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1 Cognitive Symptom Trajectories among Forensic Inpatients Diagnosed with Psychotic Disorders CSU Student Research Competition May 4 th -5 th, 2018 By: Jennifer Hatch Mentor: Danielle Burchett, PhD California State University, Monterey Bay Collaborator: David M. Glassmire, PhD Patton State Hospital
2 Disclosures The statements and opinions expressed are those of the authors and do not constitute the official views or the official policy of DSH-Patton, the California Department of State Hospitals, or the State of California. Funding: Undergraduate Research Opportunities Center (UROC) University of Minnesota Press: Test Division
3 Overview of Psychotic Disorders Schizophrenia, Schizoaffective Characterized by Hallucinations & Delusions 1% of U.S. population (American Psychiatric Association [APA], 2013; Fazel & Danesh, 2002)
4 Clinicians need accurate information for: Assessment Understanding patient experience Treatment
5 Two-Part Cross-Sectional Study Overall Cognitive Symptom Trajectory Impact of Comorbid Mood Disorders
6 Cognitive Symptoms Processing Speed Reasoning Verbal Memory Working Memory Attention/ Vigilance (Dickinson, & Harvey, 2009; Garcia, Viechtbauer, Simons, van Os, & Krabbendam, 2009; Keefe, & Harvey, 2012)
7 Research Question 1 What is the trajectory of cognitive symptoms for patients as they age? Research Question 2 How would comorbid mood disorders impact cognitive symptom severity?
8 Research So Far Follow Patients over Time Compare across Age Groups (American Psychiatric Association [APA], 2013; Fazel & Danesh, 2002)
9 Severity of Symptoms Neurodevelopmental Trajectory Model Young Middle Older (Heaton et al., 2001; Kurtz, 2005)
10 Severity of Symptoms Neurodegenerative Trajectory Model Young Middle Older (Irani et al., 2011; Herold, Schmid, Lässer, Seidl, & Schröder, 2017)
11 Research Question 1 What is the trajectory of cognitive symptoms for patients as they age?
12 Research Question 1 Hypotheses: Neurodegenerative Trajectory
13 Mood Disorders Anxiety Depression Mania
14 Research Question 2 How would comorbid mood disorders impact cognitive symptom severity? Exploratory Analyses: Due to the limited and mixed research, we could not form formal hypotheses (Bora, Yucel, & Pantelis, 2009; Depp et al., 2007)
15 Method
16 2.4% Sample (N = 708) 73.7% Male 17.4% 2.7% 27.4% Caucasian 50.1% African American Hispanic Asian American Other
17 Years at Hospital M(SD) = 2.46(4.30) 48.7% 25.3% 19.1% 3.1% 3.2% 0.6% Not Guilty by Reason of Insanity Mentally Disordered Offender Incompetent to Stand Trial Mentally Disordered Sex Offender Prison Transfer Other
18 Measures Minnesota Multiphasic Personality Inventory 2 Restructured Form (MMPI-2-RF) VRIN-r COG
19 Variable Response Inconsistency Revised (VRIN-r) Reading Comprehension Problems Uncooperative VRIN-r Cognitive Problems Fatigue (Ben-Porath, 2012; Ben-Porath & Tellegen, 2008/2011)
20 Variable Response Inconsistency Revised (VRIN-r) Reading Comprehension Problems Uncooperative VRIN-r Cognitive Problems Fatigue (Ben-Porath, 2012; Ben-Porath & Tellegen, 2008/2011)
21 Cognitive Complaints (COG) Scale Reading Comprehension Working Memory COG Attention/ Vigilance Troubling Thoughts (Ben-Porath, 2012; Ben-Porath & Tellegen, 2008/2011)
22 Cognitive Complaints (COG) Scale Reading Comprehension Working Memory COG Attention/ Vigilance Troubling Thoughts (Ben-Porath, 2012; Ben-Porath & Tellegen, 2008/2011)
23 Cognitive Complaints (COG) Scale Reading Comprehension Working Memory COG Attention/ Vigilance Troubling Thoughts (Ben-Porath, 2012; Ben-Porath & Tellegen, 2008/2011)
24 Cognitive Complaints (COG) Scale Reading Comprehension Working Memory COG Attention/ Vigilance Troubling Thoughts (Ben-Porath, 2012; Ben-Porath & Tellegen, 2008/2011)
25 Cognitive Complaints (COG) Scale Reading Comprehension Working Memory COG Attention/ Vigilance Troubling Thoughts (Ben-Porath, 2012; Ben-Porath & Tellegen, 2008/2011)
26 Procedures: RQ 1 Young (18-34 years) Middle (35-49 years) Older (> 50 years) Removed Invalid Protocols for COG analyses (Burchett & Ben-Porath, 2010; Ben-Porath, 2012)
27 Procedures for Research Question 1 Analysis of Variance (ANOVA) to compare mean scores across 3 groups Group 1 Group 2 Group 3
28 Procedures: RQ 2 Schizophrenia (Sz) Sz Only Young Middle Older Sz + Mood Young Middle Older
29 Procedures for Research Question 2 Independent Samples t-tests to compare mean scores across 2 groups Group 1 Group 2
30 Procedures for Research Question 2 Sz Only Young Middle Older Sz Mood Young Middle Older
31 Procedures for Research Question 2 Sz Only Young Middle Older Sz Mood Young Middle Older
32 Procedures for Research Question 2 Sz Only Young Middle Older Sz Mood Young Middle Older
33 Results
34 Research Question 1 What is the trajectory of cognitive symptoms for patients as they age?
35 Research Question 1 Hypotheses: Neurodegenerative Trajectory
36 Severity of Symptoms VRIN-r ANOVA Results Young Middle Older (n = 236) (n = 338) (n = 134)
37 Severity of Symptoms VRIN-r ANOVA Results No significant differences were found F(2, 705) = 1.52, p = Young Middle Older (n = 236) (n = 338) (n = 134)
38 Severity of Symptoms COG ANOVA Results Young Middle Older (n = 148) (n = 148) (n = 95)
39 Severity of Symptoms COG ANOVA Results No significant differences were found F(2, 456) =.69, p = Young Middle Older (n = 148) (n = 148) (n = 95)
40 Research Question 1 Hypotheses: Neurodegenerative Trajectory
41 Research Question 1 Results: Neither Trajectory
42 Research Question 2 How would comorbid mood disorders impact cognitive symptom severity? Exploratory Analyses: Due to the limited and mixed research, we could not form formal hypotheses (Bora, Yucel, & Pantelis, 2009; Depp et al., 2007)
43 VRIN-r Mean Scores VRIN-r Independent Samples t-test Results Sz Only Sz + Mood (n = 116)(n = 120) (n = 172)(n = 166) (n = 65) (n = 69) Young Middle Older
44 VRIN-r Mean Scores VRIN-r Independent Samples t-test Results Sz Only Sz + Mood (n = 116)(n = 120) (n = 172)(n = 166) (n = 65) (n = 69) Young Middle Older
45 VRIN-r Mean Scores VRIN-r Independent Samples t-test Results Sz Only Sz + Mood No significant differences (n = 116)(n = 120) (n = 172)(n = 166) (n = 65) (n = 69) Young Middle Older
46 COG Mean Scores COG Independent Samples t-test Results Sz Only Sz + Mood (n = 81) (n = 67) (n = 116)(n = 100) (n = 46) (n = 49) Young Middle Older
47 COG Mean Scores COG Independent Samples t-test Results Sz Only Sz + Mood (n = 81) (n = 67) (n = 116)(n = 100) (n = 46) (n = 49) Young Middle Older
48 COG Mean Scores COG Independent Samples t-test Results Sz Only Sz + Mood No significant differences (n = 81) (n = 67) (n = 116)(n = 100) (n = 46) (n = 49) Young Middle Older
49 Research Question 2 Results: Comorbid mood disorders did not significantly impact cognitive symptom severity.
50 Conclusions & Future Directions
51 Research Question 1 Patients may not experience increased cognitive symptom severity as they age Research Question 2 Having mood disorders may not impact cognitive dysfunction
52 How does this inform Clinicians? Clinicians may not have to worry about cognitive symptoms worsening over time due to age Comorbid mood disorders may not impact the level of treatment needed for cognitive symptoms
53 Future Directions in Research Use more direct and specific measures of cognitive symptoms Among larger samples and younger age groups Controlling for additional variables
54 Acknowledgements Mentor: Danielle Burchett, PhD Department of Psychology Collaborator: David M. Glassmire, PhD, APPB
55 References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders : DSM- 5(5th ed.). Arlington, VA: American Psychiatric Association. Ben-Porath, Y. S. & Tellegen, A. (2008/2011). MMPI-2-RF Manual for Administration, Scoring, and Interpretation. Minneapolis: University of Minnesota Press. Ben-Porath, Y.S. (2012). Interpreting the MMPI -2-RF. Minneapolis: University of Minnesota Press. Bora, E., Yucel, M., & Pantelis, C. (2009). Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychosis: meta-analytic study. The British Journal of Psychiatry, 195(6), doi: /bjp.bp Burchett, D. & Ben-Porath, Y. S. (2010) The impact of overreporting on MMPI-2-RF substantive scale score validity. Assessment, 17(4), doi: / Depp. C. A., Moore, D. J., Sitzer, Palmer, B. W., Eyler, L. T., Roesch, S., Jeste, D. V. (2007). Neurocognitive impairment in middle-aged and older adults with bipolar disorders: Comparison to schizophrenia and normal comparison subjects. Journal of Affective Disorders, 101(1), doi: /j.jad Fazel, S. & Danesh, J. (2002). Serious mental disorder in prisoners: a systematic review of 62 surveys. The Lancet, 359(9306), doi: /S (02)
56 References Fucetola, R., Seidman, L. J., Kremen, W. S., Faraone, S. V., Goldstein, J. M., & Tsuang, M. T. (2000). Age and neuropsychologic function in schizophrenia: A decline in executive abilities beyond that observed in healthy volunteers. Biological Psychology, 48(2), doi: /S (00) Heaton, R. K., Gladsjo, J. A., Palmer, B. W., Kuck, J., Marcotte, T. D., & Jeste, D. V. (2001). Stability and course of neuropsychological deficits in schizophrenia. Archives of General Psychiatry, 58(1), doi: /archpsyc Herold, C. J., Schmid, L. A., Lasser, M. M., Seidl, U., & Schroder, J. (2017). Cognitive performance in patients with chronic schizophrenia across the lifespan. The Journal of Gerontopsychology and Geriatric Psychiatry, 30(1), doi: / /a Hulshoff Pol, H. E., Schnack, H. G., Bertens, M. G., van Haren, N. E., van der Tweel, I., Staal W. G., Baaré, W. F., & Kahn, R. S. (2002). Volume changes in gray matter in patients with schizophrenia. The American journal of Psychiatry, 159(2), doi: /appi.ajp Irani, F., Kalkstein, S., Moberg, E. A., & Moberg, P. J. (2011). Neuropsychological performance in older patients with schizophrenia: A meta-analysis of cross-sectional and longitudinal studies. Schizophrenia Bulletin, 37(6), doi: /schbul/sbq057 Kurtz, M. M. (2005). Neurocognitive impairment across the lifespan in schizophrenia: an update. Schizophrenia research, 74(1), doi: /j.schres
57 Thank you! Questions?
58 Schizophrenia Only Schizophrenia Disorders: , , , , , Schizophrenia with Mood Schizoaffective Disorder: , Depressive/Anxiety Disorders: , , , , , , Bipolar Disorders: , , , , , , , , , , , , , , , 296.7, , , Excluded from Analyses: DSM-IV-TR Diagnostic Codes Drug-Induced Psychotic Disorders: 291.3, , , , Psychotic Disorders due to Medical Condition: , Mood Disorders due to Medical Condition: Delusional Disorders, Brief Psychotic Disorder, Psychotic Disorder NOS: , 298.8, 298.9
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