INTRODUCTION:Catatonia is a neuropsychiatric syndrome associated with cognitive impairments, yet the neurocognitive performance of catatonia relative to other psychiatric disorders is poorly understood. This study characterised neurocognitive profiles in patients with a history of catatonia compared to schizophrenia spectrum (SSD), bipolar disorder (BD), and major depressive disorder (MDD) across a comprehensive battery of neuropsychological tests. METHODS:Sixty-seven adults who underwent neuropsychological assessment were classified into catatonia (n = 10), SSD (n = 23), BD (n = 19), and MDD (n = 15) groups. Composite z-scores were generated across six domains: language, visuospatial skills, memory, attention, processing speed, and executive functioning. RESULTS:Global neurocognitive functioning was similar, and approximated population norms, in BD and MDD, but significantly lower in catatonia (z = -1.63) and SSD (z = -1.14) groups. Significant differences emerged in overall neurocognitive scores (ηp2 = .47) and memory, attention, processing speed, executive functioning (ηp² = 0.30-0.41), but not language. Post hoc tests showed MDD and BD outperformed SSD and catatonia groups, with no differences within these pairs. Neurobehavioural examinations distinguished catatonia from SSD by increased affective blunting, withdrawal, psychomotor slowing, and slow mentation. CONCLUSIONS:Catatonia is associated with substantial neurocognitive impairment, most similar to SSD, but with distinct neurobehavioural features. Routine screening and targeted neurocognitive assessment may enhance diagnosis and understanding of catatonia.
Introduction: A vast body of cognitive research in psychosis has focused on auditory hallucinations, though more recent studies are turning towards other sensory modalities. This study aimed to compare the cognitive profile of persons experiencing uni- or multisensory versus multimodal hallucinations. Methods: Participants with primary diagnosis of a psychotic disorder were subdivided into those experiencing uni- or multisensory (UMS; n = 31) versus multimodal (MM; n = 28) hallucinations relative to non-clinical controls (NC; n = 32). Cognitive assessment comprised the MATRICS Consensus Cognitive Battery, supplemented by a Colour Word Interference Test. Analyses of variance (ANOVAs) and correlation analyses were performed. Results: The UMS and MM groups performed significantly worse than the NC group on some cognitive domains (i.e. speed of processing, attention/vigilance, working memory, verbal learning), but not others (i.e. reasoning and problem-solving, social cognition). For visual learning, the MM group performed significantly worse than the NC group only, whereas for inhibition, the UMS group performed significantly worse than the NC group only. Conclusion: A novel cognitive profile associated with multimodal hallucinations was documented. Dissociation between performance of the two clinical groups on visual learning and inhibition suggests these cognitive domains may be of relevance to hallucinations, pending further investigations.
Objective: This cross-sectional study aimed to evaluate the direct and indirect associations between psychological pain, decision-making and suicidality in patients with schizophrenia, with particular emphasis on lifetime suicide attempt history and current suicidal ideation severity. Methods: One hundred outpatients with schizophrenia (50 with and 50 without lifetime suicide attempt history) were assessed using the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Beck Suicide Ideation and Hopelessness Scales, Psychological Pain Scale, Iowa Gambling Task (IGT), Wisconsin Card Sorting Test, and Stroop Test. Multivariable logistic regression was used for lifetime suicide attempt history, and PROCESS Model 4 was used to test the indirect effect of IGT on suicidal ideation. Results: Higher psychological pain (OR = 1.075, 95% CI [1.026-1.127], p = 0.041), a greater number of lifetime psychiatric hospitalisations (OR = 1.300, 95%CI [1.065-1.586], p = 0.010), and lower IGT total score (OR = 0.932, 95%CI [0.887-0.979], p = 0.005) were independently associated with lifetime suicide attempt history. IGT also showed a significant indirect effect in the association between psychological pain and suicidal ideation (effect = 0.031, 95%CI [0.011-0.062]). Conclusion: Psychological pain and poorer decision-making performance were associated with suicidality-related outcomes in schizophrenia.
INTRODUCTION:Subjective visual disturbances and objective visual deficits are common across the psychosis spectrum. Few investigations have tested them in the same sample to ask whether subjective disturbances may arise from low-level visual processing deficits. This study assessed whether reduced contrast sensitivity (CS), a low-level visual processing deficit in people with schizophrenia (PSZ), may contribute to subjective visual disturbances across the psychosis spectrum. METHODS:PSZ (n = 54) and controls (n = 54) matched for gender, age, and race/ethnicity, together with High PLE (n = 55) and Low PLE (n = 45) matched for gender, age, race/ethnicity, education, and IQ completed a CS task and the Bonn Scale, a structured interview assessing visual distortions. Group differences in CS and Bonn scores as well as their correlations with social risk factors were evaluated. In addition, the Bonn Scale's factor structure was examined. RESULTS:PSZ and High PLE endorsed more distortions than controls. In PSZ, distortion severity, but not CS, correlated with social risk factors and clinical symptoms. Only PSZ showed reduced CS, and no associations between distortions and CS were observed. CONCLUSIONS:Findings do not support a bottom-up account of visual distortions; instead, they may arise from higher-order processes.
OBJECTIVE:The present study investigated the congruency sequence effect (CSE), a key marker of conflict adaptation, in individuals with schizophrenia (SZ). Given the cognitive control deficits associated with SZ, we examined whether the CSE is preserved in SZ using a confound-minimized Flanker task. METHODS:19 SZs and 19 healthy controls (HC) performed a Flanker task with congruent and incongruent trials. Error trials, post-error trials, and response repetitions were excluded. Reaction times, accuracy, and event-related potentials (P2, N2, P3) were analysed as a function of current and previous trial congruency. RESULTS:Both groups exhibited flanker effect and a CSE: responses were faster and more accurate for congruent than incongruent trials, and after congruent compared with incongruent trials. SZs were slower overall, but the pattern and magnitude of the CSE did not differ between groups. Electrophysiologically, incongruent trials elicited larger N2 and P3 amplitudes, and previous-trial congruency modulated N2, P2, and P3. No group differences emerged in ERP amplitudes. CONCLUSION:SZs demonstrate behavioural and neural patterns of conflict adaptation comparable to HCs. These findings suggest that, despite evidence of functional abnormalities in brain regions associated with conflict detection and adaptation, the CSE may be preserved in medicated SZs.
INTRODUCTION:Although many studies have explored theory of mind (ToM) deficits in schizophrenia, it is crucial to consider individual variations in neurocognitive and emotional functioning in subjects with schizophrenia. The purpose of the current study was to test the predictive value of several neurocognitive and emotional processes in ToM deficits, including autobiographical memory (AM, examining separately the impact of its semantic and episodic components), executive functioning, attentional capacity and facial emotion expressions (FEE) recognition abilities. METHODS:Thirty participants with schizophrenia were recruited, as well as 30 control participants, matched on age, sex and level of education. All participants were assessed on measures of ToM, AM, executive functioning, attentional resources and FEE recognition. RESULTS:Compared to control participants, participants with schizophrenia achieved poorer performances on tasks involving AM and ToM abilities. Multiple regression analyses revealed that episodic AM is the strongest predictor of ToM deficits in both groups. Additionally, some of the emotional and executive measures emerged as significant predictors, albeit to a lesser extent. CONCLUSIONS:The most noticeable finding of our study relates to the significant contribution of AM in ToM performance. This finding was evidenced in both participants with schizophrenia and control participants.
BACKGROUND AND HYPOTHESIS:Adaptive management of guilt and shame is regulated by social approach and withdrawal and thus relates to the quantity and quality of our social interactions. People with schizophrenia (SZ) self-report reduced guilt-proneness compared to healthy controls (HC). However, previous studies have not distinguished between anticipatory and consequential guilt, nor between guilty affect and associated action tendencies. STUDY DESIGN:We compared 24 SZ with 24 HC on anticipatory guilt, (TOSCA-3, GASP); consequential guilt (PFQ-2), and empathy and Theory of Mind (ToM). STUDY RESULTS:Differing profiles emerged: SZ reported higher consequential relative to anticipatory guilt, while HC reported the opposite pattern. SZ self-reported reduced repair and increased withdrawal compared to HC. In SZ, anticipatory guilt was predicted by empathic concern and ToM; consequential guilt by social withdrawal and ToM skill. CONCLUSION:SZ participants anticipated equal affective guilt-proneness but reduced adaptive behavioural responses to guilty feelings, resulting in more chronic guilt in daily life than would be predicted by TOSCA-3 and GASP responses. The discrepancy between emotional experience and expression may partly explain previous findings of reduced TOSCA-3 guilt-proneness, as TOSCA-3 operationalises guilt as reparative, prosocial behaviours. Results highlight perceptions of reparation potential as an intervention target, with likely downstream reductions in chronic and delusional guilt and shame.
Background: Phantom Phone Signals (PPS) describe false perceptions that a smartphone has vibrated or made a sound, which are typically non-distressing. PPS are linked to frequent phone use, mood, anxiety, and hallucination-proneness. This study explored the role of delusional ideation, resilience, and metacognition in PPS using a novel PPS assessment. Method: An online questionnaire study with 265 participants (mean age: 19.74; 84.2% female, no experience of psychosis) assessed PPS using the Phantom Phone Experiences and Appraisal Scale (PPEAS), along with problematic phone use (PUMP), resilience (RS-14), hallucination-proneness (MUSEQ), delusional ideation (PDI-21), and metacognitive awareness (MSAS). Results: PPS was highly prevalent (86.8%), generally infrequent, non-distressing and non-disruptive (mean PPEAS Impact = 4.25, SD = 3.66). PPEAS impact correlated with problematic phone use (r = .345), hallucination-proneness (r = .330), and delusional ideation (r = .288), but not resilience or metacognitive awareness. Regression indicated problematic phone use, hallucination-proneness and delusional ideation explained 18.7% of PPEAS impact variance. Conclusion: PPS appears primarily driven by problematic phone use, hallucination-proneness and delusional ideation. Behavioural interventions may be the most effective approach for reducing PPS where required. Behavioural changes related to phone use may involve adaptive notification systems reducing perceptual errors in everyday technology use.
BACKGROUND:Caffeine's impact on schizophrenia, a disorder marked by cognitive and functional deficits, is unclear. We evaluated the impact of caffeine on cognition, symptoms, and functioning in patients with schizophrenia. METHOD:A PRISMA-guided systematic review searched six databases up to 30 December 2024. English-language studies of adults with schizophrenia comparing different caffeine intake levels and reporting outcomes on cognition, symptoms, or functioning were included. Data were synthesized via a random-effects model with Hedges' g for effect size and I2 statistics for heterogeneity. Prospectively registered on PROSPERO (CRD42025628484). RESULTS:Of 252 articles screened, eleven (n = 1,406) met inclusion criteria. Individual study findings were mixed: some studies reported benefits for negative symptoms, others noted increased positive symptoms. Meta-analyses revealed no significant effects on overall symptom severity (measured with the Brief Psychiatric Rating Scale (BPRS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE)). CONCLUSION:The influence of caffeine on schizophrenia is multifaceted, offering potential benefits for negative symptoms and specific cognitive domains while posing risks for positive symptom exacerbation. Given the heterogeneity in functional outcomes and the potential for interactions with antipsychotic medications, clinical management should be individualized. Future research must prioritize high-quality, longitudinal trials to resolve current inconsistencies and guide standardized clinical recommendations.
PURPOSE:Psychoticism is a common feature of psychological disorders. Deficits in perceptual inference have been associated with the development of psychotic symptoms. Traditional testing of perceptual inference has had low ecological validity, limiting the ability to infer functional relationships. The aims of this study were to investigate the relationship between the capacity to infer relevance in dynamic environments and dimensional psychoticism, as well as to investigate the association between inferring relevance and dimensional psychoticism. METHOD:Four hundred participants, representative of the general population of the USA, completed an online questionnaire consisting of the Brief Symptom Inventory, as well as demographic and clinical questions, followed by a computerised Inferring Relevance Task. RESULTS:Dimensional psychoticism was not significantly associated with inferring relevance. An ability to infer relevance also did not significantly distinguish between individuals with and without symptoms of psychoticism. CONCLUSIONS:The ability to infer relevance may not be a reliable marker of psychotic-like experiences in general population samples. Future research should use a clinical population to better understand the potential interactions between neurocognitive mechanisms and how this may be associated with psychoticism.
INTRODUCTION:Depressed mood and anhedonia increase steadily through adolescence, and their associations become more tied at the transition to adulthood. However, it remains unclear whether the relationship is best explained by reciprocal influences or by a third variable. METHOD:This longitudinal study investigated the co-development and bidirectional relationships between the two symptoms over three waves among first-year university students (Mean age = 18.24 years, SD = 0.80, 41% male) using latent growth models, parallel latent growth modelling and random-intercept cross-lagged panel models. The moderating effects of childhood maltreatment on their links were explored as well. RESULTS:In general, depressed mood and state/trait anhedonia decreased concomitantly over time after entering university. The majority of students (90%) decreased in depressed mood and anhedonia over time, while the remaining 10% progressively increased. At the between-person level, increases in depressed mood were accompanied by increases in state/trait anhedonia. However, these symptoms did not reciprocally predict each other at the within-person level. Multiple-group analyses found that depressed mood and state anhedonia reciprocally influenced among individuals with higher levels of childhood maltreatment. CONCLUSION:These findings emphasised that the core elements of major depressive disorder were not directly related to each other, but rather that moderating factors play a role.
BACKGROUND:Psychotic-like experiences may reflect disrupted signal discrimination, whereby individuals overinterpret noisy sensory input as meaningful. Drawing on predictive coding accounts, we investigated whether increased sensory precision and reduced data-gathering relate to psychotic-like experiences in a signal discrimination task. METHODS:We fitted drift-diffusion models to Random Dot Motion (RDM) task data completed by 191 participants. We estimated drift rate and decision threshold: (1) across groups differing in psychotic phenotypes, and (2) as outcomes in regression models with psychotic-like experiences as predictors. Drift rate measures evidence gain and, in this task, can be considered an approximate measure of sensory precision. We also tested whether reduced data-gathering on the beads task replicated prior associations with psychotic phenotypes. RESULTS:Hallucination- and delusion-like experiences were associated with increased drift rates. Hallucination-like experiences also predicted lower decision thresholds. In the beads task, psychotic-like experiences correlated with higher confidence ratings but not with reduced data-gathering. CONCLUSIONS:Our findings indicate that psychotic-like phenomenology is linked to increased precision of signal discrimination and reduced decision thresholds. Overprecise signal discrimination and lower decision thresholds may bias perceptual inference toward false positive detections, potentially leading to anomalous experiences.
INTRODUCTION:Individuals with schizophrenia often show impairments in emotional facial expression recognition and empathy, although the precise nature of these social cognitive deficits remains unresolved. This study aims to overcome previous assessment limitations by comparing static and dynamic emotion facial expression recognition, as well as self-reported and situational empathy tasks, in schizophrenia patients and healthy controls. Correlations between these abilities and symptomatology were also explored. METHODS:This cross-sectional observational study involved 20 participants with schizophrenia and 20 controls. They completed tasks assessing facial expression recognition using static (photographs) and dynamic (videos) stimuli and empathy through a self-report (Interpersonal Reactivity Index) and situational tasks. Symptomatology was also examined for their influence on social cognitive abilities. RESULTS:Schizophrenia patients exhibit deficits in static facial expressions recognition and in self-reported empathic abilities. Nevertheless, performance in dynamic facial expressions recognition and situational empathy tasks was similar in both groups. No correlations were found between these abilities and symptomatology. CONCLUSIONS:Our data suggest that the way in which emotional facial expression recognition and empathy skills are measured provide different measures of the ability of individuals with schizophrenia. This should be taken into consideration in order not to underestimate the performance of such patients.
BACKGROUND:Capgras syndrome (CS) is a rare delusional misidentification syndrome in which individuals believe that another person has been replaced by an impostor. METHODS:A retrospective chart review was conducted for all admissions to two male psychiatric inpatient departments in a tertiary hospital in Israel between August 1, 2024, and January 31, 2025. Cases with explicit documentation of CS were included. Demographic and clinical data were extracted and analyzed. RESULTS:Among 308 hospitalised patients, five (1.62%) met criteria for CS, with a mean age of 33.6 years. Three patients (60%) had schizophrenia spectrum disorders, and two (40%) had organic psychosis associated with left frontal brain lesions. Four patients (80%) presented during their first psychiatric admission after committing severe violence against family members perceived as impostors. Treatment response varied: CS resolved in some cases with antipsychotics alone, while others required Clozapine and adjunctive interventions. CONCLUSIONS:CS may be underrecognized but carries significant clinical implications, particularly due to its association with violence in first-episode psychosis. Early identification and tailored treatment are critical for risk reduction.
INTRODUCTION:Approximately 6.9% to 8.9% of nongeriatric adults in the United States report persistent symptoms following SARS-CoV-2, one of which being persistent cognitive concerns. Across clinical populations, discrepancies have been identified between subjective cognitive concerns and performance on objective neurocognitive measures, such that subjective cognitive concerns often do not correlate with objective neurocognitive deficits. METHODS:The current study investigated the relationship between subjective cognitive concerns and objective neurocognitive test performance in a sample of 54 nongeriatric adults who underwent outpatient neuropsychological evaluation due to SARS-CoV-2 related persistent cognitive concerns. Multiple linear regressions analysed the relationship between reported cognitive concerns and objective neurocognitive test performance, as well as the relationship between depression and anxiety and subjective cognitive concerns. RESULTS:Subjective cognitive concerns did not significantly predict performance on objective neurocognitive test measures. Increased self-reported symptoms of depression and anxiety predicted the presence of subjective cognitive concerns, with depressive symptom endorsement serving as the primary predictor. CONCLUSIONS:Results suggest that internalising psychopathology may be an important marker of subjective cognitive concerns in this population. While the origins of internalising symptoms are unclear, the impact of these factors emphasises the need for comprehensive support in addressing long-term effects experienced by individuals following SARS-CoV-2 infection.
INTRODUCTION:Schizophrenia (SCZ) spectrum is characterised by aberrant processing of social cues. However, little is known about the specific stages of visual attention and their connection to subclinical and clinical symptoms in psychosis. This study aimed to investigate the visual processing of social and non-social parts of naturalistic scenes, and its link to positive and negative symptoms. METHODS:Employing eye-tracking and a free-viewing paradigm, we tested 27 individuals with SCZ and 28 matched controls and compared them on measures capturing both attention orientation (first fixation latency, velocity of entry saccade) and attention maintenance (duration of duration, number of saccades). RESULTS:We did not find significant differences in attentional processing between schizophrenia and the control group. However, we observed that the severity of positive symptoms was associated with a delayed attention orientation toward the social aspects of the scenes, whereas negative symptoms were correlated with delayed attention orientation toward non-social contexts. CONCLUSION:Our results reveal distinct relationship profiles between positive and negative symptoms in schizophrenia and early stages of visual attention to social vs. non-social stimuli.
BACKGROUND:Sentiment in the speech of people with schizophrenia spectrum disorder (SSD) may reflect psychosis severity. Previous research examines speech from semi-structured interviews or self-narrative prompts, where differences in measured sentiment may be driven by differences in life experiences. We measured sentiment in speech evoked from standardised stimuli among participants with a psychotic disorder. METHODS:Two cohorts (N = 97) participated in this study. Symptom domains were assessed using the Brief Psychiatric Rating Scale and were represented as Anxious Depression, Hostile Suspiciousness, Thought Disturbance, and Withdrawal Retardation. Participant speech during picture description tasks was quantified for sentiments: Valence, Arousal, Dominance, Happiness, Sadness, Anger, Fear, Disgust, and Surprise. Correlations between clinical and sentiment measures were conducted separately for the two cohorts and two timepoints in Cohort 1. Within-participant longitudinal relationships were examined with linear mixed models. RESULTS:Several replicable relationships between sentiment and symptom severity were found: two replicable findings among Cohorts 1 and 2 and three replicable findings across Cohort 1 timepoints. Five findings were also generalised to within-participant longitudinal relationships. CONCLUSIONS:Sentiment measures were related to the four symptom domains in the context of standardised stimuli, suggesting a disruption in emotion processing among people with a psychotic disorder.
INTRODUCTION:People with psychosis place greater confidence in errors and less confidence in accurate judgements relative to controls. This overconfidence in errors bias is theorised to contribute to the formation and maintenance of delusions. However, no research has examined whether people with psychosis have an impaired ability to judge whether they are confident or not, known as resolution. This study aimed to establish whether psychosis populations show a resolution deficit. METHOD:We used hierarchical Bayesian modelling and Type 2 Signal Detection Theory to explore whether participants with schizophrenia (n = 25) had poorer resolution and higher overconfidence than high delusion-prone (n = 25) and low delusion-prone participants (n = 25) when making confidence judgements. A discrimination index and over/underconfidence statistic examined resolution and overconfidence, respectively. RESULTS:While all participants showed a low discrimination index, schizophrenia participants had a meaningfully lower discrimination index than low delusion-prone participants, indicating poorer resolution. All groups were overconfident, with schizophrenia participants showing the greatest level of overconfidence. CONCLUSIONS:Results suggest schizophrenia patients show impairments in using confidence judgements to discriminate between correct and incorrect judgements. Resolution deficits in psychosis could have theoretical and clinical implications for our approach towards delusions.
INTRODUCTION:Hoarding disorder represents a considerable health concern that warrants further investigation of its associated neuropsychological components. The present study examined a key aspect of the cognitive-behavioural model of hoarding, information processing (memory, attention, decision making, categorisation). Mixed findings in the literature on the presence of cognitive deficits may be attributable to the use of assessment tools with low ecological validity. Thus, novel virtual reality (VR) environments were developed to examine the information-processing components with improved ecological validity. METHODS:Two groups (i.e., with hoarding disorder, n = 36; without hoarding disorder, n = 40) similar in age and gender were recruited from the community to complete a series of standardised and novel VR memory and decision-making tasks, and to complete a categorisation task for objects in a messy VR home office. RESULTS:Higher attentional difficulties related to ADHD symptoms, poorer category efficiency, and poorer trait, but not state, memory confidence, were reported in the hoarding group. There was no evidence of memory and decision-making impairments specific to the hoarding group. CONCLUSIONS:Results from this research advance our understanding of the cognitive-behavioural components of hoarding and offer implications for future treatment and VR research initiatives.
