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Behavioral Sciences
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Prevention and Recovery in People with Schizophrenia and Related Disorders
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Prevention and Recovery in People with Schizophrenia and Related Disorders

A special issue of Behavioral Sciences (ISSN 2076-328X). This special issue belongs to the section "Experimental and Clinical Neurosciences".

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 7768

Special Issue Editors

Dr. Kelsey Bonfils

E-Mail Website
Guest Editor
School of Psychology, University of Southern Mississippi, Hattiesburg, MI 93907, USA
Interests: clinical psychology; adults; serious mental illness; social cognition; sleep disturbance; schizophrenia-spectrum disorders; psychosis
Dr. Ashley M. Schnakenberg Martin

E-Mail Website
Guest Editor
Yale School of Medicine, Yale University, New Haven, CT 06510, USA
Interests: psychophysiology; EEG; EEG signal processing; evoked potentials; cognitive neuropsychology; schizophrenia; event-related potentials; cognitive neuroscience; electroencephalography; metacognition

Special Issue Information

Dear Colleagues,

Schizophrenia-spectrum disorders are associated with a host of symptoms and functional impacts, such as difficulty finding or keeping a job, attending school, and maintaining social relationships. Despite these challenges, people with these disorders are able to work toward recovery and live meaningful and fulfilling lives. This Special Issue aims to contribute to our understanding of determinants of recovery for people with schizophrenia and related disorders, including those with other serious mental illnesses (e.g., bipolar disorders or other psychotic illnesses), as well as determinants of prevention or recovery for those considered to be at-risk (e.g., prodromal, clinical high risk, or high schizotypy). We define recovery broadly to include both objective indicators (e.g., return to work or school) and subjective indicators (e.g., perceived recovery, quality of life, wellbeing, or sense of meaning or purpose). We welcome submissions to this Special Issue that expand our knowledge of determinants of recovery through empirical, theoretical, or systematic review/meta-analytic approaches. Contributions examining a variety of determinants, including such potential areas as neurocognition, metacognition, sociodemographic and background factors, illness- or symptom-related factors, social cognition, or other social factors are encouraged. Treatment studies with recovery-oriented outcomes are also welcome, but submissions are not limited to those reporting on intervention work.

Dr. Kelsey Bonfils
Dr. Ashley M. Schnakenberg Martin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Behavioral Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (10 papers)

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Research

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14 pages, 293 KiB  
Article
Differential Risk: Gender and Racial Differences in the Relationship between Trauma, Discrimination, and Schizotypy
by Mahogany A. Monette, Madisen T. Russell, Danielle B. Abel, Jarrett T. Lewis, Jessica L. Mickens, Evan J. Myers, Megan M. Hricovec, David C. Cicero, J. Wolny, William P. Hetrick, Michael D. Masucci, Alex S. Cohen, Christopher J. Burgin, Thomas R. Kwapil and Kyle S. Minor
Behav. Sci. 2024, 14(5), 363; https://doi.org/10.3390/bs14050363 - 25 Apr 2024
Viewed by 315
Abstract
Traumatic experiences are associated with increased experiences of positive schizotypy. This may be especially important for People of Color, who experience higher rates of trauma and racial discrimination. No study to date has examined how racial disparities in traumatic experiences may impact schizotypy. [...] Read more.
Traumatic experiences are associated with increased experiences of positive schizotypy. This may be especially important for People of Color, who experience higher rates of trauma and racial discrimination. No study to date has examined how racial disparities in traumatic experiences may impact schizotypy. Furthermore, of the studies that have examined the relationship between trauma and schizotypy, none have examined racial discrimination as a potential moderator. The present study examined if racial discrimination moderates the relationship between trauma and multidimensional (positive, negative, and disorganized) schizotypy. In a sample of 770 college students, we conducted chi-squared analyses, analyses of variance, and stepwise regressions. We found that Black students experienced significantly higher racial discrimination and trauma than Latinx and Asian students. Furthermore, Black and Latinx students experienced significantly more multidimensional schizotypy items than Asian students. Trauma and racial discrimination explained 8 to 23% of the variance in each dimension of schizotypy. Racial discrimination did not moderate the relationships between trauma and multidimensional schizotypy. Our findings suggest that we need to examine risk factors that may prevent recovery from psychotic disorders. Additionally, disorganized schizotypy showed the most robust associations and may be a critical site of intervention. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
11 pages, 227 KiB  
Article
The Impact of the Global Pandemic on Veterans with Serious Mental Illness (SMI): Healthcare Utilization and Mortality
by Isabella Soreca, Monique Boudreaux-Kelly, Yeon-Jung Seo and Gretchen Haas
Behav. Sci. 2024, 14(5), 356; https://doi.org/10.3390/bs14050356 - 24 Apr 2024
Viewed by 254
Abstract
Background: Individuals with serious mental illness (SMI) experience barriers to accessing and engaging with healthcare, which may have been exacerbated during the emergence of the global pandemic and the rapid shift to telemedicine platforms, substantially decreasing healthcare utilization for non-COVID-19 disorders. Important repercussions [...] Read more.
Background: Individuals with serious mental illness (SMI) experience barriers to accessing and engaging with healthcare, which may have been exacerbated during the emergence of the global pandemic and the rapid shift to telemedicine platforms, substantially decreasing healthcare utilization for non-COVID-19 disorders. Important repercussions on morbidity and mortality may be seen in the months and years to come, which may disproportionately affect high-risk populations, such as patients with SMI, with reduced access to technology platforms. In this study, we explored the impact of the pandemic on healthcare utilization and all-cause mortality rate in SMI compared to non-SMI individuals for the months of March–September 2020 and the same two quarters in 2019. Methods: Data were obtained from the VA Corporate Data Warehouse (CDW), a data repository from clinical and administrative VA systems. The sample included veterans with ≥1 outpatient clinical encounter nationally between 1 January 2019 and 31 December 2020. Results: The cohort for this study included 1,018,047 veterans receiving care through the Veterans Health Administration between 2019 and 2020. Of those, 339,349 had a diagnosis of SMI. Patients with SMI had a significantly larger pre–post-pandemic decrease in outpatient (49.7%, p < 0.001), inpatient (14.4%, p < 0.001), and ED (14.5%, p < 0.001) visits compared to non-SMI patients. Overall, 3752 (1.59%) veterans without SMI and 4562 (1.93%) veterans with SMI died during our observation period. Veterans without SMI who died during the observation period were more likely to have had a positive COVID-19 test compared to veterans with SMI. Unadjusted analyses showed that veterans with SMI were approximately 2.5 times more likely to die than veterans without SMI during the first 6 months of the pandemic, compared to the same two quarters of the previous year. However, after adjustment by pertinent covariates, the predictors associated with an increased risk of death from SMI were older age, being male, a higher CAN score, more inpatient stays in the pre period compared to post, and a positive COVID-19 test. Discussion: Consistent with our initial hypothesis, all the indices of healthcare utilization, namely the number of outpatient, inpatient, and ED visits, significantly decreased between pre- and post-pandemic and did more so for veterans with SMI, despite having more chronic medical illnesses and being prescribed more medications than veterans without SMI. On the other hand, while mortality was greater post-pandemic, factors such as age, morbidity, and having a positive COVID-19 test predicted mortality above and beyond having an SMI diagnosis. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
17 pages, 244 KiB  
Article
A Recovery-Oriented Approach: Application of Metacognitive Reflection and Insight Therapy (MERIT) for Youth with Clinical High Risk (CHR) for Psychosis
by Bethany L. Leonhardt, Andrew C. Visco, Jay A. Hamm and Jenifer L. Vohs
Behav. Sci. 2024, 14(4), 325; https://doi.org/10.3390/bs14040325 - 15 Apr 2024
Viewed by 447
Abstract
Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can [...] Read more.
Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can both stave off prolonged suffering and intervene before mental health challenges become part of an individual’s identity. However, there are few treatment modalities that can address some of the specific needs of CHR. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative psychotherapy that can be applied to the CHR population. MERIT offers unique advantages to working with the CHR population as it aims to improve self-direction and recovery through stimulation of metacognitive capacity, a phenomenon that has been associated with recovery. This paper explores unique aspects of the CHR population and how MERIT can address barriers to recovery for individuals experiencing psychosis-like symptoms. Several case examples and a clinical vignette using MERIT to support patients with CHR are offered to exemplify this approach. MERIT offers a way to assist persons with CHR to address barriers to their personal recovery and to develop nuanced understandings of ways to master challenges. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
12 pages, 262 KiB  
Article
Narrative-Derived Indices of Metacognition among People with Schizophrenia: Associations with Self-Reported and Performance-Based Social Functioning
by Melissa F. V. Kilicoglu, Nancy B. Lundin, Kaley Angers and Aubrey M. Moe
Behav. Sci. 2024, 14(4), 265; https://doi.org/10.3390/bs14040265 - 23 Mar 2024
Viewed by 707
Abstract
Metacognitive functioning—which broadly encompasses the mental processes involved in thinking about the thinking of one’s self and the thinking of others—is often impaired among individuals living with schizophrenia and may contribute to difficulties in social and interpersonal functioning. Although the majority of studies [...] Read more.
Metacognitive functioning—which broadly encompasses the mental processes involved in thinking about the thinking of one’s self and the thinking of others—is often impaired among individuals living with schizophrenia and may contribute to difficulties in social and interpersonal functioning. Although the majority of studies assessing metacognition among individuals with schizophrenia use standardized, laboratory-based measurements, an increasing number of studies have measured metacognitive capacity using natural language produced by individuals living with mental illness. At the same time, less is known about how language-derived indices of metacognitive function relate to key social outcomes among people with schizophrenia. The primary objective of this study was to employ a validated language coding system (the Metacognition Assessment Scale, Abbreviated; MAS-A) to assess metacognitive functioning from the spoken life narratives of individuals with schizophrenia (n = 32) and community controls (n = 15). Among individuals with schizophrenia, we also examined the associations between language-derived metacognition and measures of self-reported and performance-based social functioning. Our results suggest that most aspects of metacognition in our sample were not significantly diminished in people with schizophrenia compared to community controls. Unexpectedly, the MAS-A subscale related to one’s ability to master psychological difficulties was rated higher among individuals with schizophrenia. Further, our results suggest that among people with schizophrenia, higher metacognitive functioning in the domain of self-reflectivity was associated with poorer self-reported social functioning, while a greater metacognitive awareness of other individuals’ minds was associated with better scores on aspects of performance-based social functioning. Collectively, these results underscore the utility of assessing metacognitive functioning via life-story narratives to understand social outcomes and highlight possible aspects of resiliency among individuals who have experienced a serious mental illness. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
9 pages, 200 KiB  
Article
An Investigation of Employment Hope as a Key Factor Influencing Perceptions of Subjective Recovery among Adults with Serious Mental Illness Seeking Community Work
by Marina Kukla, Alan B. McGuire, Kenneth C. Weber, Jessi Hatfield, Nancy Henry, Eric Kulesza and Angela L. Rollins
Behav. Sci. 2024, 14(3), 246; https://doi.org/10.3390/bs14030246 - 19 Mar 2024
Viewed by 845
Abstract
Introduction: Employment is an important contributor to recovery in people with serious mental illness (SMI), yet studies have not explored how subjective elements of employment hope contribute to perceptions of global recovery in this population. Methods: The current study examined the relationship between [...] Read more.
Introduction: Employment is an important contributor to recovery in people with serious mental illness (SMI), yet studies have not explored how subjective elements of employment hope contribute to perceptions of global recovery in this population. Methods: The current study examined the relationship between employment hope and subjective recovery in 276 unemployed adults with SMI participating in a multi-site clinical trial of a cognitive behavioral group intervention tailored toward work and combined with vocational rehabilitation. Participants had diagnoses of schizophrenia spectrum, bipolar, depressive, and posttraumatic stress disorders, and were receiving services at three Veterans Affairs healthcare facilities in the United States. Data were collected at study baseline. Linear regression analysis examined the relationship between employment hope (Short Employment Hope Scale; EHS-14) and subjective recovery (Recovery Assessment Scale; RAS) after controlling for psychiatric symptom severity and mental-health-related burden on daily life. Results: After accounting for covariates, employment hope significantly contributed to the regression model explaining subjective recovery. The overall model of predictor variables explained 52.5% of the variance in recovery. The results further explore the relationships between EHS-14 and RAS subscales. Conclusions: The findings suggest that employment hope is a key intervention target to bolster subjective recovery in this vulnerable population. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
15 pages, 1807 KiB  
Article
Empathy and Schizotypy: A Network Comparison of the Interpersonal Reactivity Index in High and Low Schizotypy Groups
by Lillian A. Hammer, Aleksandr Karnick, Kendall Beals, Lauren Luther and Kelsey A. Bonfils
Behav. Sci. 2024, 14(3), 245; https://doi.org/10.3390/bs14030245 - 18 Mar 2024
Viewed by 779
Abstract
Empathy is a multifaceted concept that is vital to effective social functioning; yet, it is impaired in high schizotypy groups. Furthermore, empathy has been found to be a mediator in the relationship between schizotypy and social functioning, highlighting the importance of empathy as [...] Read more.
Empathy is a multifaceted concept that is vital to effective social functioning; yet, it is impaired in high schizotypy groups. Furthermore, empathy has been found to be a mediator in the relationship between schizotypy and social functioning, highlighting the importance of empathy as a driver in social outcomes. Despite this, the four-factor structure of a widely-used measure of empathy—the Interpersonal Reactivity Index (IRI)—has been found to be psychometrically weak in high schizotypy samples. As such, this study aimed to assess differences in the item-level network of the IRI between high (n = 427) and low schizotypy groups (n = 470). The results reveal that there are significant differences in the structure of these networks, though they evidence similar strengths. Within the high schizotypy group, the network structure was consistent with the four-factor structure of the IRI subscales; items from each subscale clustered together and were distinct from those in the other subscales. By contrast, the low schizotypy group evidenced six clusters that did not mirror the IRI subscales. These results suggest that the item-level structure of the IRI is dependent upon the level of schizotypy of the sample, with the high schizotypy group’s network functioning similarly to what would be expected from the original four-factor structure. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
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15 pages, 275 KiB  
Article
Narrative Forewarnings: A Qualitative Analysis of the Themes Preceding Disorganized Speech in Schizophrenia
by Robert J. Bettis, Laura A. Faith, Ashlynn M. Beard, Brailee A. Whan, Ceouna M. Hegwood, Mahogany A. Monette, Evan J. Myers, Imani S. Linton, Bethany L. Leonhardt, Michelle P. Salyers and Kyle S. Minor
Behav. Sci. 2024, 14(3), 212; https://doi.org/10.3390/bs14030212 - 06 Mar 2024
Viewed by 942
Abstract
Disorganized speech is a critical barrier to recovery in schizophrenia, with profound negative impacts on one’s ability to engage with the world. Despite the limited efficacy of existing treatments in addressing disorganization, a qualitative analysis of what leads to disorganization in patient narratives [...] Read more.
Disorganized speech is a critical barrier to recovery in schizophrenia, with profound negative impacts on one’s ability to engage with the world. Despite the limited efficacy of existing treatments in addressing disorganization, a qualitative analysis of what leads to disorganization in patient narratives has been lacking. This study addresses this gap through inductive thematic analysis of 30 narrative interviews with individuals with schizophrenia, matched based on whether Formal Thought Disorder (FTD) is present. Through this analysis, we identified four core themes (alienation, interpersonal tension, personal benchmarks, and adverse experiences) and eight subthemes. Our findings suggest that disorganization may serve as a protective mechanism against psychological distress and highlight how the severity of FTD influences these themes. Alienation, particularly due to illness-related stigma, emerged more prominently in those with FTD. The themes of personal benchmarks and interpersonal tension pointed towards a heightened sensitivity to social interactions and self-perception among those with schizophrenia. Adverse experiences, encompassing past challenges, suggest a potential link between trauma and symptom exacerbation. Our qualitative analysis of what themes precede disorganized speech has implications for tailoring psychotherapy. By considering an individual’s specific triggers and level of disorganization, therapy may be more effectively targeted to improve recovery-based outcomes. By identifying themes within patient narratives, this study advances our understanding of the qualitative aspects preceding disorganized speech in schizophrenia, paving the way for more personalized and effective recovery-focused interventions. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
14 pages, 295 KiB  
Article
Relationships between Sleep Quality, Introspective Accuracy, and Confidence Differ among People with Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder with Psychotic Features
by Cassi R. Springfield, Amy E. Pinkham, Philip D. Harvey, Raeanne C. Moore, Robert A. Ackerman, Colin A. Depp and Kelsey A. Bonfils
Behav. Sci. 2024, 14(3), 192; https://doi.org/10.3390/bs14030192 - 28 Feb 2024
Viewed by 840
Abstract
People with schizophrenia-spectrum and bipolar disorders have difficulty accurately estimating their abilities and skills (impaired introspective accuracy [IA]) and tend to over- or underestimate their performance. This discrepancy between self-reported and objective task performance has been identified as a significant predictor of functional [...] Read more.
People with schizophrenia-spectrum and bipolar disorders have difficulty accurately estimating their abilities and skills (impaired introspective accuracy [IA]) and tend to over- or underestimate their performance. This discrepancy between self-reported and objective task performance has been identified as a significant predictor of functional impairment. Yet, the factors driving this discrepancy are currently unclear. To date, the relationships between sleep quality and IA have not been examined. The current study aimed to explore the relationships between sleep quality and IA in participants diagnosed with schizophrenia (SCZ; n = 36), schizoaffective disorder (SCZ-A; n = 55), and bipolar disorder with psychotic features (BP; n = 87). Participants completed tasks of emotion recognition, estimated their performance on the tasks (used to calculate IA), and provided confidence ratings for their accuracy judgments. Participants also self-reported their sleep quality. These results suggest significantly greater discrepancies between self-reported and actual task scores for those with SCZ and SCZ-A compared to participants with BP. For those with SCZ, lower confidence on the tasks and underestimation of abilities were associated with lower sleep quality, while for those with SCZ-A, lower sleep quality was associated with higher confidence and overestimation of performance. Results suggest differential relationships between diagnostic groups. Future research is needed to further explore the factors driving these differing relationships, particularly the contrasting relationships between SCZ and SCZ-A. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)

Review

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13 pages, 266 KiB  
Review
Metacognition as a Transdiagnostic Determinant of Recovery in Schizotypy and Schizophrenia Spectrum Disorders
by Courtney N. Wiesepape, Elizabeth A. Smith, Jaclyn D. Hillis-Mascia, Sarah E. Queller Soza, Madyson M. Morris, Alison V. James and Alexis Stokes
Behav. Sci. 2024, 14(4), 336; https://doi.org/10.3390/bs14040336 - 17 Apr 2024
Viewed by 459
Abstract
The term schizotypy refers to the latent personality organization that is thought to underpin the liability to develop schizophrenia and associated disorders. Metacognition, or the ability to understand and form increasingly complex and integrated ideas of oneself, others, and one’s community, has been [...] Read more.
The term schizotypy refers to the latent personality organization that is thought to underpin the liability to develop schizophrenia and associated disorders. Metacognition, or the ability to understand and form increasingly complex and integrated ideas of oneself, others, and one’s community, has been proposed to be an important transdiagnostic construct across schizophrenia spectrum disorders and a range of both clinical and non-clinical manifestations of schizotypy. In this paper, we review evidence that deficits in metacognition are present in individuals with relatively high levels of schizotypy and that these deficits are related to symptomology, function, and quality of life. We address the idea that decrements in metacognition may also contribute to the progression from schizotypy to more severe manifestations, while the amelioration of these deficits may enhance aspects of recovery, including the ability to form an integrated sense of self, others, and the wider world. We also review the following two recovery-oriented psychotherapies that target metacognition to promote recovery in individuals with clinical manifestations of schizotypy: Evolutionary Systems Therapy for Schizotypy (ESTS) and Metacognitive Reflection and Insight Therapy (MERIT). Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)

Other

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25 pages, 324 KiB  
Systematic Review
The Discrepancy between Subjective and Objective Evaluations of Cognitive and Functional Ability among People with Schizophrenia: A Systematic Review
by Molly Harris, Emily Blanco, Hunter Howie and Melisa Rempfer
Behav. Sci. 2024, 14(1), 30; https://doi.org/10.3390/bs14010030 - 30 Dec 2023
Viewed by 1257
Abstract
Background: An important aspect of recovery in schizophrenia relates to one’s subjective, lived experience. Self-report is a subjective measurement method with yet-uncertain utility in the assessment of functioning among individuals diagnosed with schizophrenia-spectrum disorder. No review to date has comprehensively synthesized existing research [...] Read more.
Background: An important aspect of recovery in schizophrenia relates to one’s subjective, lived experience. Self-report is a subjective measurement method with yet-uncertain utility in the assessment of functioning among individuals diagnosed with schizophrenia-spectrum disorder. No review to date has comprehensively synthesized existing research to evaluate the degree of correspondence, or lack thereof, between subjective and objective assessments of cognitive and everyday functioning, nor how extant data can inform the use of self-reported information in treatment and research. Methods: A systematic review was completed to provide a broad perspective of the literature on this topic. Relevant manuscripts were identified via a search strategy using key terms in PubMed and PsycINFO and a review of manuscript bibliographies. Twenty-six studies met the inclusion criteria. Results: These studies show minimal to modest associations between subjective assessments of cognition and everyday functioning and objective assessments of these domains, including informant reports and neuropsychological and behavioral measures. Individuals with schizophrenia appear to overestimate their functioning when compared to objective measures. Depression and greater cognitive ability tend to predict greater correspondence between subjective and objective assessments of cognition and everyday functioning. Discussion: This review discusses how we might understand the low correspondence between subjective and objective measures of functioning and provides recommendations for using and eliciting self-reported information in the pursuit of recovery-centered practices. Full article
(This article belongs to the Special Issue Prevention and Recovery in People with Schizophrenia and Related Disorders)
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