Editor-in-Chief: John A. Talbott, MD
ISSN: 0022-3018
Online ISSN: 1539-736X
Frequency: 12 issues / year
Impact Factor: 1.836

EDITORIAL
John A. Talbott, MD

ORIGINAL ARTICLES

Sensory Gating Deficits in First-Episode Psychosis: Evidence From Neurophysiology, Psychophysiology, and Neuropsychology
Isabel Morales-Muñoz, PhD, Rosa Jurado-Barba, PhD, Sara Fernández-Guinea, PhD, Roberto Rodríguez-Jiménez, MD, PhD, Miguel Ángel Jiménez-Arriero, MD, PhD, José R. Criado, PhD, Gabriel Rubio, MD, PhD

Thirty-eight patients with first-episode psychosis (FEP) were compared to thirty-eight controls. A condition-test paradigm of event-related potentials (ERP), prepulse inhibition (PPI), and some specific tasks of the MATRICS Consensus Cognitive Battery (MCCB) were used. The ERP components measured were P50, N1, and P2. The PPI intervals examined were 30, 60, and 120 msec. Regarding the MCCB, processing speed and attention/vigilance cognitive domains were selected. FEP patients showed significant deficits in N1 and P2 components, at 30 and 60 PPI levels and in all the MCCB subtests selected. We obtained significant relationships in N1 with PPI-60, and with one MCCB subtest for processing speed. In addition, this same subtest showed significant association with P2. Therefore, sensory gating functioning is widely impaired since the very early stages of schizophrenia.

Inner Speech and Clarity of Self-Concept in Thought Disorder and Auditory-Verbal Hallucinations
Paulo de Sousa, PhD, William Sellwood, PhD, Amy Spray, BSc, Charles Fernyhough, PhD, Richard P. Bentall, PhD

Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations.

Early Therapeutic Alliance, Treatment Retention, and 12-Month Outcomes in a Healthy Lifestyles Intervention for People with Psychotic Disorders
Michelle Andrews, MClinPsych, Amanda L. Baker, PhD, Sean A. Halpin, PhD, Terry J. Lewin, BCom(Psych)Hons, Robyn Richmond, PhD, Frances J. Kay-Lambkin, PhD, Sacha L. Filia, PhD, David Castle, MD, Jill M. Williams, MD, Vanessa Clark, PhD, Robin Callister, PhD

Early therapeutic alliance, treatment retention, and 12-month outcomes were examined in a subsample of smokers with a psychotic disorder (N = 178) participating in a healthy lifestyles study comparing a telephone versus face-to-face delivered intervention. Therapeutic alliance was assessed using the Agnew Relationship Measure; primary outcomes were treatment retention and changes in symptoms and health behaviors. Contrary to expectations, early alliance did not predict treatment retention. However, elements of both client- and therapist-rated alliance predicted some clinical outcomes. Some modest interactions between early alliance and intervention condition were also identified, highlighting the need to further examine the interplay between therapeutic alliance and treatment modality.

The Role of Metacognitive Self-Reflectivity in Emotional Awareness and Subjective Indices of Recovery in Schizophrenia
Kelsey A. Bonfils, MS, Lauren Luther, MSEd, Sunita George, MA, Kelly D. Buck, PMHCNS-BC, Paul H. Lysaker, PhD

The authors hypothesized that increased emotional awareness would be associated with greater self-esteem, hope, and self-reflectivity and that self-reflectivity would moderate links between emotional awareness and self-esteem and hope—such that significant relationships would only be observed at lower levels of self-reflectivity. Participants were 56 people with schizophrenia spectrum disorders. Correlations revealed that better emotional awareness was significantly associated with increased self-esteem and hope but not self-reflectivity. Self-reflectivity moderated the relationship between emotional awareness and self-esteem but not hope. Overall, findings suggest that emotional awareness may affect self-esteem for those low in self-reflectivity, but other factors may be important for those with greater self-reflectivity. Results emphasize the importance of interventions tailored to enhance self-reflective capacity in clients with schizophrenia.

Medical Student Beliefs and Attitudes Toward Mental Illness Across Five Nations
Elina A. Stefanovics, PhD, Robert A. Rosenheck, MD, Hongo He, MD, PhD, Angela Ofori-Atta, PhD, Maria Cavalcanti, PhD, Catherine Chiles, MD

This study used a 36-item questionnaire to compare attitudes toward people with mental illness and beliefs about the causes of mental illness among medical students from the United States, Brazil, Ghana, Nigeria, and China (N = 1131). Exploratory factor analysis identified the underlying factor structure of the questionnaire, and analysis of covariance was then used to compare factors representing four nonstigmatized attitudes across students from the five countries. U.S. medical students scored highest on all four factors, followed by those from Brazil. Nigerian and Ghanaian students scored lowest on nonsupernatural etiology of mental illness, and Chinese students showed the lowest score on personal social acceptance and public policy acceptance of people with mental illness.

Stigmatizing Attitudes and Beliefs About Anorexia and Bulimia Nervosa Among Italian Undergraduates
Manuela Caslini, MD, PhD, Cristina Crocamo, MSc, Antonios Dakanalis, PhD, Martina Tremolada, MD, Massimo Clerici, MD, PhD, Giuseppe Carrà, MD, PhD

A total of 2109 participants completed an online survey including questionnaires related to stigmatizing beliefs toward anorexia nervosa (AN) and bulimia nervosa (BN), and personal contacts with people with eating disorders (EDs). Undergraduates reported almost overlapping low levels of stigmatizing trends for AN and BN, apart from personal responsibility and social distance. Those aged 18 to 25 and living with family held higher stigmatizing attitudes. Stigma was lower in underweight participants and in those (12%) reporting a previous ED diagnosis. Although not improving stigmatizing attitudes, 83% of the sample was familiar with people with an ED. Antistigma actions to increase awareness on EDs and to improve treatment-seeking behaviors are needed.

Déjà Vu Experiences in Healthy Czech Adults
Lenka Lacinová, PhD, Radka Neužilová Michalčáková, PhD, Jan Širůček, PhD, Stanislav Ježek, PhD, Jakub Chromec, Zuzana Masopustová, PhD, Tomáš Urbánek, PhD, Milan Brázdil, PhD

The study examines the prevalence of déjà vu in healthy Czech adults and explores its relationships with a number of variables: age, sex, neuroticism, depression, the degree of irritability in the limbic system, perceived stress, and finally attachment avoidance and anxiety. The participants were 365 healthy adults ranging from 18 to 70 years recruited in the Czech Republic (mean age = 29.05; SD = 11.17) who filled out online questionnaires. Déjà vu experiences were reported by 324 (88.8%) of them. Persons who experienced déjà vu were younger than the persons who had not experienced it. We found that sex, levels of neuroticism, depression, perceived stress, and attachment did not serve as predictors of experiences of déjà vu phenomena. Finally, those who had reported déjà vu experiences reported more limbic system irritability symptoms.

The Young and the Stressed: Stress, Impulse Control, and Health in College Students
Eric W. Leppink, BA, Brian L. Odlaug, PhD, MPH, Katherine Lust, PhD, MPH, Gary Christenson, MD, Jon E. Grant, JD, MD, MPH

High levels of stress are common among young adults, particularly those enrolled in college. These degrees of stress have shown numerous deleterious effects across both academic and health variables. Findings regarding the role of stress in the presentation of impulse control disorders, particular among college students, are limited. This study examined potential associations between perceived stress, academic achievement, physical/mental health, and impulse control disorders in young adults. A total of 1805 students completed an online survey and were included in the analysis. Responders were grouped by their overall score on the Perceived Stress Scale into mild, moderate, or severe. Severe perceived stress was associated with worse academic achievement and worse physical health, as well as higher rates of psychiatric and impulsive disorders. These findings may suggest associations between stress and numerous aspects of mental/physical health in young adults, which could be an important consideration for individuals working with college students.

Borderline Personality Disorder and Narcissistic Personality Disorder Diagnoses From the Perspective of the DSM-5 Personality Traits: A Study on Italian Clinical Participants
Andrea Fossati, PhD, Antonella Somma, PhD, Serena Borroni, PsyD, Cesare Maffei, MD, Kristian E. Markon, PhD, and Robert F. Krueger, PhD

To evaluate the associations between DSM-5 Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5 (PID-5) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n = 49), b) BPD (n = 32), c) any other PD (n = 91), and d) no PD (n = 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5 traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit
Eno Umotong, BSc, MBBS

The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues, particularly in regards to capacity and drug suitability.

BRIEF REPORT

The Role of Theory-Specified Techniques and Therapeutic Alliance in Promoting Positive Outcomes: Integrative psychotherapy for World Trade Center responders
Peter Tejas Haugen, PhD, Aditi Sinha Werth, PhD, Alyce Lauren Foster, PhD, Jesse Owen, PhD

World Trade Center responders demonstrate high symptom burden, underscoring the importance of refining treatment approaches for this cohort. One method is examining the impact of therapy techniques on outcomes, and the interactions between technique and alliance on outcomes. This study a) examined the interaction of early treatment techniques on integrative psychotherapy outcomes and b) explored whether associations differed at varying levels of alliance. Twenty-nine adult responders diagnosed with partial or full posttraumatic stress disorder received outpatient psychotherapy and completed weekly measures of alliance, technique, and symptom distress. Analyses indicated significant interactions between 1) alliance and psychodynamic interventions on outcomes and 2) alliance and cognitive behavioral (CB) interventions on outcomes. These findings reiterate the critical roles technique and responsiveness to the alliance play in engendering successful outcomes.

BOOK REVIEW

The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia. Victor I. Reus et al. (2016) Arlington, VA: American Psychiatric Association. 210 pp.

Reviewed by Maria D. Llorente, MD, and Joanna C. Lim, MD.

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Dr. Talbott and Lippincott Williams & Wilkins
wish to thank the
University of Maryland School of Medicine
Department of Psychiatry
for their support of
The Journal of Nervous and Mental Disease 

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