Abstract
Background
Previous research suggests that bipolar disorder may be associated with increased risk-taking / impulsivity. Risky decision-making paradigm is an objective, performance-based ...measure which has been increasingly applied in bipolar disorder research examining. Nonetheless, literature focused only on chronically ill samples, with illness chronicity, clinical heterogeneity and prolonged medication exposure being potential confounding factors of study results. The current study aimed to explore whether patients with early-stage psychotic bipolar disorder (BDP) exhibit impaired risky decision-making relative to healthy controls, using a well-validated, widely-applied experimental paradigm of Balloon Analogue Risk Task (BART).
Methods
Thirty-nine patients with early-stage BDP (defined by having received psychiatric treatment for first-episode BDP within 3 years since service entry) and 36 demographically matched healthy controls were recruited. BART was administered to examine risky decision-making performance. Deliberative risky behavior was operationalized as the willingness to inflate balloons as each pump was accompanied by an extra point gained in the temporary repository or balloon explosion. Three performance-based indices (adjusted score, explosion rate and cumulative score) were derived and analyzed.
Results
There were no significant differences between patients and controls in age, gender and educational levels. Independent samples t-tests illustrated that patients had significantly lower adjusted score (t = -3.45, p = .001, d = .791), explosion rate (t = -2.75, p = .007, d = .631) and cumulative score (t = -3.07, p = .003, d = .714) in BART compared to controls. Similar findings were obtained when comparison analyses were restricted to patients who were treated with antipsychotic medications at the time of study assessment (n = 30). No significant correlations between BART performance-based indices and measures of clinical and treatment variables were found in patient sample.
Discussion
Our results demonstrated that early-stage BDP patients displayed suboptimal risky decision-making compared with controls. Abnormal risky decision-making observed in the euthymic state of patients in early stage of bipolar disorder suggests that such impairment might represent a trait factor in the disorder. Further prospective research is warranted to clarify the longitudinal course of risky decision-making impairment in bipolar disorder.
Abstract
Background
Negative symptoms are prevalent and predictive of clinical and functional outcomes across different phases of psychotic disorders. Yet, heterogeneity in conceptualizing the latent ...structure of negative symptoms presents hindrances to the development of effective interventions. While a 2-dimensional construct of negative symptoms (i.e., Motivation and pleasure MAP and Emotional expressivity EXP dimensions) have previously been derived from exploratory factor analyses and adopted widely in research, conflicting findings in favor of a 5-factor structure have emerged from confirmatory factor analyses recently. Further evidence is needed to evaluate whether this conclusion can be generalized to the prodromal and early phases of psychosis.
Methods
Data were drawn from 3 studies that administered the Brief Negative Symptom Scale (BNSS), a second-generation clinical rating instrument, to assess negative symptoms in Chinese patients with early psychosis or clinical high-risk for psychosis (CHR) in Hong Kong. The early psychosis sample comprised 131 and 246 outpatients recruited in 2 separate studies who received treatment within 5 years since service entry for first-episode psychosis, whereas the CHR sample included 110 help-seeking individuals ascertained using CAARMS criteria. Confirmatory factor analyses (CFAs) were employed to examine competing hypotheses about the factor structure of negative symptoms as measured by BNSS. The fit of five competing models were evaluated, including 1) a unifactorial model, 2) a 2-factor model with EXP and MAP factors, 3) a 3-factor model proposed by Garcia-Portilla et al. (anhedonia and asociality, avolition and blunted affect, and alogia), 4) a 5-factor model specifying the five NIMH consensus development conference domains (blunted affect, alogia, anhedonia, avolition, asociality), and 5) a hierarchical model with two second order-factors reflecting EXP and MAP, and five first-order factors reflecting the five consensus domains.
Results
In the early psychosis sample, the 1-, 2-, and 3-factor models provided poor fit for the data. The 5-factor and hierarchical models were excellent fit, with the hierarchical model being slightly more parsimonious. Similarly, CFA of the CHR sample demonstrated that the 1-, 2-, and 3-factor models were poor fit for the BNSS, whereas the 5-factor and hierarchical models provided strong fit. The 5-factor model is slightly favored over the hierarchical model in the CHR sample.
Discussion
Similar to results obtained from chronic schizophrenia patients in previous CFA studies, the current findings suggest that the 5 consensus domains are fundamental to the conceptualization of negative symptoms in the prodromal and early phases of psychosis. The current practice of conceptualizing negative symptoms as a two-dimensional construct may preclude information that reflects the narrower facets of idiosyncratic symptom profiles and facilitates functional recovery.
Abstract
Background
Abnormal reward sensitivity is a biosignature to mood disorders spectrum. Recent data suggested either elevated or preserved positive but impaired negative reinforcement learning ...in patients with bipolar disorder. Functional MRI studies provided extra evidence on heightened reward sensitivity in manic patients. Of note, these investigations mostly rest on chronically ill samples, conditions of whom may have been confounded by prolonged exposure to medications. This study aims to examine reinforcement learning performance and its relationship with symptomology in patients with early-stage psychotic bipolar disorder (BDP).
Methods
This study is based on 38 patients with early-stage BDP (defined by having received psychiatric treatment for first-episode BDP within 3 years since service entry) who have been euthymic for at least eight weeks and 40 demographically-matched controls. Reinforcement learning performance was evaluated using Gain-vs-Loss-Avoidance Task (GLAT), which measured the correct responses in both gain and loss-avoidance pairs with reinforcement probability at either 90% or 80% across four blocks in the training phase and one block in the test/transfer phase. Comparison analyses on reinforcement learning performance were conducted on two groups. Associations of reinforcement learning measures with symptom scores, cognitive functions and functioning measures were also tested.
Results
There was no group difference in gender, age or education level. Repeated-measures analysis of variance (ANOVA) showed significant main effects of group (F=6.52, p=0.013), block (F=43.71, p<0.001), probability (F= 5.58, p<0.001), and block x group (F=2.87, p=0.040) interaction. Post-hoc tests revealed that controls performed better than patients across blocks (p<0.05). Patients also showed a lower lose-shift rate (t= 2.21, p=0.03) and punishment-driven learning accuracy rates (t=2.42, p=0.018) than controls. Marginally significant main effect of stimulus pair (F=3.98, p=0.05) was revealed in the test phase, with controls showing a significantly higher preference in Frequent Winner vs Frequent Loser (FWFL) pair than patients (t=-2.25, p=0.028). No significant correlations between learning measures and any of the symptom dimensions in patient sample.
Discussion
Our preliminary findings provided a brief evidence on the negative reinforcement learning impairment in early-stage BDP patients. Further investigation is required to verify and confirm our results of impaired negative reinforcement learning in the initial course of bipolar disorder.
Abstract
Background
Subjective quality of life (SQoL) is an important outcome domain in patients with early psychosis. In an attempt to better understand and maximize SQoL of early psychosis ...patients, an increasing number of research has been conducted to investigate factors associated with SQoL. Nonetheless, most previous studies focused on younger patients with early psychosis. In this study, the correlates of SQoL in adult patients who had completed 3-year specialized early intervention service for first-episode psychosis (FEP) in Hong Kong were investigated.
Methods
In total, one hundred and one Chinese patients aged 26–55 years who completed 3-year specialized early intervention service for psychosis in Hong Kong were recruited. Assessments on illness onset (DUP), clinical (PANSS, BNSS, SUMD), intrinsic motivation (by items in Quality of Life Scale, QLS), functional (SOFAS), antipsychotic-induced parkinsonism features (Simpson-Angus Scale, SAS) were conducted. SQoL was evaluated by Chinese version SF-12 which consist of physical and mental components for analysis.
Results
Correlation analyses showed that SF12 physical health score was correlated with PANSS depression component (p<0.001), QLS intrinsic motivation score (p=0.001) and SAS score (p<0.05) while SF12 mental health score was correlated with PANSS depression score (p<0.001), QLS intrinsic motivation score (p<0.05) and SAS score (p<0.05). Multiple linear regression analyses further revealed that lower PANSS depression score (p<0.001) and higher intrinsic motivation (measured by QLS, p<0.05) were independently associated with better physical SQoL, while lower PANSS depression score (p<0.001) and lower SAS side-effect score (p<0.05) were independently related to better mental SQoL.
Discussion
Our results are consistent with the literature which indicates that SQoL is significantly related to depressive symptoms. In addition, patients with higher intrinsic motivation and less antipsychotic-induced extrapyramidal side-effect have better SQoL. Further analysis on the longitudinal data will clarify variables predictive of SQoL at follow-up.
We adapted/developed and examined the test–retest reliability and internal consistency of eight parent-report measures of home and neighborhood environmental correlates of physical activity ...appropriate for Chinese preschool-aged children and their parents/primary caregivers living in densely populated urban environments. This study consisted of a qualitative (cognitive interviews) and a quantitative (test–retest reliability) component. Chinese versions of the measures were pilot-tested on 20 parents of Hong Kong preschool-aged children using cognitive interviews. Measures were then administered to 61 parents twice, 1 week apart. Test–retest reliability and internal consistency were computed. Except for two items, the test–retest reliability of items and scale summary scores ranged from moderate to excellent. The internal consistency of the measures exceeded recommended minimal values (Cronbach’s α > .70). The parent-report measures examined in this study are potentially appropriate for use in investigations of environmental correlates of the physical activity of Chinese preschool-aged children living in densely populated urban environments. However, their predictive validity with respect to Chinese preschool-aged children’s physical activity needs to be assessed in future studies.
We adapted/developed and examined the test–retest reliability and internal consistency of eight parent-report measures of home and neighborhood environmental correlates of physical activity ...appropriate for Chinese preschool-aged children and their parents/primary caregivers living in densely populated urban environments. This study consisted of a qualitative (cognitive interviews) and a quantitative (test–retest reliability) component. Chinese versions of the measures were pilot-tested on 20 parents of Hong Kong preschool-aged children using cognitive interviews. Measures were then administered to 61 parents twice, 1 week apart. Test–retest reliability and internal consistency were computed. Except for two items, the test–retest reliability of items and scale summary scores ranged from moderate to excellent. The internal consistency of the measures exceeded recommended minimal values (Cronbach’s α > .70). The parent-report measures examined in this study are potentially appropriate for use in investigations of environmental correlates of the physical activity of Chinese preschool-aged children living in densely populated urban environments. However, their predictive validity with respect to Chinese preschool-aged children’s physical activity needs to be assessed in future studies.
Abstract
The underpinnings of language deviations in psychotic symptoms (eg, formal thought disorder, delusions) remain unclear. We examined whether the semantic networks underlying word associations ...are useful predictors of clinical outcomes in psychosis. Fifty-one patients with schizophrenia and other psychotic disorders and 51 matched healthy controls generated words in a Cantonese continued word association task. Patterns of word associations were examined using semantic similarity metrics derived from word embeddings (fastText) and the structure of individual semantic networks. A longitudinal design—baseline and 6 months later—enabled investigation of the relationship of changes in semantic associations in patients who were in an acute psychotic state at baseline compared to clinical stabilization 6 months later. The semantic similarity measure increased over time in patients, while it remained stable in controls. Moreover, the change in semantic similarity over time correlated with the changes in patients’ formal thought disorder symptoms. There were differences in individual semantic networks between the groups at both time points. Patients had less structured networks on average, as evidenced by a smaller network diameter and clustering coefficient, and smaller average shortest path lengths. The identification of several state-like semantic measures that change over time with patients’ mental states allows for nuanced comparison with clinical measures. Semantic measures are complex. Semantic similarity was a state-like measure that changed over time with mental state in psychotic disorders, whereas individual semantic network parameters were trait-like and stable over time.
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