Handwriting movement analyses for monitoring drug-induced motor side effects in schizophrenia patients treated with risperidone

Epidemiologic studies indicate that nearly 60% of schizophrenia (SZ) patients treated with conventional antipsychotic drugs develop extrapyramidal side effects (EPS) such as parkinsonism and tardive dyskinesia. Although the prevalence of EPS has decreased due to the newer antipsychotics, EPS continue to limit the effectiveness of these medicines. Ongoing monitoring of EPS is likely to improve treatment outcome or compliance and reduce the frequency of re-hospitalization. A quantitative analysis of handwriting kinematics was used to evaluate effects of antipsychotic medication type and dose in schizophrenia patients. Twenty-seven schizophrenia patients treated with risperidone, six schizophrenia patients who received no antipsychotic medication and 47 healthy comparison participants were enrolled. Participants performed a 20-min handwriting task consisting of loops of various sizes and a sentence. Data were captured and analyzed using MovAlyzeR software. Results indicated that risperidone-treated participants exhibited significantly more dysfluent handwriting movements than either healthy or untreated SZ participants. Risperidone-treated participants exhibited lower movement velocities during production of simple loops compared to unmedicated patients. Handwriting dysfluency during sentence writing increased with dose. A 3-factor model consisting of kinematic variables derived from sentence writing accounted for 83% (r = .91) of the variability in medication dose. In contrast, we found no association between observer-based EPS severity ratings and medication dose. These findings support the importance of handwriting-based measures to monitor EPS in medicated schizophrenia patients.     

Noncompliance: Medical and Psychological Aspects

Patient noncompliance to oral medication regimens was assessed by interview in a sample of 109 private practice patients at two pharmacies in an outer western suburb of Sydney. Patients were classified into one of the five following groups on the basis of their stated degree of noncompliance to all medications taken (perfect compliance on all medications, occasional noncompliance on all medications, frequent noncompliance on all medications, occasional noncompliance on only some of the medications taken, and frequent noncompliance on only some of the medications taken). Selected medical/phnrmacological, doctor-patient relationship, attitudinal and personality variables were measured and univariate and multivariate analyses of the data undertaken. Contrary to expectations, the total number of medications reportedly taken rind complexity of the regimen were inversely related to noncompliance. Respondents reported satisfaction with the doctor's consultations, skepticism of doctors, attitudes to medication and scores on Rotter's (1966) Internal-External Locus of Control Scale (IEC) did not distinguish the compliant group from the four noncompliant groups combined. The most noteworthy finding concerned the marked ditlerences between the noncompliant groups, especially in relation to the patient's opinion of having to take the medication and the Personal Control scores of the IEC.     

Effects of Stimulant Medication Treatment on Mothers' and Children's Attributions for the Behavior of Children with Attention Deficit Hyperactivity Disorder

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and children's self-perceptions of these medication-related differences in attributions are discussed.     

Antipsychotic dose modulates behavioral and neural responses to feedback during reinforcement learning in schizophrenia

Schizophrenia is characterized by an abnormal dopamine system, and dopamine blockade is the primary mechanism of antipsychotic treatment. Consistent with the known role of dopamine in reward processing, prior research has demonstrated that patients with schizophrenia exhibit impairments in reward-based learning. However, it remains unknown how treatment with antipsychotic medication impacts the behavioral and neural signatures of reinforcement learning in schizophrenia. The goal of this study was to examine whether antipsychotic medication modulates behavioral and neural responses to prediction error coding during reinforcement learning. Patients with schizophrenia completed a reinforcement learning task while undergoing functional magnetic resonance imaging. The task consisted of two separate conditions in which participants accumulated monetary gain or avoided monetary loss. Behavioral results indicated that antipsychotic medication dose was associated with altered behavioral approaches to learning, such that patients taking higher doses of medication showed increased sensitivity to negative reinforcement. Higher doses of antipsychotic medication were also associated with higher learning rates (LRs), suggesting that medication enhanced sensitivity to trial-by-trial feedback. Neuroimaging data demonstrated that antipsychotic dose was related to differences in neural signatures of feedback prediction error during the loss condition. Specifically, patients taking higher doses of medication showed attenuated prediction error responses in the striatum and the medial prefrontal cortex. These findings indicate that antipsychotic medication treatment may influence motivational processes in patients with schizophrenia.     

The role of parent-adolescent concordance in compliance with cancer chemotherapy

In an attempt to examine factors affecting compliance with orally administered chemotherapy agents, we have examined the relation of agreement of parents and their adolescent children on various treatment-related issues and compliance with cancer chemotherapy. In a longitudinal study, 16 parent/cancer patient pairs were interviewed regarding their knowledge and understanding of illness, medications, and treatment, and their medication compliance. Adolescent responses matched closely those of parents on topics pertaining to medication dose, frequency, number, and purpose. Age was positively correlated with agreement for medication instructions. Disagreements were more commonly found in patients under 17 years of age. Compliance was greater when parents and patients agreed on who was responsible for medication administration, and on their understanding of medication instructions, number, and effectiveness. Treatment of the adolescent oncology patient should include consideration of psychosocial developmental factors, encourage parent-child communication, and place less reliance on self-administered therapy.     

Comparison of Two Subtests of the Bay Area Functional Performance Evaluation

This study compared different versions of two subtests of an existing occupational therapy evaluation, The Bay Area Functional Performance Evaluation. The two subtests examined were the shell sorting task and the house floor plan. Modifications in these subtests were made in order to make the testing medium more relevant to the patients. The subjects were twenty patients with a diagnosis of schizophrenia and twenty normal controls. The age range of the subjects was between 20 and 39 years. The patients with schizophrenia and th,e normal controls were randomly divided and half of each group were administered the original subtests and half were administered a modified version. For each subject a time and an accuracy score was obtained. It was hypothesized that patients with schizophrenia would score more poorly than normal controls on both versions of the tasks, but that difference between groups would be less on the modified version of the tests. Results indicated that the patients witlh schizophrenia performed significantly more poorly (lower accuracy scores and longer time) than the normal controls on both the original two subtests and the modified versions. There was no group by task interaction. These results contribute to the validity of the ex.isting evaluation.     

Use of Self-Report Measures of Anxiety and Depression in Outpatients with Schizophrenia: Reliability and Validity

The psychometrics of many self-report measures of anxiety and depression have been established for patients with anxiety disorders, but little is known about use of these measures in patients with psychotic disorders. This study examined psychometrics of commonly used self-report measures. Self-report measures and interviewer ratings were collected on 33 outpatients diagnosed with schizophrenia disorders. A sample of 46 patients with anxiety disorders completed the same self-report measures. Internal consistency was high for the self-report measures in both samples. Test-retest reliability was moderate to high. Scores on self-report measures were correlated with interviewer ratings and with scores on other self-report measures of similar constructs, supporting the convergent validity of the measures. Reliable and valid information about anxiety and depression can be obtained through administering the self-report measures to outpatients diagnosed with psychotic disorders. There was more overlap among measures than was expected, possibly because of poor discriminant validity. One explanation of this may be that anxiety constructs overlap more in patients with schizophrenia or related disorders than in non-psychotic populations.     

虚拟现实技术应用于神经心理评估的研究概述

传统神经心理评估的实验控制和生态效度的平衡问题日益受到研究人员的关注,而新兴的虚拟现实(Virtual Reality,VR)技术为问题的改善带来了希望,它不仅可以模拟现实环境并支持被试的直接交互,而且能对传统测试进行再现和扩展。它所形成的评估系统能对刺激的内容和表象、任务的复杂度和被试的响应进行灵活控制,所获取的信息更丰富、准确。在初步评估注意过程(注意、单侧空间忽略)、记忆(前瞻记忆、情景记忆、空间记忆、地形定向)和执行功能方面已获得了令人满意的效果。然而目前VR评估的应用仍存在技术和设备方面的不足,以及对评估者和被试不同操作要求的局限,因此今后除了要规范化现有VR评估系统,还应该进一步发展基础条件来推动系统的广泛应用。     

Validity of video-mediated recall procedures for mothers' emotion and child ratings.

The validity of video-mediated recall (VR) measures of mothers' experience of emotion and appraisals of their children's behavior was evaluated. While viewing videotapes of their immediately preceding interactions, 97 mothers used a dial to continuously rate their toddlers' behavior and then their own emotion. Mothers' appraisals, emotion, and autonomic responses measured as averages across each VR condition were associated with their autonomic responses and their children's misbehavior measured during the live interactions. Less correspondence was found when similar relations were assessed in 10-s intervals. Additional tests supported concurrent and discriminant validity of the averaged VR measures. Taken together, the results suggest acceptable construct validity, but that the timing of mothers' thoughts and feelings may differ between live interactions and VR.     

Psychosocial mediators of antiretroviral nonadherence in HIV-positive adults with substance use and mental health problems.

This study used data from 1,889 HIV-positive patients on antiretroviral (ARV) medications who participated in the HIV Cost and Services Utilization Study to investigate whether nonadherence to ARV medications among patients with mental health and substance use problems could be explained by difficulty getting and negative attitudes toward ARV medications, poor fit of the regimen with lifestyle, lack of instruction and cues for remembering the regimen from a health care provider, and poor support from others for taking ARV medications. Difficulty getting ARV medications and poor fit with lifestyle were significant mediators of nonadherence for patients with a probable psychiatric disorder. Difficulty getting medication was a mediator for heavy drinkers, and poor fit with lifestyle was a mediator for drug users who drank heavily. Further research is needed to identify and address the barriers to adherence in these populations.     

Relationship between hemispatial inattention and performance of activities of daily living in patients with schizophrenia

This study investigated the relation of hemispatial inattention to the performance of daily functions in 32 patients with schizophrenia or schizoaffective disorder and in 31 healthy controls. They were tested on the relationship between a target cancellation task and the Activities of Daily Living Rating Scale-II (ADLRS-II). According to the results of the hemispatial inattention test, the patients with schizophrenia made more omissions in the cancellation test than the controls. In addition, the results showed a significant correlation between number of omissions on the cancellation test and the ADLRS-II score in the study participants. A statistically significant relationship was observed between hemispatial inattention and the functional status of patients with schizophrenia, and suggests the need to incorporate measures of visual attention into psychiatric rehabilitation assessments.     

虚拟现实技术在心理学领域的应用与展望

虚拟现实(VR)技术因其能够提高实验研究的生态效度、条件控制水平、可重复性以及避免实地操作带来的危险,被众多研究者引入心理学领域。VR技术除了被用于改良实验程序外,也广泛应用于注意、记忆和执行能力等神经心理测验评估,在恐惧症、焦虑症、创伤后应激障碍和精神分裂症等精神障碍的临床治疗中亦取得丰硕成果。未来研究可致力于改进VR技术本身存在的问题、扩大样本量并扩展研究方法和范围,为VR应用提供更可靠的信效度证据。     

Sex Differences in Effectiveness of Extended-Release Stimulant Medication among Adolescents with Attention-Deficit/Hyperactivity Disorder

This study examined whether adolescent females with attention-deficit/hyperactivity disorder (ADHD) are differentially responsive than their male counterparts to extended-release stimulant medications. This investigation may bear special importance for an adolescent (as opposed to child) population, because hormonal and metabolism differences between sexes are most likely to emerge at this time. Male (n = 19) and female (n = 16) adolescents, ages 16–19 with ADHD, participated in a randomized, double-blind crossover study evaluating the effectiveness of osmotic-release methylphenidate, extended release amphetamine salts, placebo, and routine limited medication regimen. Medication efficacy was evaluated using ADHD symptom ratings from adolescent self-report and parent report, along with objective measures of inattention and hyperactivity/impulsivity during driving performance and neuropsychological tasks. Males and females were largely equivalent in impairment, and medication was similarly effective in reducing symptoms. No interactions were found between sex and medication on any measure of effectiveness or side effects. This finding suggests that the efficacy and tolerability of extended-release stimulant medications is equivalent for male and female adolescents with ADHD.     

Medication use and the assessment of agoraphobic avoidance

Many anxiety disorder patients who present for behaviour therapy are already taking anxiolytic medications. The present study added a new subscale to the Mobility Inventory labelled ‘Without Medication’ to assess possible reliance on medication for coping with phobic situations. 121 Patients with panic-related disorders were administered the scale. The results supported the reliability and validity of the existing Mobility Inventory subscales in general and of the new subscale in particular. It appears to reliably assess a clinically important domain that is not measured in traditional self-report measures of phobic avoidance.     

Drug treatment refusal,diagnosis, and length of hospitalization in involuntary psychiatric patients

A retrospective study of 664 involuntary psychotic inpatients who were discharged in a 27-month period indicated that 18% refused antipsychotic drug treatment. Statistical differences between refusers and consenters were found in diagnosis, length of hospitalization, and dosage of antipsychotic medications prescribed at the time of discharge. Compared with consenters, refusers were more often diagnosed as having bipolar or schizoaffective disorder while a majority of consenting patients were diagnosed as having schizophrenia. The variance in length of stay was explained by diagnosis alone. Refusers were receiving antipsychotic medication at discharge of one-half the average daily dosage of consenters. Both refusal status and diagnosis were found to contribute statistically to the variance in antipsychotic drug dosage.     

Cognitive control and consistency in compliance

Abstract

The purpose of this prospective study was two-fold. First, three modes of compliance assessment were used to examine whether renal dialysis patients comply consistently across medical regimens (fluid, potassium, phosphorous, protein) and whether compliance is consistent across mode of assessment (patient self assessment, medical staff ratings, physiological data). Second. a cognitive model predicting fluid compliance was tested to see if it would generalize to predict dietary compliance and medication taking. Patients' self-control perceptions of compliance, staff assessments of compliance, and physiological data were collected prospectively for 85 end-stage renal disease (ESRD) patients. Results indicated substantial consistency across medical regimen depending on the mode of assessment; staff assessment showed the most consistency, followed by patients' self-assessments and lastly by physiological data. Despite this consistency across medical regimens, the cognitive-control model only predicted fluid compliance; the model failed to explain dietary and medication compliance. Reasons and implications for these results are discussed.     

A Self-Management Program for Adolescents and Children with Renal Transplantation

This paper describes the development and implementation of a self-management program designed to address noncompliance in adolescents with renal transplants. Transplantation provides the best treatment alternative for End-Stage Renal Disease (ESRD), but is a procedure that subsequently demands recipients follow a life-long medication regimen. Nonadherance to medical therapy is a serious problem for adolescents; it is one of the most common causes of chronic graft rejection in this population. To improve compliance rates for this population, a self-management program was designed: (1) to provide social support; (2) to review information about medications and transplant management; and (3) to both teach and provide transplantation patients the opportunity to practice self-management skills. Details about the program, including recruitment issues and session content, are provided. Evaluations by participants indicated that the program was effective in creating a supportive environment for both patients and their parents, and in addressing health-related concerns.     

Social Support and Demographic Factors Influencing Compliance of Hemodialysis Patients1

The relationships between measures of social support, demographic and situational factors, and regimen compliance were examined among 60 in-center hemodialysis patients. Data were obtained from structured interviews, self-report questionnaires, and information from the medical records of each patient. Correlational analyses indicate that social support is significantly related to regimen compliance, as measured by potassium, phosphorus, and blood urea nitrogen (BUN). Contrary to prediction, this relationship disappears when the effects due to the demographic and situational factors are first removed from the regression equations. Age, gender, and length of time on dialysis are also significant predictors of compliance. These findings suggest     

Intra-individual reaction time variability in schizophrenia, depression and borderline personality disorder

Intra-individual reaction time variability (IIV) in neuropsychological task performance reflects short term fluctuations in performance. Increased IIV has been reported in patients with schizophrenia and could be related to a deficient neural timing mechanism, but the role of IIV in adult patients with other psychiatric disorders has not been established. Therefore, we compared IIV measures obtained in a Go/Nogo task from patients with schizophrenia, major depression and borderline personality disorder. IIV was increased for patients with schizophrenia. When correcting for differences in mean reaction time, depressive and borderline patients also showed increased IIV. Importantly, all groups showed a strong association between IIV and accuracy of task performance. This suggests that increased IIV might be a sensitive marker for the efficiency of top-down attentional control in all diagnostic groups. Aside from these similarities, the complete results including measures of IIV, mean reaction time and accuracy show differential patterns for patients with schizophrenia compared to those with borderline personality disorder or depression. These results are discussed with respect to common versus disorder-specific neural mechanisms underlying increased IIV.     

Mind wandering in schizophrenia: A thought-sampling study

Mind wandering has consistently been associated with impairments in cognition, emotion and daily performance. However, few experimental studies on mind wandering have been conducted in individuals with schizophrenia. The present study aimed to examine mind wandering in schizophrenia patients with a thought-sampling experiment embedded in a rapid go/no-go task and the relationship between the frequency of mind wandering and psychotic symptoms. Fifty-eight schizophrenia patients and 56 matched healthy controls were recruited and engaged in a task that assessed mind wandering. The results showed that schizophrenia patients (1.4%) reported less frequent mind wandering than healthy controls (5.8%). Moreover, there was no significant correlation between the frequency of mind wandering and psychotic symptoms in schizophrenia patients. Further studies in different stages of schizophrenia and in patients with more severe psychotic symptoms are needed to demonstrate a more comprehensive picture of mind wandering in schizophrenia.