Abstract Background Persistent cognitive dysfunction in unipolar depression (UD) contributes to socio-occupational impairment, but there are no feasible methods to screen for and monitor cognitive ...dysfunction in this patient group. The present study investigated the validity of two new instruments to screen for cognitive dysfunction in UD, and their associations with socio-occupational capacity. Method Participants ( n =53) with UD in partial or full remission and healthy control persons ( n =103) were assessed with two new screening instruments, the Danish translations of the Screen for Cognitive Impairment in Psychiatry (SCIP-D) and Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and with established neuropsychological and self-assessment measures. Depression symptoms and socio-occupational function were rated with the Hamilton Depression Rating Scale and Functional Assessment Short Test respectively. Results The SCIP-D and COBRA were valid for detection of objective and subjective cognitive impairment, respectively. The three parallel SCIP-D forms were equivalent. A combined SCIP-D-COBRA measure showed high sensitivity and good specificity for objective cognitive impairment (91% and 70%, respectively). There was no correlation between subjective and objective measures of cognition. Subjective cognitive difficulties correlated more with socio-occupational impairment ( r =0.7, p <0.01) than did objective cognitive difficulties, for which there was a weak correlation with the executive skills domain only ( r =−0.3, p =0.05). Limitations A modest sample size. Conclusions The SCIP-D and COBRA are valid measures of objective and subjective cognitive impairment, respectively, and should ideally be implemented together in the screening for cognitive dysfunction in UD.
Many patients with work-related stress display cognitive impairment that may hamper recovery. We examined objective and subjective tools for screening of cognitive impairment in this patient group.
...Patients were assessed with Danish versions of the objective Screen for Cognitive Impairment in Psychiatry (SCIP-D), standardized neuropsychological tests that tapped into the same cognitive domains, the self-assessed Cognitive Failure Questionnaire (CFQ), and several additional scales of symptom severity and psychosocial status. Concurrent validity of the SCIP-D and CFQ was assessed by calculation of Pearson's correlation coefficients between the objective and subjective tools and the scores on more conventional standardized neuropsychological tests. Decision validity was assessed with logistic receiver-operating-characteristic analyses using a cut-score approach to the objective and the subjective test results to predict impairment detected by the standardized tests. Cognitive norms were established through the data of 79 healthy controls. SCIP-D scores were compared between patients and healthy controls with independent t-tests.
We included 82 patients with work-related stress. The SCIP-D total scores were strongly associated with standardized neuropsychological tests (r=0.76, P<0.001). The self-assessed CFQ was not associated with either measure of objective cognitive functioning (r≤0.12, P≥0.30). The optimal SCIP-D total-score cut of ≤72 identified 43.2% of the patients with global objective cognitive impairment. The patients performed mildly-to.moderately lower than the healthy controls on the SCIP-D total score (Cohen's d=0.39) and the subtests for working memory (d=0.39) and processing speed (d=0.61).
The SCIP-D is a valid screening tool sensitive to objective performance-based cognitive impairment among patients with work-related stress.
Cognitive impairment is a core feature of schizophrenia and a major impediment to social and vocational rehabilitation. A number of studies have claimed cognitive benefits from treatment with various ...atypical antipsychotic drugs (APDs). The currently available evidence supporting cognitive improvement with atypical APDs was evaluated in two meta-analyses. Studies that (1) prospectively examined cognitive change to the atypical APDs clozapine, olanzapine, quetiapine, and risperidone, (2) included a commonly used neuropsychological test, and (3) provided data from which relevant effect sizes could be calculated, were included. Forty-one studies met these criteria. Neuropsychological test data from each study were combined into a Global Cognitive Index and nine cognitive domain scores. Two meta-analyses were carried out. The first included 14 controlled, random assignment trials that assigned subjects to an atypical APD and a typical APD control arm. The second analysis included all prospective investigations of atypical treatment and the within-group change score divided by its standard deviation served as an estimate of effect size (ES). The first analysis revealed that atypicals are superior to typicals at improving overall cognitive function (ES=0.24). Specific improvements were observed in the learning and processing speed domains. The second analysis extended the improvements to a broader range of cognitive domains (ES range=0.17–0.46) and identified significant differences between treatments in attention and verbal fluency. Moderator variables such as study blind and random assignment influence results of cognitive change to atypical APDs. Atypical antipsychotics produce a mild remediation of cognitive deficits in schizophrenia, and specific atypicals have differential effects within certain cognitive domains.
Abstract Introduction Cognitive impairment is common in bipolar disorder and contributes to socio-occupational difficulties. The objective was to validate and evaluate instruments to screen for and ...monitor cognitive impairments, and improve the understanding of the association between cognitive measures and socio-occupational capacity. Methods Patients with bipolar disorder in partial or full remission ( n =84) and healthy controls ( n =68) were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP), Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA), and established neuropsychological tests and subjective rating scales. Socio-occupational function and affective symptoms were evaluated with the Functional Assessment Short Test, and the Hamilton Depression Rating Scale 17-items and Young Mania Rating Scale, respectively. Concurrent validity of the SCIP and COBRA were assessed by correlation with established objective and subjective cognitive measures, and decision validity was determined with Receiver–Operating–Characteristic analyses. Correlations and linear regression analyses were conducted to determine the associations between objective and subjective cognitive impairment, and socio-occupational difficulties. Results The SCIP and COBRA correlated strongly with established objective and subjective cognitive measures, respectively. The SCIP yielded higher sensitivity and specificity for detection of cognitive dysfunction than the COBRA or a combined SCIP–COBRA measure. Correlations between objective and subjective cognitive impairment were weak but both were associated with socio-occupational difficulties. Limitations Influence of ageing was not investigated. Conclusions The SCIP and COBRA are valid for detection of objective and subjective cognitive impairment in bipolar disorder. Screening for cognitive dysfunction should be conducted with an objective measure like the SCIP.
Objective: Although there is a consensus that cannabis intoxication will have deleterious effects on a wide spectrum of cognitive skills, there is no consensus regarding the duration of time from ...last use necessary to ameliorate these effects. Method: A systematic review and series of meta-analyses were undertaken to assess anticipated gains in verbal learning with longer periods of cannabis abstinence. Studies assessing verbal learning performance in abstinent regular cannabis users and nonusing control participants; studies reporting length of cannabis abstinence at the time of neuropsychological assessment; and studies implementing one of three highly comparable measures of verbal learning and memory were included in the analyses. The included tasks have demonstrated some of the most robust declines associated with cannabis use and are prevalent in the clinical practice of neuropsychology. We assessed associations between cannabis abstinence and verbal learning scores via mixed effects subgroup analyses. Results: Twenty-three studies (k = 28; N = 1,711) met all inclusion criteria. Cannabis users abstinent for 7 days or fewer performed worse than controls on verbal learning tasks, whereas cannabis users abstinent for longer periods showed no average significant difference in verbal learning performance compared with controls. Conclusions: Based on available evidence, some amelioration of verbal learning limitations presumed to result from cannabis appear to resolve between 7 and 28 days of sustained abstinence. However, in the reviewed studies, years of regular use were inversely related to longer periods of abstinence and verbal learning performance, undermining a confident inference that abstinence alone has direct benefits to verbal learning and memory.
General Scientific Summary
Prior investigations have reported lasting, nonacute neuropsychological deficits associated with regular cannabis that may be ameliorated with sustained abstinence. This meta-analysis sought to more precisely quantify the period of abstinence needed for cannabis-users' verbal memory deficits to dissipate relative to nonusing control participants. Regular cannabis users demonstrated reliable verbal memory deficits within the first 7 days of abstinence, whereas cannabis users abstinent for more than 7 days performed as well as nonusing controls. However, participants with longer abstinence periods were also more likely to have used cannabis regularly for fewer years, undermining a confident inference that abstinence alone has direct benefits to verbal learning and memory.
Cognitive dysfunction has been reported in acute psychiatric patients for a long time. The detection of cognitive deficits is crucial both for clinical treatment and for predicting the psychosocial ...functional level in the further course of the disease. The SCIP is a well-evaluated screening instrument for the examination of cognitive performance in psychiatric patients. We recently integrated the SCIP into our routine admission and discharge assessments on two inpatient wards, and we examined the cognitive profiles of patients with psychotic and affective disorders over the course of their admission.
Shortly after admission, and prior to discharge, patients were routinely referred for examination with the SCIP. A total of 529 assessments were completed on admission, and 227 returned for SCIP at the time of discharge. After standardization of the test results against a normative sample, we examined the normalized test values in terms of percentages of pathological cognitive performance based on the total SCIP score, and each of the SCIP subscale scores. We conducted cluster analysis to identify cognitive subgroups within the clinical sample.
More than 70% of the SCIP results on admission were pathological. At discharge, improvements were observed, especially on tests with attention and speed components. Cluster analysis identified two groups. The cluster with chronic patients showed poorer results at admission, but greater improvement and reached the level of the others at discharge.
The SCIP appears to have value in routine diagnostic assessments, and in the quantification of improvements in cognitive performance during an inpatient stay. The greatest benefit was observed in chronically ill patients with many previous stays.
DRKS00019825 (retrospectively registered on 03.12.2019).
The International Society for Bipolar Disorders Targeting Cognition Task Force recommends screening for and monitoring of cognitive impairments in patients with bipolar disorder (BD) with the Screen ...for Cognitive Impairment in Psychiatry (SCIP). The study aimed to provide the first demographically adjusted norms and change norms for the SCIP and to compare the cognitive trajectory over one year in remitted BD patients with normative cognitive change.
Patients with fully or partially remitted BD and healthy controls (HC) were assessed with the SCIP at baseline and at a one-year follow-up. Regression-based models were used to determine demographically adjusted norms and change norms. Using the change models, predicted follow-up scores were calculated for BD and HC, and independent t-tests were used to compare deviations of the observed from the predicted follow-up scores for BD vs. HC to assess differences in cognitive trajectories.
Baseline data were collected for n=273 HC and n=218 BD, and follow-up data for n=139 HC and n=74 BD. Baseline norm models included age, sex and years of education, while change models included baseline SCIP scores and age. Patients with follow-up data showed selective impairments within verbal learning and recall at baseline. They followed the normative cognitive trajectories for all cognitive domains but verbal learning.
Cognition was assessed with a screening tool.
We recommend implementing demographically adjusted norms and change norms for the SCIP in clinical and research settings. Change norms seem sensitive to subtle and selective cognitive decline over one year in remitted BD.
Promising preliminary evidence suggests that EMDR may reduce suicidal ideation (SI) when used to treat Major Depressive Disorder, Posttraumatic Stress Disorder, and trauma symptoms in the context of ...acute mental health crises. EMDR has never been tested specifically for treating SI, and there is a lack of data regarding the safety and effectiveness of web-based, therapist-delivered EMDR in populations with known SI. The primary objective of this study was to investigate the impact of web-based, therapist-delivered EMDR, targeting experiences associated with suicidal thinking. Secondary objectives included examining the effect of EMDR treatment on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation, as well as safety and attrition.
This randomized control trial (ClinicalTrials.gov ID number: NCT04181047) assigned adult outpatients reporting SI to either a web-based EMDR intervention or a treatment as usual (TAU) group. TAU included primary and mental health services available within the Canadian public health system. Participants in the EMDR group received up to 12 web-based EMDR desensitization sessions, delivered twice weekly during the COVID-19 pandemic (2021-2023). The Health Research Ethics Board at the University of Alberta approved the protocol prior to initiation of data collection for this study (protocol ID number: Pro00090989).
Forty-two adult outpatients received either EMDR (n=20) or TAU (n=22). Participants reported a high prevalence of early onset and chronic SI, and there was a high rate of psychiatric comorbidity. In the EMDR group, median SI, depression, anxiety, and posttraumatic symptom scale scores decreased from baseline to the four month follow-up. In the TAU group, only the median SI and posttraumatic symptom scale scores decreased from baseline to four month follow up. Although sample size precludes direct comparison, there were numerically fewer adverse events and fewer dropouts in the EMDR group relative to the TAU group.
Study results provide promising preliminary evidence that web-based EMDR may be a viable delivery approach to address SI. In this complex population, a short treatment course was associated with reductions of SI and other symptoms across multiple diagnostic categories. Further investigation is warranted to verify and extend these results.
https://clinicaltrials.gov/study/NCT04181047?id=NCT04181047&rank=1, identifier NCT04181047.
The Screen for Cognitive Impairment in Psychiatry (SCIP) is a brief scale designed for detecting cognitive deficits in patients with psychiatric disorders including schizophrenia. In this preliminary ...study the psychometric properties of the German version of the SCIP are examined in a sample of patients with schizophrenia and schizoaffective psychosis (DSM-IV) as well as in healthy controls.
Thirty patients and thirty matched controls were asked to complete two versions of the SCIP separated by two-week intervals in addition to psychiatric and neurocognitive instruments including assessments to measure psychosocial functioning. Feasibility, reliability and validity of the SCIP were examined in order to determine parallel reliability. The convergent validity was assessed by the BACS (Brief Assessment of Cognition in Schizophrenia) and the MMSE (Mini-Mental-State-Examination).
Significant differences in cognitive performance between patients and healthy controls were detected in both versions of the SCIP. The SCIP effectively discriminated between patients and the control sample. The reliability of the parallel versions of the SCIP was supported by high correlations between the alternate forms, and by the high internal consistency of SCIP subtests within the patient sample. Construct validity of the SCIP was supported by high correlations between the SCIP and the BACS total scores, and by high correlations with common cognitive domain scores from the two tests.
Our data show that the German version of the SCIP (SCIP-G) is a brief, valid and reliable assessment tool for the detection of cognitive impairment in patients with schizophrenia or schizoaffective psychosis.
•Treatment outcome trajectories are not understood for emerging adult inpatients.•LCGA analysis of symptom change trajectories found four patient groups.•Groups theoretically correspond to ...responders, treatment seekers and rejecters.•Groups differed on demographics, diagnoses, and service utilization patterns.•Results have implications for developing stepped-care models for inpatient care.
Early intervention for emerging adults with addiction and mental health disorders is beneficial for long-term recovery. The present study investigated the utility of routine outcome monitoring during acute inpatient hospitalization for identifying emerging adults at risk of poor outcomes. This is a retrospective study using latent class growth analysis (LCGA) to identify patient groups with different recovery trajectories, with additional analyses to clarify the characteristics of these trajectory groups. The results identified four patient groups: Rapid responders (38%), gradual responders (34%), high distress non-responders (9%), and low distress non-responders (19%). The high distress non-responding group is characterized by behaviours and disorders associated with ambivalent care seeking: Voluntary admission, longer length of stay, lower service satisfaction, higher outpatient service utilization, elevated risk of emergency department presentation and hospital readmission, and depression/personality disorder diagnosis. The low distress group is characterized by behaviours and disorders associated with treatment rejection: Involuntary admission, shorter length of stay, reduced post-discharge service utilization, and psychotic disorder diagnosis. The results have implications for identifying at-risk youth and developing stepped-care models for more effective and efficient inpatient care.
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