Optimizing treatment of schizophrenia. Enhancing affective/cognitive and depressive functioning

Recognition and treatment of schizophrenia has largely focused on positive symptoms of the disorder, such as delusions, hallucinations, and disorganization. However, other important symptoms, such as depression, cognition, and social functioning, have not received comparable attention. Fifty percent of schizophrenic patients suffer from comorbid depression, which is a major risk factor for suicide in this population, while 10% to 25% suffer from comorbid obsessive-compulsive disorder. Cognitive deficits commonly observed in patients with schizophrenia include problems with concentration, attention, and memory, as well as problem-solving and verbal skills. These deficits are observed at early stages of the illness and can predict deficits in functional capabilities, such as occupational and social skills, educational attainment, and the ability to live independently. The severity of such impairments affects all patient in this population, including up to 10% of patients working full time and up to one third of those working part time. In light of the debilitating effects of depression, cognitive impairment, and other aspects of affective functioning on the quality of life of patients with schizophrenia, physicians need to partner with their patients to address these concerns and determine an appropriate treatment regimen. This can be done with simple functional-based cognitive questioning, the use of evidence-based psychosocial practices, and psychoeducation on the many pharmacotherapeutic options. It is recommended that depressive or suicidal symptoms of schizophrenia be treated with an antidepressant or mood stabilizer only if the symptoms have not subsided after treatment of the psychosis with an atypical antipsychotic. Additionally, relative to older medications, atypicals have demonstrated benefit in improving some of the cognitive impairments.     

Laws and their instances

Philosophical Studies - I present an argument for the view that laws ground their instances. I then outline two important consequences that follow if we accept the conclusion of this argument....     

Complexities in Adjustment Patterns among the “Best and the Brightest”: Risk and Resilience in the Context of High Achieving Schools

Youth in high achieving schools (HAS) are at elevated risk for serious adjustment problems—including internalizing and externalizing symptoms and substance use—given unrelenting pressures to be “the best.” For resilience researchers, successful risk evasion in these high-pressure settings should, arguably, be defined in terms of the absence of serious symptoms plus behaviorally manifested integrity and altruism. Future interventions should target that which is the fundamental basis of resilience: Dependable, supportive relationships in everyday settings. These must be promoted between adults and children and among them, toward enhancing positive development among youth and families in these high stress environments.     

Against Radical Quantum Ontologies

Some theories of quantum mechanical phenomena endorse wave function realism, according to which the physical space we inhabit is very different from the physical space we appear to inhabit. In this paper I explore an argument against wave function realism that appeals to a type of simplicity that, although often overlooked, plays a crucial role in scientific theory choice. The type of simplicity in question is simplicity of fit between the way a theory says the world is and the way the world appears to be. This argument can be understood as one way of spelling out the so‐called “incredulous stare objection” that is sometimes leveled against surprising metaphysical theories.     

Characteristics of Repetitive Thought Associated with Borderline Personality Features: A Multimodal Investigation of Ruminative Content and Style

Increased ruminative style of thought has been well documented in borderline personality disorder (BPD); however, less is known about how the content of rumination relates to domains of BPD features. Relationships between forms of rumination and BPD features were examined in an undergraduate sample with a wide range of BPD features. Participants completed self-report measures of rumination and a free-writing task about their repetitive thought. Rumination on specific themes, including anger rumination, depressive brooding, rumination on interpersonal situations, anxious rumination, and stress-reactive rumination were significantly associated with most BPD features after controlling for general rumination. Coded writing samples suggested that BPD features are associated with repetitive thought that is negative in valence, difficult to control, prolonged, unhelpful, and unresolved. Although rumination is often described as a form of self-focused attention, BPD relationship difficulties were correlated with greater other-focus in the writing samples, which may reflect more interpersonal themes. Across both self-reports and the writing task, the BPD feature of self-destructive behavior was associated specifically with anger and hostility, suggesting this content may play a particularly important role in fueling impulsive behavior. These findings suggest that both the style and the content of repetitive thought may play a role in BPD features.     

The Psychosocial Impact of Undergoing Prophylactic Total Gastrectomy (PTG) to Manage the Risk of Hereditary Diffuse Gastric Cancer (HDGC)

Individuals identified as at high risk of developing Hereditary Diffuse Gastric Cancer (HDGC) are advised to undergo prophylactic surgery - have their stomach removed - in their early twenties. Research with (older) cancer patients who undergo gastrectomy for curative reasons suggests that gastric resection has a number of physical and psychosocial sequelae. Because it is difficult to extrapolate the findings of studies of older cancer patients to younger healthy patients who are considering prophylactic total gastrectomy (PTG), the aim of this qualitative interview study was to determine the psychosocial implications of undergoing prophylactic surgery to manage genetic risk. Fourteen men and 13 women from the UK’s Familial Gastric Cancer study who had undergone PTG were invited to participate in qualitative interviews. Most reported that undergoing surgery and convalescence was easier than anticipated. There was evidence that age affected experiences of PTG, with younger patients tending to report faster recovery times and more transient aftereffects. All saw the benefits of risk reduction as outweighing the costs of surgery. Surgery was described as having a range of physical impacts (disrupted appetite, weight loss, fatigue, GI symptoms) that had related psychological, social and economic implications. Those considering PTG need to be aware that its impact on quality of life is difficult to predict and negative sequelae may be ongoing for some individuals.     

Maternal insightfulness and preschoolers' emotion and behavior problems: Reciprocal influences in a therapeutic preschool program

Mothers' insightfulness, which involves understanding the motives underlying the child's behavior in a complete, open, and accepting way, was examined both at the beginning and at the end of a therapeutic preschool program for preschoolers using the Insightfulness Assessment (Oppenheim & Koren‐Karie, 2002). The goal of the study was to examine the links between improvement in mothers' insightfulness and reduction in children's behavior problems. Thirty‐two children referred to a therapeutic preschool program for a range of behavioral and emotional problems and their mothers participated in the study. Results showed that mothers who shifted from noninsightfulness before treatment to insightfulness after treatment had children whose behavior problems decreased whereas mothers who did not make such gains had children whose behavior problems increased. The social skills of all children improved during treatment. The possible mechanisms linking the gains of mothers and children are discussed within the framework of attachment theory.     

Structure and measurement of depression in youths: applying item response theory to clinical data

Our goals in this article were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3,403 children and adolescents from 12 contributing clinical and nonclinical samples; all participants had received the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Aged Children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Furthermore, use of IRT-based information about symptom severity and discriminability in the measurement of depression severity was shown to reduce measurement error and increase measurement fidelity.     

Non-verbal number acuity correlates with symbolic mathematics achievement: but only in children

The process by which adults develop competence in symbolic mathematics tasks is poorly understood. Nonhuman animals, human infants, and human adults all form nonverbal representations of the approximate numerosity of arrays of dots and are capable of using these representations to perform basic mathematical operations. Several researchers have speculated that individual differences in the acuity of such nonverbal number representations provide the basis for individual differences in symbolic mathematical competence. Specifically, prior research has found that 14-year-old children’s ability to rapidly compare the numerosities of two sets of colored dots is correlated with their mathematics achievements at ages 5–11. In the present study, we demonstrated that although when measured concurrently the same relationship holds in children, it does not hold in adults. We conclude that the association between nonverbal number acuity and mathematics achievement changes with age and that nonverbal number representations do not hold the key to explaining the wide variety of mathematical performance levels in adults.