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      Neural changes following cognitive behaviour therapy for psychosis: a longitudinal study

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          Abstract

          A growing body of evidence demonstrates that persistent positive symptoms, particularly delusions, can be improved by cognitive behaviour therapy for psychosis. Heightened perception and processing of threat are believed to constitute the genesis of delusions. The present study aimed to examine functional brain changes following cognitive behaviour therapy for psychosis. The study involved 56 outpatients with one or more persistent positive distressing symptoms of schizophrenia. Twenty-eight patients receiving cognitive behaviour therapy for psychosis for 6–8 months in addition to their usual treatment were matched with 28 patients receiving treatment as usual. Patients’ symptoms were assessed by a rater blind to treatment group, and they underwent functional magnetic resonance imaging during an affect processing task at baseline and end of treatment follow-up. The two groups were comparable at baseline in terms of clinical and demographic parameters and neural and behavioural responses to facial and control stimuli. The cognitive behaviour therapy for psychosis with treatment-as-usual group (22 subjects) showed significant clinical improvement compared with the treatment-as-usual group (16 subjects), which showed no change at follow-up. The cognitive behaviour therapy for psychosis with treatment-as-usual group, but not the treatment-as-usual group, showed decreased activation of the inferior frontal, insula, thalamus, putamen and occipital areas to fearful and angry expressions at treatment follow-up compared with baseline. Reduction of functional magnetic resonance imaging response during angry expressions correlated directly with symptom improvement. This study provides the first evidence that cognitive behaviour therapy for psychosis attenuates brain responses to threatening stimuli and suggests that cognitive behaviour therapy for psychosis may mediate symptom reduction by promoting processing of threats in a less distressing way.

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          The positive and negative syndrome scale (PANSS) for schizophrenia.

          The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
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            Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs

            New England Journal of Medicine, 342(25), 1887-1892
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              The neural bases of emotion regulation: reappraisal and suppression of negative emotion.

              Emotion regulation strategies are thought to differ in when and how they influence the emotion-generative process. However, no study to date has directly probed the neural bases of two contrasting (e.g., cognitive versus behavioral) emotion regulation strategies. This study used functional magnetic resonance imaging (fMRI) to examine cognitive reappraisal (a cognitive strategy thought to have its impact early in the emotion-generative process) and expressive suppression (a behavioral strategy thought to have its impact later in the emotion-generative process). Seventeen women viewed 15 sec neutral and negative emotion-eliciting films under four conditions--watch-neutral, watch-negative, reappraise-negative, and suppress-negative--while providing emotion experience ratings and having their facial expressions videotaped. Reappraisal resulted in early (0-4.5 sec) prefrontal cortex (PFC) responses, decreased negative emotion experience, and decreased amygdala and insular responses. Suppression produced late (10.5-15 sec) PFC responses, decreased negative emotion behavior and experience, but increased amygdala and insular responses. These findings demonstrate the differential efficacy of reappraisal and suppression on emotional experience, facial behavior, and neural response and highlight intriguing differences in the temporal dynamics of these two emotion regulation strategies.
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                Author and article information

                Journal
                Brain
                brainj
                brain
                Brain
                Oxford University Press
                0006-8950
                1460-2156
                August 2011
                11 July 2011
                11 July 2011
                : 134
                : 8
                : 2396-2407
                Affiliations
                1 Department of Psychology, Institute of Psychiatry, King's College London, London SE5 8AF, UK
                2 NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
                3 Department of Neuroimaging, Institute of Psychiatry, King's College London, London SE5 8AF, UK
                4 South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
                5 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
                Author notes
                Correspondence to: Veena Kumari, Department of Psychology, P078, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK E-mail: veena.kumari@ 123456kcl.ac.uk
                Article
                awr154
                10.1093/brain/awr154
                3155705
                21772062
                894604d4-4720-460d-97af-e83fbf1aeb30
                © The Author (2011). Published by Oxford University Press on behalf of the Guarantors of Brain.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 October 2010
                : 22 April 2011
                : 19 May 2011
                Page count
                Pages: 12
                Categories
                Original Articles

                Neurosciences
                schizophrenia,threat,fmri,cognitive behaviour therapy
                Neurosciences
                schizophrenia, threat, fmri, cognitive behaviour therapy

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