Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-22T18:00:32.982Z Has data issue: false hasContentIssue false
  • English
  • Français

From neurological soft signs to functional outcome in young individuals in treatment with secondary services for non-psychotic disorders: a path analysis

Published online by Cambridge University Press:  05 January 2017

A. Minichino ,
M. Francesconi ,
R. E. Carrión ,
R. Delle Chiaie ,
A. Bevilacqua ,
M. Parisi ,
S. Rullo ,
F. S. Bersani ,
M. Biondi  and
K. Cadenhead
A. Minichino*
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy Department of Psychiatry, UCSD, La Jolla, CA, USA
M. Francesconi
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy Department of Psychiatry, UCSD, La Jolla, CA, USA
R. E. Carrión
Affiliation:
Division of Psychiatry, Zucker Hillside Hospital, Long Island, NY, USA
R. Delle Chiaie
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
A. Bevilacqua
Affiliation:
Research Center in Neurobiology, Daniel Bovet (CRiN), Rome, Italy Department of Psychology, Section of Neuroscience, Sapienza University of Rome, Rome, Italy
M. Parisi
Affiliation:
Villa Armonia Nuova, Rome, Italy
S. Rullo
Affiliation:
Casa di Cura Villa Letizia, Rome, Italy
F. S. Bersani
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
M. Biondi
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
K. Cadenhead
Affiliation:
Department of Psychiatry, UCSD, La Jolla, CA, USA
*
*Address for correspondence: A. Minichino, Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università, 3000185 Rome, Italy. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Functional decline among patients with mental illness is not unique to individuals with psychotic disorders. Despite this, research on early predictors of functional outcome mainly focused on individuals thought to have an ‘at risk mental state’ (ARMS) for psychosis. There is evidence suggesting that certain early vulnerability markers, such as neurological soft signs (NSS), may explain variability in functional outcomes independent of the level of psychosis risk and the traditional diagnostic classification.

Method

Structural equation modeling was applied to baseline data from a prospective longitudinal study of 138 young individuals in treatment with secondary services for non-psychotic disorders. We evaluated theoretically based models of pathways to functional outcome starting from NSS. The intervening variables were established according to previous evidence and drawn from two general categories: cognition (neuro- and social-) and negative symptoms (expressive and experiential).

Results

A final trimmed model was a single path running from NSS to neurocognition to experiential negative symptoms to outcome. It could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from NSS to outcome was significant. The validity of the model was independent of the ARMS status and the psychiatric diagnosis.

Conclusions

Our results provide evidence for a single pathway model in which the starting and intervening variables represent modifiable trans-diagnostic therapeutic targets to improve functional trajectories in young individuals with a recent-onset psychiatric diagnosis and different levels of psychosis risk.

Keywords

Cognitionfunctioningnegative symptomsneurological soft signsstructural equation modeling
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 7 , May 2017 , pp. 1192 - 1203
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

† These two authors contributed equally to this work.

References

Abdi, H, Williams, LJ (2010). Principal component analysis. Wiley Interdisciplinary Reviews Computational Statistics 2, 433–459.CrossRefGoogle Scholar
Allott, K, Liu, P, Proffitt, T-M, Killackey, E (2011). Cognition at illness onset as a predictor of later functional outcome in early psychosis: systematic review and methodological critique. Schizophrenia Research 125, 221–235.Google Scholar
Amminger, GP, Mechelli, A, Rice, S, Kim, SW, Klier, CM, McNamara, RK, Berk, M, McGorry, PD, Schäfer, MR (2015). Predictors of treatment response in young people at ultra-high risk for psychosis who received long-chain omega-3 fatty acids. Translational Psychiatry 5, e495.Google Scholar
Arango, C, Bartko, JJ, Gold, JM, Buchanan, RW (1999). Prediction of neuropsychological performance by neurological signs in schizophrenia. American Journal of Psychiatry 156, 1349–1457.Google Scholar
Barbato, M, Liu, L, Penn, DL, Keefe, RSE, Perkins, DO, Woods, SW, Addington, J (2013). Social cognition as a mediator between neurocognition and functional outcome in individuals at clinical high risk for psychosis. Schizophrenia Research 150, 542–546.Google Scholar
Barbato, M, Penn, DL, Perkins, DO, Woods, SW, Liu, L, Addington, J (2014). Metacognitive functioning in individuals at clinical high risk for psychosis. Behavioral and Cognitive Psychotherapy 42, 526–534.Google Scholar
Baş, TÖ, Poyraz, CA, Baş, A, Poyraz, BÇ, Tosun, M (2015). The impact of cognitive impairment, neurological soft signs and subdepressive symptoms on functional outcome in bipolar disorder. Journal of Affective Disorders 174, 336–341.Google Scholar
Baune, BT, Miller, R, McAfoose, J, Johnson, M, Quirk, F, Mitchell, D (2010). The role of cognitive impairment in general functioning in major depression. Psychiatry Research 176, 183–189.Google Scholar
Beck, AT, Rector, NA (2005). Cognitive approaches to schizophrenia: theory and therapy. Annual Review of Clinical Psychology 1, 577–606.Google Scholar
Bedwell, JS, Butler, PD, Chan, CC, Trachik, BJ (2015). Transdiagnostic psychiatric symptoms related to visual evoked potential abnormalities. Psychiatry Research 230, 262–270.Google Scholar
Bersani, FS, Minichino, A, Fattapposta, F, Bernabei, L, Spagnoli, F, Mannarelli, D, Francesconi, M, Pauletti, C, Corrado, A, Vergnani, L, Taddei, I, Biondi, M, Delle Chiaie, R (2015). Prefrontocerebellar transcranial direct current stimulation increases amplitude and decreases latency of P3b component in patients with euthymic bipolar disorder. Neuropsychiatric Disease and Treatment 11, 2913–2917.Google Scholar
Bosco, FM, Colle, L, De Fazio, S, Bono, A, Ruberti, S, Tirassa, M (2009). Th.o.m.a.s.: an exploratory assessment of theory of mind in schizophrenic subjects. Consciousness and Cognition 18, 306–319.Google Scholar
Bowie, CR, Harvey, PD (2006). Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatric Disease and Treatment 2, 531–536.CrossRefGoogle ScholarPubMed
Buchanan, RW, Heinrichs, DW (1989). The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Research 27, 335–350.Google Scholar
Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, D, Tsuang, M, McGlashan, T, Heinssen, R (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 28–37.Google Scholar
Carrión, RE, McLaughlin, D, Goldberg, TE, Auther, AM, Olsen, RH, Olvet, DM, Correll, CU, Cornblatt, BA (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA Psychiatry 70, 1133–1142.Google Scholar
Chan, RCK, Dai, S, Lui, SSY, Ho, KKY, Hung, KSY, Wang, Y, Geng, F, Li, Z, Cheung, EFC (2015). Re-visiting the nature and relationships between neurological signs and neurocognitive functions in first-episode schizophrenia: an invariance model across time. Scientific Reports 5, 11850.Google Scholar
Chan, RCK, Wang, Y, Wang, L, Chen, EYH, Manschreck, TC, Li, Z, Yu, X, Gong, Q (2009). Neurological soft signs and their relationships to neurocognitive functions: a re-visit with the structural equation modeling design. PLoS ONE 4, e8469.Google Scholar
Cotter, J, Drake, RJ, Bucci, S, Firth, J, Edge, D, Yung, AR (2014). What drives poor functioning in the at-risk mental state? A systematic review. Schizophrenia Research 159, 267–277.Google Scholar
Dazzan, P (2005). The structural brain correlates of neurological soft signs in healthy individuals. Cerebral Cortex 16, 1225–1231.CrossRefGoogle ScholarPubMed
Dazzan, P, Murray, RM (2002). Neurological soft signs in first-episode psychosis: a systematic review. British Journal of Psychiatry. Supplement 43, s50–s57.Google Scholar
De la Fuente, JM, Bobes, J, Vizuete, C, Bascaran, MT, Morlán, I, Mendlewicz, J (2006). Neurologic soft signs in borderline personality disorder. Journal of Clinical Psychiatry 67, 541–546.Google Scholar
Doncaster, CP (2007). Structural equation modeling and natural systems. Fish and Fisheries 8, 368–369.Google Scholar
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS (1997). User's Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders: SCID-II. American Psychiatric Press: Washington, DC.Google Scholar
Firth, J, Stubbs, B, Rosenbaum, S, Vancampfort, D, Malchow, B, Schuch, F, Elliott, R, Nuechterlein, KH, Yung, AR (2016). Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophrenia Bulletin. Published online 11 August 2016. doi:10.1093/schbul/sbw115.Google Scholar
Fisher, M, Holland, C, Merzenich, MM, Vinogradov, S (2009). Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. American Journal of Psychiatry 166, 805–811.Google Scholar
Fisher, M, Loewy, R, Carter, C, Lee, A, Ragland, JD, Niendam, T, Schlosser, D, Pham, L, Miskovich, T, Vinogradov, S (2015). Neuroplasticity-based auditory training via laptop computer improves cognition in young individuals with recent onset schizophrenia. Schizophrenia Bulletin 41, 250–258.Google Scholar
Francesconi, M, Minichino, A, Carrión, RE, Delle Chiaie, R, Bevilacqua, A, Parisi, M, Rullo, S, Bersani, FS, Biondi, M, Cadenhead, K (2016). Psychosis prediction in secondary mental health services. A broad, comprehensive approach to the “at risk mental state” syndrome. European Psychiatry 40, 96–104.Google Scholar
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E, McGuire, P (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220–229.Google Scholar
Granholm, E, Holden, J, Link, PC, McQuaid, JR (2014). Randomized clinical trial of cognitive behavioral social skills training for schizophrenia: improvement in functioning and experiential negative symptoms. Journal of Consulting and Clinical Psychology 82, 1173–1185.Google Scholar
Grant, PM, Beck, AT (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin 35, 798–806.Google Scholar
Green, MF, Hellemann, G, Horan, WP, Lee, J, Wynn, JK (2012). From perception to functional outcome in schizophrenia: modeling the role of ability and motivation. Archives of General Psychiatry 69, 1216–1224.Google Scholar
Hall, RC (1995). Global Assessment of Functioning. A modified scale. Psychosomatics 36, 267–275.Google Scholar
Harvey, PD (2011). Mood symptoms, cognition, and everyday functioning: in major depression, bipolar disorder, and schizophrenia. Innovations in Clinical Neuroscience 8, 14–18.Google Scholar
Harvey, PD, Koren, D, Reichenberg, A, Bowie, CR (2006). Negative symptoms and cognitive deficits: what is the nature of their relationship? Schizophrenia Bulletin 32, 250–258.Google Scholar
Hatton, SN, Lagopoulos, J, Hermens, DF, Naismith, SL, Bennett, MR, Hickie, IB (2012). Correlating anterior insula gray matter volume changes in young people with clinical and neurocognitive outcomes: an MRI study. BMC Psychiatry 12, 45.Google Scholar
Henry, AD, Coster, WJ (1996). Predictors of functional outcome among adolescents and young adults with psychotic disorders. American Journal of Occupational Therapy 50, 171–181.Google Scholar
Hezel, DM, McNally, RJ (2014). Theory of mind impairments in social anxiety disorder. Behavior Therapy 45, 530–540.Google Scholar
Holzer, L, Chinet, L, Jaugey, L, Plancherel, B, Sofia, C, Halfon, O, Randolph, C (2007). Detection of cognitive impairment with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in adolescents with psychotic symptomatology. Schizophrenia Research 95, 48–53.Google Scholar
Hoyle, RH (1995). Structural Equation Modeling: Concepts, Issues, and Applications. SAGE Publications: Thousand Oaks, CA.Google Scholar
Insel, T, Cuthbert, B, Garvey, M, Heinssen, R, Pine, DS, Quinn, K, Sanislow, C, Wang, P (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. American Journal of Psychiatry 167, 748–751.CrossRefGoogle Scholar
Iosifescu, DV (2012). The relation between mood, cognition and psychosocial functioning in psychiatric disorders. European Neuropsychopharmacology 22, S499–S504.Google Scholar
Kessler, RC, Aguilar-Gaxiola, S, Alonso, J, Chatterji, S, Lee, S, Ormel, J, Ustün, TB, Wang, PS (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemioliogia e Psichiatria Sociale 18, 23–33.Google Scholar
Kline, RB, Santor, DA (1999). Principles & practice of structural equation modelling. Canadian Psychology 40, 381.Google Scholar
Lee, RSC, Hermens, DF, Naismith, SL, Lagopoulos, J, Jones, A, Scott, J, Chitty, KM, White, D, Robillard, R, Scott, EM, Hickie, IB (2015). Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study. Translational Psychiatry 5, e555.Google Scholar
Lee, RSC, Hermens, DF, Redoblado-Hodge, MA, Naismith, SL, Porter, MA, Kaur, M, White, D, Scott, EM, Hickie, IB (2013). Neuropsychological and socio-occupational functioning in young psychiatric outpatients: a longitudinal investigation. PLOS ONE 8, e58176.Google ScholarPubMed
Lovric, M (2011). International Encyclopedia of Statistical Science. Springer: Berlin, Heidelberg.Google Scholar
Lyne, J, Renwick, L, O'Donoghue, B, Kinsella, A, Malone, K, Turner, N, O'Callaghan, E, Clarke, M (2015). Negative symptom domain prevalence across diagnostic boundaries: the relevance of diagnostic shifts. Psychiatry Research 228, 347–354.Google Scholar
Martínez-Domínguez, S, Penadés, R, Segura, B, González-Rodríguez, A, Catalán, R (2015). Influence of social cognition on daily functioning in schizophrenia: study of incremental validity and mediational effects. Psychiatry Research 225, 374–380.Google Scholar
Meyer, EC, Carrión, RE, Cornblatt, BA, Addington, J, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF, Woods, SW, Heinssen, R, Seidman, LJ (2014). The relationship of neurocognition and negative symptoms to social and role functioning over time in individuals at clinical high risk in the first phase of the North American Prodrome Longitudinal Study. Schizophrenia Bulletin 40, 1452–1461.CrossRefGoogle ScholarPubMed
Millan, MJ, Agid, Y, Brüne, M, Bullmore, ET, Carter, CS, Clayton, NS, Connor, R, Davis, S, Deakin, B, DeRubeis, RJ, Dubois, B, Geyer, MA, Goodwin, GM, Gorwood, P, Jay, TM, Joëls, M, Mansuy, IM, Meyer-Lindenberg, A, Murphy, D, Rolls, ET, Saletu, B, Spedding, M, Sweeney, J, Whittington, M, Young, LJ (2012). Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nature Reviews. Drug Discovery 11, 141–168.Google Scholar
Minichino, A, Bersani, FS, Bernabei, L, Spagnoli, F, Vergnani, L, Corrado, A, Taddei, I, Biondi, M, Delle Chiaie, R (2015). Prefronto-cerebellar transcranial direct current stimulation improves visuospatial memory, executive functions, and neurological soft signs in patients with euthymic bipolar disorder. Neuropsychiatry Disease and Treatment 11, 2265–2270.Google Scholar
Mittal, VA, Dean, DJ, Bernard, JA, Orr, JM, Pelletier-Baldelli, A, Carol, EE, Gupta, T, Turner, J, Leopold, DR, Robustelli, BL, Millman, ZB (2014). Neurological soft signs predict abnormal cerebellar–thalamic tract development and negative symptoms in adolescents at high risk for psychosis: a longitudinal perspective. Schizophrenia Bulletin 40, 1204–1215.Google Scholar
Norman, RMG, Manchanda, R, Harricharan, R, Northcott, S (2015). The course of negative symptoms over the first five years of treatment: data from an early intervention program for psychosis. Schizophrenia Research 169, 412–417.Google Scholar
Nuechterlein, KH, Barch, DM, Gold, JM, Goldberg, TE, Green, MF, Heaton, RK (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research 72, 29–39.CrossRefGoogle ScholarPubMed
Parker, G, Rosen, A, Trauer, T, Hadzi-Pavlovic, D (2007). Disability associated with mood states and comparator conditions: application of the Life Skills Profile measure of disability. Bipolar Disorders 9, 11–15.Google Scholar
Plaisier, I, Beekman, ATF, de Graaf, R, Smit, JH, van Dyck, R, Penninx, BWJH (2010). Work functioning in persons with depressive and anxiety disorders: the role of specific psychopathological characteristics. Journal of Affective Disorders 125, 198–206.Google Scholar
Randolph, C, Tierney, MC, Mohr, E, Chase, TN (1998). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology 20, 310–319.CrossRefGoogle ScholarPubMed
Rassovsky, Y, Horan, WP, Lee, J, Sergi, MJ, Green, MF (2011). Pathways between early visual processing and functional outcome in schizophrenia. Psychological Medicine 41, 487–497.CrossRefGoogle ScholarPubMed
Rosen, A, Hadzi-Pavlovic, D, Parker, G (1989). The life skills profile: a measure assessing function and disability in schizophrenia. Schizophrenia Bulletin 15, 325–337.Google Scholar
Ruocco, AC, Lam, J, McMain, SF (2014). Subjective cognitive complaints and functional disability in patients with borderline personality disorder and their nonaffected first-degree relatives. Canadian Journal of Psychiatry 59, 335–344.Google Scholar
Schermelleh-Engel, K, Moosbrugger, H, Müller, H (2003). Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research-Online 8, 23–74.Google Scholar
Schmidt, SJ, Mueller, DR, Roder, V (2011). Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling. Schizophrenia Bulletin 37, S41–S54.Google Scholar
Sergi, MJ, Rassovsky, Y, Nuechterlein, KH, Green, MF (2006). Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. American Journal of Psychiatry 163, 448–454.Google Scholar
Stone, VE, Baron-Cohen, S, Knight, RT (1998). Frontal lobe contributions to theory of mind. Journal of Cognitive Neuroscience 10, 640–656.CrossRefGoogle ScholarPubMed
Tomotake, M (2011). Quality of life and its predictors in people with schizophrenia. Journal of Medical Investigation 58, 167–174.CrossRefGoogle ScholarPubMed
Trauer, T, Duckmanton, RA, Chiu, E (1995). The Life Skills Profile: a study of its psychometric properties. Australian and New Zealand Journal of Psychiatry 29, 492–499.Google Scholar
Valmaggia, LR, Stahl, D, Yung, AR, Nelson, B, Fusar-Poli, P, McGorry, PD, McGuire, PK (2013). Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study. Psychological Medicine 43, 2311–2325.Google Scholar
Vellante, M, Baron-Cohen, S, Melis, M, Marrone, M, Petretto, DR, Masala, C, Preti, A (2013). The “Reading the Mind in the Eyes” test: systematic review of psychometric properties and a validation study in Italy. Cognitive Neuropsychiatry 18, 326–354.Google Scholar
Wang, YG, Wang, YQ, Chen, SL, Zhu, CY, Wang, K (2008). Theory of mind disability in major depression with or without psychotic symptoms: a componential view. Psychiatry Research 161, 153–161.Google Scholar
Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472–485.Google Scholar
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2004). Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Australian and New Zealand Journal of Psychiatry 39, 964–971.Google Scholar
Zhao, Q, Li, Z, Huang, J, Yan, C, Dazzan, P, Pantelis, C, Cheung, EFC, Lui, SSY, Chan, RCK (2014). Neurological soft signs are not “soft” in brain structure and functional networks: evidence from ALE meta-analysis. Schizophrenia Bulletin 40, 626–641.Google Scholar
Supplementary material: File

Minichino supplementary material

Minichino supplementary material 1

Download Minichino supplementary material(File)
File 145.9 KB