ.

Metacognitive Training to Improve Insight and Work Outcome in Schizophrenia.

Individuals with psychotic disorders have deficits in metacognition. Thirty-four adults with schizophrenia were randomized to 2 months of metacognitive training (MCT) or a healthy living skills control group. All participants were enrolled in a work therapy program, followed by a supported employment program. Assessments were conducted at baseline, at the end of the 2-month active intervention, and at 4- and 12-month follow-ups. At the end of active intervention, the MCT group demonstrated greater improvement and better work behavior relative to controls. At follow-up, the MCT group demonstrated significantly greater insight and fewer positive symptoms and a greater percentage were employed in the community. We speculate that being better able to think about one's thoughts, recognize biases in thinking, and correct those thoughts may aid in responding to workplace challenges and hence improve work outcomes.