ORCID Profile
0000-0003-3339-6665
Current Organisation
University of Melbourne
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Publisher: Springer Science and Business Media LLC
Date: 15-04-2014
DOI: 10.1038/MP.2014.33
Abstract: Many women with schizophrenia remain symptomatic despite optimal use of current therapies. While previous studies suggest that adjunctive oestrogen therapy might be effective, large-scale clinical trials are required before clinical applications are possible. This study is the first large-scale randomized-controlled trial in women with treatment-resistant schizophrenia. This Definitive Oestrogen Patch Trial was an 8-week, three-arm, double-blind, randomized-controlled trial conducted between 2006 and 2011. The 183 female participants were aged between 18 and 45 (mean = 35 years), with schizophrenia or schizoaffective disorder and ongoing symptoms of psychosis (Positive and Negative Syndrome Scale, PANSS score>60) despite a stable dose of antipsychotic medication for at least 4 weeks. Mean duration of illness was more than 10 years. Participants received transdermal estradiol 200 μg, transdermal estradiol 100 μg or an identical placebo patch. For the 180 women who completed the study, the a priori outcome measure was the change in PANSS score measured at baseline and days 7, 14, 28 and 56. Cognition was assessed at baseline and day 56 using the Repeatable Battery of Neuropsychological Status. Data were analysed using latent growth curve modelling. Both estradiol groups had greater decreases in PANSS positive, general and total symptoms compared with the placebo group (P<0.01), with a greater effect seen for 200 μg than 100 μg estradiol. The largest effect size was for the positive subscale of PANSS in the estradiol 200 μg treatment group (effect size 0.44, P<0.01). This study shows estradiol is an effective and clinically significant adjunctive therapy for women with treatment-resistant schizophrenia, particularly for positive symptoms.
Publisher: Wiley
Date: 20-04-2020
DOI: 10.1111/BDI.12907
Publisher: SAGE Publications
Date: 28-04-2019
Abstract: The personality characteristics and symptoms observed in schizophrenia are postulated to lie on a continuum, with non-clinical manifestations referred to as schizotypy. High schizotypy behaviours are argued to correspond with the three main clusters of symptoms in schizophrenia: positive, negative and cognitive/disorganised symptoms, yet there is limited empirical evidence to support this. This study aimed to investigate whether schizotypy dimensions significantly correlate with their respective schizophrenia symptomatology in the largest s le to date. A total of 361 adults (103 patients with schizophrenia/schizoaffective disorder and 258 healthy controls) were assessed for schizotypy using the Oxford-Liverpool Inventory of Feelings and Experiences. The MATRICS Consensus Cognitive Battery supplemented by the Stroop task and Wisconsin Card Sorting Test was administered to all participants to obtain objective measurements of cognition. Schizophrenia symptomatology was assessed using the Positive and Negative Syndrome Scale in patients only. The results demonstrated significant correlations between the Oxford-Liverpool Inventory of Feelings and Experiences positive and negative subscales and their respective Positive and Negative Syndrome Scale subscales only, indicating that positive and negative schizotypy dimensions across patients and controls accurately reflect the respective schizophrenia symptomatology observed in patients. Cognitive performance did not correlate with cognitive/disorganised symptom dimensions of the Oxford-Liverpool Inventory of Feelings and Experiences or the Positive and Negative Syndrome Scale, indicating that cognitive impairment is an independent symptom dimension that requires objective cognitive testing. Collectively, the findings provide empirical evidence for the continuum theory and support the use of schizotypy as a model for investigating schizophrenia.
Publisher: Cambridge University Press (CUP)
Date: 23-05-2016
Publisher: Cambridge University Press (CUP)
Date: 11-04-2014
DOI: 10.1017/S1355617714000253
Abstract: The ability to integrate information from different sensory channels is a vital process that serves to facilitate perceptual decoding in times of unimodal ambiguity. Despite its relevance to psychosocial functioning, multimodal integration of emotional information across facial and prosodic modes has not been addressed in bipolar disorder (BD). In light of this paucity of research we investigated multimodal processing in a BD cohort using a focused attention paradigm. Fifty BD patients and 52 healthy controls completed a task assessing the cross-modal influence of emotional prosody on facial emotion recognition across congruent and incongruent facial and prosodic conditions, where attention was directed to the facial channel. There were no differences in multi-modal integration between groups at the level of accuracy, but differences were evident at the level of response time emotional prosody biased facial recognition latencies in the control group only, where a fourfold increase in response times was evident between congruent and incongruent conditions relative to patients. The results of this study indicate that the automatic process of integrating multimodal information from facial and prosodic sensory channels is delayed in BD. Given that interpersonal communication usually occurs in real time, these results have implications for social functioning in the disorder. ( JINS , 2014, 20 , 1–9)
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/BDI.12748
Publisher: Public Library of Science (PLoS)
Date: 02-05-2014
Publisher: Wiley
Date: 28-03-2013
DOI: 10.1111/ACPS.12125
Abstract: Growing evidence suggests that patients with bipolar disorder (BD) are impaired in their ability to process non-verbal emotion, although few comprehensive reviews of the behavioural literature exist, and there has been little consideration of methodological issues that may account for discrepant empirical findings. This review examines the behavioural facial, prosodic and multimodal processing literature in BD and discusses methodological issues in the context of this evidence. Major computer databases including Google Scholar and PsychINFO were consulted to conduct a comprehensive review of quantitative behavioural differences in the emotion-processing literature in BD. Articles were accepted only if the target population s le met criteria for a DSM-III, DSM-IV or ICD-10 diagnosis, and they contained a healthy control group. The current literature suggests that facial emotion processing is impaired, and there is preliminary evidence for some behavioural impairment in the processing of emotional prosody. The specificity or generalisability of impairments in facial emotion processing and the effects of mood state are unclear. Similarly, the lack of clarity around the impact of auditory processes on emotional prosody processing warrants a comprehensive examination of the auditory profile in BD.
Publisher: Oxford University Press (OUP)
Date: 21-08-2017
Publisher: Cambridge University Press (CUP)
Date: 17-12-2020
DOI: 10.1017/S0033291720004626
Abstract: There has been relatively limited work focused on understanding whether relatives of in iduals with bipolar disorder (BD) have difficulties in the regulation of emotion, particularly in relation to perceptions about whether emotions can be effectively regulated, or trait behaviours that acknowledge emotions as self-regulators themselves. In this study, we assessed the presence and extent of difficulties in these dimensions of emotion regulation in in iduals with BD compared to unaffected first-degree biological relatives (FDR) for the first time. In total, 161 participants, including euthymic in iduals with BD, unaffected FDRs, and healthy controls, were compared on the Difficulties in Emotion Regulation Scale (DERS) – a multi-dimensional measure of habitual emotion regulation. Clinical data were also collected and examined in relation to DERS scores in a secondary analysis. In the BD group, difficulties were evident for most dimensions of emotion regulation as measured by the DERS and correlated with an earlier onset of illness and more mood episodes. FDRs displayed generally normal emotion regulation, except in terms of their beliefs that emotions can be effectively regulated on this dimension, their reported difficulty was intermediate to the BD group and controls. Habitual emotion regulation difficulties in BD persist irrespective of mood state, are related to the course of illness, and should be targeted in psychological interventions. Further, the perception that emotions cannot be effectively regulated during times of distress seems to represent an endophenotype for BD.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.JAD.2014.03.043
Abstract: People with bipolar disorder (BD) experience significant psychosocial impairment. Understandings of the nature and causes of such impairment is limited by the lack of research exploring the extent to which subjectively reported functioning should be valued as an indicator of objective dysfunction, or examining the relative influence of neurocognition, social cognition and emotion regulation on these important, but different aspects of psychosocial functioning in the context of mania and depression symptoms. This study aimed to address this paucity of research by conducting a comprehensive investigation of psychosocial functioning in a well characterised group of BD patients. Fifty-one BD patients were compared to 52 healthy controls on objectively and subjectively assessed psychosocial outcomes. Relationships between current mood symptoms, psychosocial function and neurocognitive, social cognitive and emotion regulation measures were also examined in the patient group. Patients had significantly worse scores on the global objective and subjective functioning measures relative to controls. In the patient group, although these scores were correlated, regression analyses showed that variance in each of the measures was explained by different predictors. Depressive symptomatology was the most important predictor of global subjective functioning, and neurocognition had a concurrent and important influence with depressive symptoms on objective psychosocial function. Emotion regulation also had an indirect effect on psychosocial functioning via its influence on depressive symptomatology. As this study was cross-sectional in nature, we are unable to draw precise conclusions regarding contributing pathways involved in psychosocial functioning in BD. These results suggest that patients' own evaluations of their subjective functioning represent important indicators of the extent to which their observable function is impaired. They also highlight the importance of incorporating cognitive and emotion regulation assessments into clinical practice when working to reduce psychosocial dysfunction with patients diagnosed with BD.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JAD.2017.08.029
Abstract: Although the study of cognition in first degree relatives (FDRs) is not new, findings in this group are still somewhat inconsistent and much of the research examining FDR populations include in iduals under the age of 25, who are arguably still at significant risk to go on to develop BD. The present study aimed to establish the value of cognitive performance as a genuine endophenotypic marker of familial risk for bipolar disorder (BD), by examining cognition in FDRs aged 25 years or older. The current study compared the cognitive performance of 27 unaffected FDRs to 47 healthy controls (HCs) and 28 BD patients using the MATRICS Consensus Cognitive Battery (MCCB). Results indicated that FDRs had impaired verbal learning performance, as well as selective impairments on a measure of speed of processing and a measure of spatial working memory compared to HC. Limitations relate to the potential insensitivity of some of the tests in the MCCB for detecting cognitive deficits that have been previously noted in BD and FDR s les using other batteries. Findings from this study implicate verbal learning, processing speed and working memory performance as promising candidate endophenotypes of familial risk for BD.
Publisher: Cambridge University Press (CUP)
Date: 07-06-2017
DOI: 10.1017/S003329171700143X
Abstract: Our previous work revealed substantial heterogeneity in the cognitive profile of bipolar disorder (BD) due to the presence of three underlying cognitive subgroups characterized as: globally impaired, selectively impaired, or cognitively intact. In an effort to determine whether these subgroups are differentially related to genetic risk for the illness, we investigated whether cognitive deficits were more pronounced in unaffected siblings (UAS) of BD probands within identified clusters. Cluster analysis was used to identify cognitive clusters in BD ( N = 60). UAS ( N = 49) were classified into groups according to their proband sibling's cluster assignment comparisons were made across all clusters and healthy controls (HCs N = 71). Three cognitive clusters in BD emerged: a globally impaired (36.7%), a selectively impaired (30%), and a cognitively intact cluster (33.3%). UAS showed a qualitatively similar pattern to their BD siblings UAS of the globally impaired BD cluster showed verbal memory and general cognitive impairments relative to HCs. In contrast, UAS of the other two clusters did not differ from HCs. This study corroborates findings from prior work regarding the presence of cognitive heterogeneity in BD. UAS of subjects in the globally impaired BD cluster presented with a qualitatively similar cognitive profile to their siblings and performed worse than all other BD clusters and UAS groups. This suggests that inherited risk factors may be contributing to cognitive deficits more notably in one subgroup of patients with BD, pointing toward differential causes of cognitive deficits in discrete subgroups of patients with the disorder.
Publisher: Wiley
Date: 29-08-2019
DOI: 10.1111/BDI.12821
Abstract: Cognitive dysfunction affects a significant proportion of people with bipolar disorder (BD), but the cause, trajectory and correlates of such dysfunction remains unclear. Increased understanding of these factors is required to progress treatment development for this symptom dimension. This paper provides a critical overview of the literature concerning the trajectories and emerging correlates of cognitive functioning in BD. It is a narrative review in which we provide a qualitative synthesis of current evidence concerning clinical, molecular, neural and lifestyle correlates of cognitive impairment in BD across the lifespan (in premorbid, prodromal, early onset, post-onset, elderly cohorts). There is emerging evidence of empirical links between cognitive impairment and an increased inflammatory state, brain structural abnormalities and reduced neuroprotection in BD. However, evidence regarding the progressive nature of cognitive impairment is mixed, since consensus between different cross-sectional data is lacking and does not align to the outcomes of the limited longitudinal studies available. Increased recognition of cognitive heterogeneity in BD may help to explain some inconsistencies in the extant literature. Large, longitudinally focussed studies of cognition and its covariation alongside biological and lifestyle factors are required to better define cognitive trajectories in BD, and eventually pave the way for the application of a precision medicine approach for in idual patients in clinical practice.
Publisher: Wiley
Date: 07-07-2022
DOI: 10.1111/BJC.12318
Abstract: Evidence shows impaired theory of mind (ToM) in patients with bipolar disorder (BD), yet research examining its cognitive and affective components simultaneously is sparse. Moreover, recognition of socially competitive 'fortune of others' emotions (e.g. envy/gloat) may be related to ToM, but has not been assessed in BD. Finally, if and how ToM and 'fortune of others' emotions relate to affective empathy in BD is currently unclear. This study aimed to address these points. 64 BD patients and 34 healthy controls completed the Yoni task, a visual task assessing first- and second-order cognitive and affective ToM as well as 'fortune of others' emotions. The Toronto Empathy Questionnaire was used to assess self-reported affective empathy. Patients with BD showed no deficits in cognitive and affective ToM or recognition of 'fortune of others' emotions. The ability to infer 'fortune of others' emotions correlated with several ToM measures, indicating that these functions are part of the same system. Patients with BD reported similar levels of affective empathy to healthy controls, and this was not related to ToM or 'fortune of others' emotions, suggesting that affective empathy represents a separate social domain. These findings highlight areas of spared social functioning in BD, which may be utilized in therapeutic strategies. Our results suggest theory of mind and empathy may represent areas of potentially spared cognitive functioning in BD. As many BD patients have experienced adversity during developmental periods in which theory of mind and empathy develop, our findings suggest that these abilities may be markers of resilience in the disorder. Our findings are important for the formulation of therapeutic interventions for BD, which may include considering practical ways that a patients' knowledge of intact ToM and empathy could be utilized to reduce self-stigma and promote self-efficacy, improved well-being and functioning.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.PSYCHRES.2013.07.037
Abstract: Affective prosody is substantially impaired in schizophrenia, yet little is known about affective prosody in bipolar disorder (BD). The aim of this study was to examine affective prosody performance in schizophrenia, schizoaffective disorder and BD on a newly released standardised assessment to further our understanding of BD performance. Fifty-four schizophrenia, 11 schizoaffective and 43 BD patients were compared with 112 healthy controls (HC) on four affective prosody subtests of the Comprehensive Affective Testing System (CATS). Schizophrenia patients showed a 10% reduction in accuracy on two subtests compared to HC. BD showed a trend for performance intermediary to schizophrenia and HC and schizoaffective patients performed more like HC on these four affective prosody measures. Severity of current auditory hallucination, across all patients, was related to task performance on three of the measures. These data confirm that schizophrenia and BD have reduced affective prosody performance, with deficits in BD being less pronounced than schizophrenia. The schizoaffective results in this study should be interpreted with caution due to small s le size.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.JAD.2013.07.009
Abstract: This paper reports the performance of DSM-IV-TR diagnosed bipolar disorder (BD) patients on a well-recognised measure of theory of mind (ToM) that commonly elicits group-related differences in schizophrenia research. Forty-nine BD patients and 49 age and gender matched controls completed Langdon and Coltheart (1999)Picture Sequencing Task. Relative to controls, patients with BD performed significantly worse on the ToM relevant false-belief stories of the picture sequencing task, but not on the control stories requiring social script knowledge, executive control or an understanding of causal connexions. There were no differences in the ToM performance of symptomatic versus euthymic patients or those categorised as having BD I or BD II. As sub group sizes were small, data suggesting a trait-like deficit in ToM should be interpreted with caution. The results support previous evidence of ToM impairment in BD and indicate a potential endophenotypic overlap in the phenomenology of both schizophrenia and BD.
Publisher: Cambridge University Press (CUP)
Date: 03-02-2017
DOI: 10.1017/S1355617716001211
Abstract: Objectives: Emotion recognition impairments have been demonstrated in schizophrenia (Sz), but are less consistent and lesser in magnitude in bipolar disorder (BD). This may be related to the extent to which different face processing strategies are engaged during emotion recognition in each of these disorders. We recently showed that Sz patients had impairments in the use of both featural and configural face processing strategies, whereas BD patients were impaired only in the use of the latter. Here we examine the influence that these impairments have on facial emotion recognition in these cohorts. Methods: Twenty-eight in iduals with Sz, 28 in iduals with BD, and 28 healthy controls completed a facial emotion labeling task with two conditions designed to separate the use of featural and configural face processing strategies part-based and whole-face emotion recognition. Results: Sz patients performed worse than controls on both conditions, and worse than BD patients on the whole-face condition. BD patients performed worse than controls on the whole-face condition only. Conclusions: Configural processing deficits appear to influence the recognition of facial emotions in BD, whereas both configural and featural processing abnormalities impair emotion recognition in Sz. This may explain discrepancies in the profiles of emotion recognition between the disorders. ( JINS , 2017, 23 , 287–291)
Publisher: Informa UK Limited
Date: 18-02-2019
Publisher: Oxford University Press (OUP)
Date: 2021
DOI: 10.1093/SCHIZBULLOPEN/SGAB033
Abstract: Processing speed (PS) impairment is one of the most severe and common cognitive deficits in schizophrenia. Previous studies have reported correlations between PS and white matter diffusion properties, including fractional anisotropy (FA), in several fiber bundles in schizophrenia, suggesting that white matter alterations could underpin decreased PS. In schizophrenia, white matter alterations are most prevalent within inter-hub connections of the rich club. However, the spatial and topological characteristics of this association between PS and FA have not been investigated in patients. In this context, we tested whether structural connections comprising the rich club network would underlie PS impairment in 298 patients with schizophrenia or schizoaffective disorder and 190 healthy controls from the Australian Schizophrenia Research Bank. PS, measured using the digit symbol coding task, was largely (Cohen’s d = 1.33) and significantly (P & .001) reduced in the patient group when compared with healthy controls. Significant associations between PS and FA were widespread in the patient group, involving all cerebral lobes. FA was not associated with other cognitive measures of phonological fluency and verbal working memory in patients, suggesting specificity to PS. A topological analysis revealed that despite being spatially widespread, associations between PS and FA were over-represented among connections forming the rich club network. These findings highlight the need to consider brain network topology when investigating high-order cognitive functions that may be spatially distributed among several brain regions. They also reinforce the evidence that brain hubs and their interconnections may be particularly vulnerable parts of the brain in schizophrenia.
Publisher: Wiley
Date: 09-10-2013
DOI: 10.1111/BDI.12134
Abstract: There is a large body of evidence to indicate that neurocognitive impairments in bipolar disorder (BD) may represent viable endophenotypes however, a standard consensus-based battery of cognitive tests used to measure them is yet to appear. There is potential for a neurocognitive battery which was developed for use in the related disorder, schizophrenia - the MATRICS Consensus Cognitive Battery (MCCB) - to provide a consistent measurement tool with a standard to which the cognitive capacity of BD can be compared to other disorders. However, its suitability for capturing neurocognitive impairment in BD cohorts is not well established. Moreover, neurocognitive tests recently recommended by the International Society for Bipolar Disorders (ISBD) for inclusion in a consensus neurocognitive battery for BD have not been evaluated in the context of the MCCB. An evaluation of (i) the clinical efficacy of the MCCB and (ii) the tests recommended by the ISBD in a BD cohort were the aims of the current study. A total of 50 patients with BD (mean age = 38 years) and 52 healthy controls (mean age = 34 years) completed all of the MCCB subtests, in addition to the well-recognized Trail Making Test-Part B and the Colour-Word Stroop. Multivariate analyses of variance of the MCCB domains revealed a significant group effect for overall cognition, and significantly reduced patient performance on speed of processing, working memory, and visual and verbal learning. A second multivariate analysis of variance using a newly created composite score called executive function, comprising scores on an existing MCCB subtest in addition to TMT-B and Colour-Word Stroop, revealed significant differences on this domain as well. Subgroup analysis indicated that there were no differences in any domain score performance between symptomatic and euthymic patients, or bipolar I and II disorder patient groups. Our findings suggest that the MCCB and two additionally recommended ISBD executive function measures form a promising consensus-based research tool for examining neurocognition in BD.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Wiley
Date: 07-12-2017
DOI: 10.1111/BDI.12577
Publisher: Informa UK Limited
Date: 05-2013
DOI: 10.1080/13546805.2012.690938
Abstract: Bipolar Disorder (BD) is a serious mood disorder, the aetiology of which is still unclear. The disorder is characterised by extreme mood variability in which patients fluctuate between markedly euphoric, irritable, and elevated states to periods of severe depression. The current research literature shows that BD patients demonstrate compromised neurocognitive ability in addition to these mood symptoms. Viable candidate genes implicated in neurocognitive and socioemotional processes may explain the development of these core emotion abnormalities. Additionally, links between faulty neurocognition and impaired socioemotional ability complement genetic explanations of BD pathogenesis. This review examines associations between cognition indexing prefrontal neural regions and socioemotional impairments including emotion processing and regulation. A review of the effect of COMT and TPH2 on these functions is also explored. Major computer databases including PsycINFO, Google Scholar, and Medline were consulted in order to conduct a comprehensive review of the genetic and cognitive literature in BD. This review determines that COMT and TPH2 genetic variants contribute susceptibility to abnormal prefrontal neurocognitive function which oversees the processing and regulation of emotion. This provides for greater understanding of some of the emotional and cognitive symptoms in BD. Current findings in this direction show promise, although the literature is still in its infancy and further empirical research is required to investigate these links explicitly.
Publisher: Wiley
Date: 12-2022
DOI: 10.1111/BDI.13269
Publisher: Cambridge University Press (CUP)
Date: 15-01-2014
DOI: 10.1017/S1355617713001367
Abstract: Patients with bipolar disorder (BD) have difficulty in recognizing and discriminating facial emotions. However, beyond this broad finding, existing literature is equivocal about the specific nature of impairments, and progress toward adequately profiling facial emotion processing in BD is h ered by methodological inconsistencies. The current study aimed to advance the literature by comparing 50 BD patients and 52 controls on a series of facial emotion processing tasks. Results indicated that patients with BD had a small, yet consistent impairment in emotion processing overall. This impairment did not vary as a function of specific emotions, tasks, or intensities between groups, and was not influenced by current mood state. These results suggest that past inconsistencies in the literature are unlikely to be attributable to task related artifacts influencing the estimation of an effect. These findings add to our understanding of social cognition in BD, and have important implications for clinicians treating patients with the disorder. ( JINS , 2014, 20 , 1–9)
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.JAD.2013.08.039
Abstract: Accurate emotion processing is critical to understanding the social world. Despite growing evidence of facial emotion processing impairments in patients with bipolar disorder (BD), comprehensive investigations of emotional prosodic processing is limited. The existing (albeit sparse) literature is inconsistent at best, and confounded by failures to control for the effects of gender or low level sensory-perceptual impairments. The present study sought to address this paucity of research by utilizing a novel behavioural battery to comprehensively investigate the auditory-prosodic profile of BD. Fifty BD patients and 52 healthy controls completed tasks assessing emotional and linguistic prosody, and sensitivity for discriminating tones that deviate in litude, duration and pitch. BD patients were less sensitive than their control counterparts in discriminating litude and durational cues but not pitch cues or linguistic prosody. They also demonstrated impaired ability to recognize happy intonations although this was specific to male's with the disorder. The recognition of happy in the patient group was correlated with pitch and litude sensitivity in female patients only. The small s le size of patients after stratification by current mood state prevented us from conducting subgroup comparisons between symptomatic, euthymic and control participants to explicitly examine the effects of mood. Our findings indicate the existence of a female advantage for the processing of emotional prosody in BD, specifically for the processing of happy. Although male BD patients were impaired in their ability to recognize happy prosody, this was unrelated to reduced tone discrimination sensitivity. This study indicates the importance of examining both gender and low order sensory perceptual capacity when examining emotional prosody.
Publisher: IEEE
Date: 10-2016
Publisher: Briefland
Date: 07-2013
DOI: 10.5812/IJEM.6615
Publisher: Wiley
Date: 02-03-2021
DOI: 10.1111/BDI.13063
Publisher: Cold Spring Harbor Laboratory
Date: 19-02-2020
DOI: 10.1101/2020.02.18.20022608
Abstract: Iron has been found to play an important role in neurodegeneration. Quantitative susceptibility mapping (QSM) is a relatively new – and the most accurate - MRI technique available for assessment of iron deposition in the brain. There is a rapidly growing number of studies using QSM to investigate brain iron distribution in neurodegenerative diseases including but not limited to Alzheimer’s disease, Parkinson’s disease, Amyotrophic lateral sclerosis, Huntington disease and Wilson’s disease. These studies have shown increased iron deposition in the brain regions that are associated with the pathology of the disease. Additionally, QSM is found to be accurate in differential diagnosis of neurodegenerative diseases where clinical presentations are indistinguishable. Structural changes evidenced by QSM are reported to precede the onset of clinical manifestation of neurodegenerative diseases suggesting its benefit in early diagnosis. To our knowledge, no systematic review of QSM findings in neurodegenerative diseases has been published before. A systematic synthesis and conclusion of the existing evidence can improve our understanding of the pathophysiology of neurodegeneration, describe the clinical and research utility of QSM, and point out the direction for future studies in neuropsychiatric disorders. This document is a systematic review protocol developed in accordance with Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guideline. This protocol is prepared as a guide for conducting a systematic review of studies investigating brain iron and microstructural changes in neurodegenerative diseases using quantitative susceptibility mapping (QSM). This protocol has also been submitted to Prospective Register of Systematic Reviews (PROSPERO) for registration. By publishing this protocol, we aim to enhance clarity and transparency of our systematic review and minimise the risk of bias in the process of its development.
Publisher: Wiley
Date: 20-05-2014
DOI: 10.1111/ACPS.12295
Abstract: Converging evidence suggests that in bipolar disorder (BD), social cognition and emotion regulation are affected by the capacity for effective neurocognitive function. Adaptive emotion regulation may also rely on intact social cognition, and it is possible that social cognition acts as a mediator in its relationship with neurocognition. We aimed to address this hypothesis by explicitly examining interrelationships among neurocognition, social cognition and emotion regulation in an out-patient s le meeting criteria for a DSM-IV-TR diagnosis of BD compared with controls. Fifty-one BD patients and 52 healthy controls completed a battery of tests assessing neurocognition, social cognition (emotion perception and theory of mind) and emotion regulation. Path analysis revealed that in BD, neurocognition was associated with social cognition, but social cognition was not associated with emotion regulation as expected. In contrast, a component of social cognition was found to mediate the relationship between neurocognition and emotion regulation in healthy controls. These findings highlight differences in the pattern of associations between neurocognition, social cognition and emotion regulation across BD patients and controls. In the present data, these results appear to indicate that neurocognitive and social cognitive abilities generally operate in isolation from emotion regulation in BD.
Publisher: Cambridge University Press (CUP)
Date: 03-06-2016
DOI: 10.1017/S1355617716000412
Abstract: Objectives: Use of appropriate face processing strategies is important for facial emotion recognition, which is known to be impaired in schizophrenia (SZ) and bipolar disorder (BD). There is preliminary evidence of abnormalities in the use of face processing strategies in the former, but there has been no explicit attempt to assess face processing in patients with BD. Methods: Twenty-eight BD I, 28 SZ, and 28 healthy control participants completed tasks assessing featural and configural face processing. The facial inversion effect was used as a proxy of second order configural face processing and compared to featural face processing performance (which is known to be relatively less affected by facial inversion). Results: Controls demonstrated the usual second-order inversion pattern. In the BD group, the absence of a second-order configural inversion effect in the presence of a disproportionate bias toward a featural inversion effect was evident. Despite reduced accuracy performance in the SZ group compared to controls, this group unexpectedly showed a normal second-order configural accuracy inversion pattern. This was in the context of a reverse inversion effect for response latency, suggesting a speed- versus -accuracy trade-off. Conclusions: To our knowledge, this is the first study to explicitly examine and contrast face processing in BD and SZ. Our findings indicate a generalized impairment on face processing tasks in SZ, and the presence of a second-order configural face processing impairment in BD. It is possible that these face processing impairments represent a catalyst for the facial emotion recognition deficits that are commonly reported in the literature. ( JINS , 2016, 22 , 652–661)
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.JAD.2015.12.022
Abstract: Despite known overlaps in the pattern of cognitive impairments in in iduals with bipolar disorder (BD), schizophrenia (SZ) and schizoaffective disorder (SZA), few studies have examined the extent to which cognitive performance validates traditional diagnostic boundaries in these groups. In iduals with SZ (n=49), schizoaffective disorder (n=33) and BD (n=35) completed a battery of cognitive tests measuring the domains of processing speed, immediate memory, semantic memory, learning, working memory, executive function and sustained attention. A discriminant functions analysis revealed a significant function comprising semantic memory, immediate memory and processing speed that maximally separated patients with SZ from those with BD. Initial classification scores on the basis of this function showed modest diagnostic accuracy, owing in part to the misclassification of SZA patients as having SZ. When SZA patients were removed from the model, a second cross-validated classifier yielded slightly improved diagnostic accuracy and a single function solution, of which semantic memory loaded most heavily. A cluster of non-executive cognitive processes appears to have some validity in mapping onto traditional nosological boundaries. However, since semantic memory performance was the primary driver of the discrimination between BD and SZ, it is possible that performance differences between the disorders in this cognitive domain in particular, index separate underlying aetiologies.
Publisher: Wiley
Date: 11-11-2021
DOI: 10.1111/JNP.12267
Abstract: Increasing evidence suggests that facial emotion recognition is impaired in bipolar disorder (BD). However, patient–control differences are small owing to ceiling effects on the tasks used to assess them. The extant literature is also limited by a relative absence of attention towards identifying patterns of emotion misattribution or understanding whether neutral faces are mislabelled in the same way as ones displaying emotion. We addressed these limitations by comparing facial emotion recognition performance in BD patients and healthy controls on a novel and challenging task. Thirty‐four outpatients with BD I and 32 demographically matched healthy controls completed a facial emotion recognition task requiring the labelling of neutral and emotive faces displayed at low emotional intensities. Results indicated that BD patients were significantly less accurate at labelling faces than healthy controls, particularly if they displayed fear or neutral expressions. There were no between‐group differences in response times or patterns of emotion mislabelling, with both groups confusing sad and neutral faces, although BD patients also mislabelled sad faces as angry. Task performance did not significantly correlate with mood symptom severity in the BD group. These findings suggest that facial emotion recognition impairments in BD extend to neutral face recognition. Emotion misattribution occurs in a similar, albeit exaggerated manner in patients with BD compared to healthy controls. Future behavioural and neuroimaging research should reconsider the use of neutral faces as baseline stimuli in their task designs.
Publisher: Informa UK Limited
Date: 09-2013
DOI: 10.1080/13546805.2012.725820
Abstract: Theory of mind (ToM) refers to the ability to understand the mental state of self and others. There is limited research into this topic in bipolar disorder (BD), with no previous study examining ToM in a BD group within a psychotic manic phase. Twenty-eight psychotic manic BD patients were compared with 30 schizophrenia (SCZ) patients and 29 healthy controls (HC). Participants performed a ToM story comprehension task that compared ToM stories and non-ToM stories (which we relabelled non-ToM "semantic" stories). Performance was examined by answering comprehension questions. Both patient groups were equally impaired on their scores for ToM stories (scores BD = 10/24, SCZ = 9/24, HC = 14/24, p < .001). Interestingly, both patient groups showed reduced performance on non-ToM semantic stories (scores BD = 12/24, SCZ = 9/24, HC = 15/24, p < .001) SCZ showed a larger deficit. Reduced ToM performance was correlated with delusion severity in the BD group only. ToM performance was impaired in BD patients experiencing psychotic symptoms. Patient performance was also impaired on the control condition (i.e., non-ToM semantic stories) supporting an additional deficit in semantic processing.
Publisher: Wiley
Date: 06-2020
DOI: 10.1002/EAT.23317
Publisher: Wiley
Date: 27-01-2020
DOI: 10.1111/BDI.12889
Publisher: SAGE Publications
Date: 30-10-2014
Abstract: Our aim was to assess the impact of creating a female-only area within a mixed-gender inpatient psychiatry service, on female patient safety and experience of care. The Alfred hospital reconfigured one of its two psychiatry wards to include a female-only area. Documented incidents compromising the safety of women on each ward in the 6 months following the refurbishment were compared. Further, a questionnaire assessing perceived safety and experience of care was administered to female inpatients on both wards, and staff feedback was also obtained. The occurrence of documented incidents compromising females’ safety was found to be significantly lower on the ward containing a female-only area. Women staying on this ward rated their perceived safety and experience of care significantly more positively than women staying where no such gender segregation was available. Further, the female-only area was identified by the majority of surveyed staff to provide a safer environment for female patients. Establishing female-only areas in psychiatry wards is an effective way to improve the safety and experience of care for female patients.
Publisher: Frontiers Media SA
Date: 06-2015
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.SCHRES.2014.05.026
Abstract: Facial affect processing (FAP) deficits in schizophrenia (SZ) and bipolar disorder (BD) have been widely reported although effect sizes vary across studies, and there are limited direct comparisons of the two groups. Further, there is debate as to the influence of both psychotic and mood symptoms on FAP. This study aimed to address these limitations by recruiting groups of psychosis patients with either a diagnosis of SZ or BD and comparing them to healthy controls (HC) on a well validated battery of four FAP subtests: affect discrimination, name affect, select affect and match affect. Overall, both groups performed more poorly than controls in terms of accuracy. In SZ, this was largely driven by impairments on three of the four subtests. The BD patients showed impaired performance specifically on the match affect subtest, a task that had a high cognitive load. FAP performance in the psychosis patients was correlated with severity of positive symptoms and mania. This study confirmed that FAP deficits are a consistent finding in SZ that occur independent of task specific methodology whilst FAP deficits in BD are more subtle. Further work in this group is needed to replicate these results.
Publisher: Cambridge University Press (CUP)
Date: 19-06-2018
DOI: 10.1017/S003329171700157X
Abstract: Cognitive deficits are a core feature of schizophrenia, and impairments in most domains are thought to be stable over the course of the illness. However, cross-sectional evidence indicates that some areas of cognition, such as visuospatial associative memory, may be preserved in the early stages of psychosis, but become impaired in later established illness stages. This longitudinal study investigated change in visuospatial and verbal associative memory following psychosis onset. In total 95 first-episode psychosis (FEP) patients and 63 healthy controls (HC) were assessed on neuropsychological tests at baseline, with 38 FEP and 22 HCs returning for follow-up assessment at 5–11 years. Visuospatial associative memory was assessed using the Cambridge Neuropsychological Test Automated Battery Visuospatial Paired-Associate Learning task, and verbal associative memory was assessed using Verbal Paired Associates subtest of the Wechsler Memory Scale - Revised. Visuospatial and verbal associative memory at baseline did not differ significantly between FEP patients and HCs. However, over follow-up, visuospatial associative memory deteriorated significantly for the FEP group, relative to healthy in iduals. Conversely, verbal associative memory improved to a similar degree observed in HCs. In the FEP cohort, visuospatial (but not verbal) associative memory ability at baseline was associated with functional outcome at follow-up. Areas of cognition that develop prior to psychosis onset, such as visuospatial and verbal associative memory, may be preserved early in the illness. Later deterioration in visuospatial memory ability may relate to progressive structural and functional brain abnormalities that occurs following psychosis onset.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.PSYCHRES.2014.12.001
Abstract: Current emotion regulation research in BD has tended to focus on the extent to which patients control their emotions using different cognitive strategies. Fewer studies have investigated whether patients with BD have difficulties in regulating other dimensions of emotion that serve a functional purpose and are thereby more amenable to change. To overcome this paucity of research we utilised a multi-dimensional measure of emotion regulation to characterise the emotion regulation profile of BD, and examine its utility in predicting trait mania and depression propensity. Fifty BD patients and 52 healthy controls completed the Difficulties in Emotion Regulation Scale (DERS) and the General Behaviour Inventory (GBI). Results indicated that patients had difficulties in emotion regulation across a range of dimensions. Impulse control difficulties most parsimoniously predicted trait (hypo)mania propensity in BD patients, whilst poor access to mood regulation strategies predicted depressive propensity. Predictors of the propensity to experience these moods differed in the control group. These findings represent an important step toward informing the development of new treatment strategies to remediate emotion regulation difficulties and improve BD symptomatology.
Publisher: Cold Spring Harbor Laboratory
Date: 18-07-2020
DOI: 10.1101/2020.07.16.20155887
Abstract: The novel coronavirus disease (COVID-19) poses significant mental health challenges globally however, to date, there is limited community level data. This study reports on the first wave of data from the COLLATE project (COvid-19 and you: mentaL heaLth in AusTralia now survEy), an ongoing study aimed at understanding the impact of the COVID-19 pandemic on the mental health and well-being of Australians. This paper addresses prevailing primary concerns related to the COVID-19 pandemic, current levels of negative emotions and risk factors predicting these negative emotions. On April 1st to 4th 2020, 5158 adult members of the Australian general public completed an online survey. Participants ranked their top ten current primary concerns about COVID-19, and completed standardized measures to ascertain levels of negative emotions (specifically, depression, anxiety and stress). Socio-demographic information was also collected and used in the assessment of risk factors. The top three primary concerns were all related to the health and well-being of family and loved ones. As expected, levels of negative emotion were exceptionally high. Modelling of predictors of negative emotions established several risk factors related to demographic variables, personal vulnerabilities, financial stresses, and social distancing experiences particularly being young, being female, or having a mental illness diagnosis. The data provides important characterization of the current mental health of Australians during the COVID-19 pandemic. Critically, it appears that specific groups in the Australian community may need special attention to ensure their mental health is protected during these difficult times. The data further suggests the need for immediate action to combat high levels of psychological distress, along with the exacerbation of mental health conditions, in relation to the COVID-19 pandemic in Australia. These results may provide some direction for international researchers hoping to characterize similar issues in other countries.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.PSYNEUEN.2014.02.004
Abstract: Emerging research has suggested that hormone treatments such as selective oestrogen receptor modulators (SERMs) or progestins may be useful in the treatment of mania. The current pilot study compared the use of the SERM tamoxifen and the progestin medroxyprogesterone acetate (MPA), as an adjunct to mood stabiliser medications, for the treatment of mania symptoms in 51 women in a 28-day double blind, placebo controlled study. The primary outcome was the change between baseline and day 28 mania scores as measured by the Clinician Administered Rating Scale for Mania (CARS-M). Adjunctive MPA treatment provided greater and more rapid improvement in mania symptoms compared with adjunctive placebo and tamoxifen treatment. Adjunctive therapy with MPA may be a potentially useful new treatment for persistent mania, leading to a greater and more rapid resolution of symptoms compared with mood stabiliser treatment alone.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.PSYCHRES.2019.01.032
Abstract: In iduals with schizophrenia who are homozygous at the c.267C > A (rs2067477) single nucleotide polymorphism within the muscarinic M1 receptor gene have been reported to perform less well on the Wisconsin Card Sorting Test (WCST). We investigated if rs2067477 genotype variation influenced WCST performance and non-executive cognition cross-diagnostically in a s le of 147 schizophrenia spectrum participants (SSD) and 294 healthy controls. We were unable to detect any significant differences in executive and non-executive cognitive performance across genotype. A broader genetic focus should be considered when investigating the association between the muscarinic system and cognition in SSD.
Publisher: Cambridge University Press (CUP)
Date: 09-07-2020
DOI: 10.1017/S0033291719001417
Abstract: In schizophrenia, relative stability in the magnitude of cognitive deficits across age and illness duration is inconsistent with the evidence of accelerated deterioration in brain regions known to support these functions. These discrepant brain–cognition outcomes may be explained by variability in cognitive reserve (CR), which in neurological disorders has been shown to buffer against brain pathology and minimize its impact on cognitive or clinical indicators of illness. Age-related change in fluid reasoning, working memory and frontal brain volume, area and thickness were mapped using regression analysis in 214 in iduals with schizophrenia or schizoaffective disorder and 168 healthy controls. In patients, these changes were modelled as a function of CR. Patients showed exaggerated age-related decline in brain structure, but not fluid reasoning compared to controls. In the patient group, no moderation of age-related brain structural change by CR was evident. However, age-related cognitive change was moderated by CR, such that only patients with low CR showed evidence of exaggerated fluid reasoning decline that paralleled the exaggerated age-related deterioration of underpinning brain structures seen in all patients . In schizophrenia-spectrum illness, CR may negate ageing effects on fluid reasoning by buffering against pathologically exaggerated structural brain deterioration through some form of compensation. CR may represent an important modifier that could explain inconsistencies in brain structure – cognition outcomes in the extant literature.
Publisher: Oxford University Press (OUP)
Date: 07-06-2021
Abstract: The nature of the relationship between cognition and brain morphology in schizophrenia-spectrum disorders (SSD) and bipolar disorder (BD) is uncertain. This review aimed to address this, by providing a comprehensive systematic investigation of links between several cognitive domains and brain volume, cortical thickness, and cortical surface area in SSD and BD patients across early and established illness stages. An initial search of PubMed and Scopus databases resulted in 1486 articles, of which 124 met inclusion criteria and were reviewed in detail. The majority of studies focused on SSD, while those of BD were scarce. Replicated evidence for specific regions associated with indices of cognition was minimal, however for several cognitive domains, the frontal and temporal regions were broadly implicated across both recent-onset and established SSD, and to a lesser extent BD. Collectively, the findings of this review emphasize the significance of both frontal and temporal regions for some domains of cognition in SSD, while highlighting the need for future BD-related studies on this topic.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Wiley
Date: 16-10-2019
DOI: 10.1111/BDI.12834
Abstract: Impairments in affective cognition are part of the neurocognitive profile and possible treatment targets in bipolar disorder (BD), but the findings are heterogeneous. The International Society of Bipolar Disorder (ISBD) Targeting Cognition Task Force conducted a systematic review to (i) identify the most consistent findings in affective cognition in BD, and (ii) provide suggestions for affective cognitive domains for future study and meta-analyses. The review included original studies reporting behavioral measures of affective cognition in BD patients vs controls following the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Searches were conducted on PubMed/MEDLINE, EMBASE, and PsychInfo from inception until November 2018. A total of 106 articles were included (of which nine included data for several affective domains) 41 studies assessed emotional face processing 23 studies investigated reactivity to emotional words and images 3 investigated explicit emotion regulation 17 assessed implicit emotion regulation 31 assessed reward processing and affective decision making. In general, findings were inconsistent. The most consistent findings were trait-related difficulties in facial emotion recognition and implicit emotion regulation, and impairments in reward processing and affective decision making during mood episodes. Studies using eye-tracking and facial emotion analysis revealed subtle trait-related abnormalities in emotional reactivity. The ISBD Task Force recommends facial expression recognition, implicit emotion regulation, and reward processing as domains for future research and meta-analyses. An important step to aid comparability between studies in the field would be to reach consensus on an affective cognition test battery for BD.
Publisher: Cambridge University Press (CUP)
Date: 29-05-2014
DOI: 10.1017/S1355617714000484
Abstract: Evidence suggests that standard learning and recall indexes are sensitive markers of verbal declarative memory ability in bipolar disorder (BD), but no study has examined performance across the full range of component process measures on the Hopkins Verbal Learning Test (HVLT-R) in a BD cohort. As the HVLT-R is part of a widely used battery of cognitive functioning backed by the U.S. Federal Drug Administration as the accepted battery for use in pro-cognitive trials assessing cognitive-enhancing drugs in the related disorder schizophrenia, estimating the utility of its measures in BD is important. Forty-nine BD patients and 51 healthy controls completed the HVLT-R, which was scored for 13 variables of interest, across 4 indices: recall and learning, recognition, strategic organization, and errors. BD patients had greater difficulty in learning the HVLT-R word list compared to controls. They also demonstrated impairment in delayed recall/recognition. There were no differences between the groups in terms of their slope of learning, retrieval index, retention percentage, semantic or serial clustering, errors, or level of retrieval. This pattern was consistent across symptomatic and euthymic patients. The HVLT-R has some utility in characterizing the component processes involved in memory function in BD, such that memory impairments appear to be attributable to deficient encoding processes during the acquisition phase of learning. In the case of planning pro-cognitive clinical trials, the encoding deficits in BD observed here may be sensitive enough to potentially respond to medications designed to enhance the verbal memory performance. ( JINS , 2014, 20 , 1–9)
Publisher: Elsevier BV
Date: 05-2020
Publisher: Cambridge University Press (CUP)
Date: 28-02-2017
DOI: 10.1017/S0033291717000307
Abstract: Current group-average analysis suggests quantitative but not qualitative cognitive differences between schizophrenia (SZ) and bipolar disorder (BD). There is increasing recognition that cognitive within-group heterogeneity exists in both disorders, but it remains unclear as to whether between-group comparisons of performance in cognitive subgroups emerging from within each of these nosological categories uphold group-average findings. We addressed this by identifying cognitive subgroups in large s les of SZ and BD patients independently, and comparing their cognitive profiles. The utility of a cross-diagnostic clustering approach to understanding cognitive heterogeneity in these patients was also explored. Hierarchical clustering analyses were conducted using cognitive data from 1541 participants (SZ n = 564, BD n = 402, healthy control n = 575). Three qualitatively and quantitatively similar clusters emerged within each clinical group: a severely impaired cluster, a mild-moderately impaired cluster and a relatively intact cognitive cluster. A cross-diagnostic clustering solution also resulted in three subgroups and was superior in reducing cognitive heterogeneity compared with disorder clustering independently. Quantitative SZ–BD cognitive differences commonly seen using group averages did not hold when cognitive heterogeneity was factored into our s le. Members of each corresponding subgroup, irrespective of diagnosis, might be manifesting the outcome of differences in shared cognitive risk factors.
Publisher: Elsevier BV
Date: 2016
Publisher: SAGE Publications
Date: 14-10-2013
Abstract: Neurocognitive ability and mood have often been discussed as contributing mechanisms to the severe psychosocial dysfunction experienced in bipolar disorder (BD). In contrast, there has been little discussion on the contribution of social cognition or emotion regulation. This paper aims to assert a potential role for these constructs in psychosocial functioning in BD, with an overarching goal to highlight the necessary importance of considering them in future research examining psychosocial outcomes in the disorder. This paper provides a theoretical synthesis of available and indirect evidence for an influence of (1) social cognition and (2) emotion regulation on psychosocial functioning it acknowledges important clinical questions that need addressing, and discusses how current research might be translated to improve the treatment of psychosocial dysfunction in BD. Given their assumed roles in facilitating social interactions and modulating behaviours, it is certainly plausible that abnormalities in social cognition and emotion regulation are detrimental to psychosocial functioning. Currently, there is only minimal direct evidence examining their influence, although existing BD studies are preliminarily supportive of relationships between these constructs. There are reasonable theoretical grounds, supported by indirect and preliminary evidence, to suggest that social cognition and emotion regulation may be important in the prediction of psychosocial outcome in BD. However, this proposition is limited by the paucity of empirical research directly examining this matter.
Publisher: Wiley
Date: 14-03-2019
DOI: 10.1111/BPH.14584
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.PSYCHRES.2014.05.041
Abstract: We assessed theory of mind (ToM) performance in unaffected first-degree relatives of in iduals with bipolar disorder compared to healthy controls across several well recognised tasks. Results indicated that the former group were significantly impaired on the verbal but not visual or higher-order ToM tasks, suggesting that a verbal ToM deficit might be a useful endophenotypic marker for bipolar disorder.
Start Date: 2014
End Date: 2012
Funder: Swinburne University of Technology
View Funded ActivityStart Date: 2015
End Date: 2018
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2011
End Date: 2011
Funder: Australian Rotary Health/Bipolar Expedition
View Funded Activity