The aim of the present thesis was to examine the effectiveness of the Illness Management and Recovery (IMR) program for teaching clients with schizophrenia or schizoaffective disorder to better manage their illness and to promote recovery. This was accomplished through an examination of the program’s effects on psychosocial functioning and psychopathology, the evaluation of general and specific impact of neurocognition on learning the fundamentals of illness self-management, and the impact of symptom severity on outcome of the IMR program. The utility of the illness management and recovery scale to evaluate illness self-management of clients with schizophrenia and schizoaffective disorder was also investigated. The effects of the IMR program were evaluated in a randomized controlled trial that compared participants in the program to participants receiving treatment as usual. 41 participants were recruited at six psychiatric outpatient rehabilitation centers in Uppsala, Sweden, and were randomly assigned to IMR groups for approximately 40 sessions or to a treatment as usual control condition. The IMR program participants demonstrated greater improvement compared to participants in treatment as usual in illness self-management, reduced psychiatric symptoms, improved coping skills, and decreases in suicidal ideation. The findings suggest that the IMR program is effective in improving the ability of individuals with schizophrenia and schizoaffective disorder to better manage their illness. Possible association between neurocognitive functioning and the acquisition of illness self-management skills was investigated in a total of 53 participants who completed the IMR program. Speed of processing was related to client reported illness self-management skills acquisition, before and after controlling for psychiatric symptoms and medication, but neurocognitive functioning did not predict improvement in clinician ratings of client illness self-management skills. The findings suggest that compromised neurocognitive functioning does not reduce response to training in illness self-management. The impact of symptom severity on outcome of the IMR program was explored in 52 participants who completed the program. The results suggest that significantly more participants met the severity criterion of remission at post-treatment, and it appears that participants not reaching the severity criterion at post-treatment, also benefited from the IMR program, as indicated by the similar effect sizes of the two subgroups (meeting versus not meeting the severity criterion at post-treatment). The psychometric properties of the Illness Management and Recovery Scale (IMRS) were evaluated in 107 participants with a diagnosis of schizophrenia or schizoaffective disorder. And an item-by-item investigation was conducted in order to establish their utility in monitoring the clients' progress in the IMR program. Both the client and clinician version of the IMRS demonstrated satisfactory internal consistency, large test-retest reliability, and convergent validity with conceptually related measures of psychiatric symptoms, quality of life, and perception of recovery. The findings support the utility of the IMRS as a measure of illness self-management and recovery in clients with schizophrenia and schizoaffective disorder. The general findings of this thesis support the IMR program to be effective in improving the ability of the participants to manage their disorder. The impact of neurocognitive dysfunction on the participants’ ability to learn the fundamentals of illness self-management seems to be limited, and symptom severity did not limit the benefits of the IMR program. Support for the utility of the IMRS to monitor the participants’ progress in the program was also found, providing a brief and economical method for assessing outcome of the IMR program. / Syftet med föreliggande avhandlingsarbete var att undersöka Illness Management and Recovery (IMR) programmets effekter av att lära klienter att bättre hantera negativa konsekvenser av schizofreni eller schizoaffektiv sjukdom och att främja återhämtning. Detta åstadkoms genom en utvärdering av IMR programmets inverkan på psykosocial funktion och psykopatologi, en undersökning av specifik och generell påverkan av neurokognition avseende deltagarnas möjligheter att lära in grundläggande sjukdomshanteringsfärdigheter (illness self-management), samt en undersökning av huruvida schizofrenisymtomens svårighetsgrad inverkar på programutfallet. Vidare undersöktes Illness Management and Recovery Skalans (IMRS) användbarhet för att utvärdera sjukdomshantering och återhämtning (illness self-management and recovery) hos personer med schizofreni eller schizoaffektiv sjukdom. IMR programmets effekter utvärderades genom en randomiserad kontrollerad studie i vilken 41 programdeltagare jämfördes med deltagare i kontrollgrupp vilka fick enbart sedvanlig psykiatrisk behandling. Deltagarna rekryterades vid sex subspecialiserade psykiatriska öppenvårdsmottagningar och slumpades till att antingen delta i IMR programmet eller kontrollgrupp. IMR programmets deltagare uppvisade i jämförelse med kontrollgruppen förbättring i sjukdomshantering, minskade psykiatriska symtom, förbättrade coping-färdigheter samt minskade självmordsbeteenden. Resultaten stöder antagandet att IMR programmet är effektivt vad gäller att förbättra deltagarnas förmåga att hantera negativa effekter av schizofreni och schizoaffektiv sjukdom. Möjliga associationer mellan neurokognitiv funktion och förmågan att tillägna sig färdigheter för sjukdomshantering undersöktes hos 53 deltagare som genomförde IMR programmet. Resultaten pekar på att neurokognitiva svårigheter inte inverkar på deltagarnas möjligheter att lära sig sjukdomshantering enligt IMR modellen. Processhastighet var relaterad till klientrapporterad sjukdomshantering men inte till klinikerrapporterad sjukdomshantering. Processhastighet tycks vara relevant för klientens upplevelse av hur väl han eller hon tillägnat sig programmets strategier och färdigheter, snarare än sjukdomshantering per se. Huruvida schizofrenisymtomens svårighetsgrad inverkar på utfallet av IMR programmet undersöktes hos 52 deltagare som genomförde IMR programmet. Resultaten pekar på att signifikant fler deltagare uppfyllde svårighetsgradskriteriet för remission av schizofrenisymtom efter genomfört IMR program. Även deltagare som inte uppfyllde svårighetsgradskriteriet har nytta av IMR programmet något som indikeras av de båda gruppernas (uppfyllde jämfört med uppfyllde inte svårighetsgradskriteriet) likartade effektstorlekar. Illness Management and Recovery Skalans (IMRS) psykometriska egenskaper undersöktes för 107 deltagare med en schizofreni eller schizoaffektiv diagnos. Skalans enskilda frågor analyserades för att undersöka skalans användbarhet för att utvärdera deltagares progress och utfall i IMR programmet. Både klient och kliniker versionen av skalan uppvisade tillfredsställande intern konsistens, stor test-retest reliabilitet och konvergent validitet med konceptuellt relaterade instrument för psykiatriska symtom, livskvalité och återhämtning. Resultaten stöder antagandet att IMRS är ett användbart instrument för att utvärdera sjukdomskontroll och återhämtning för personer med schizofreni eller schizoaffektiv sjukdom. Avhandlingsarbetets resultat stöder antagandet att IMR programmet är effektivt vad gäller att förbättra deltagarnas förmåga att hantera de negativa konsekvenserna av schizofreni och schizoaffektiv sjukdom. Neurokognitiva svårigheter inverkar i begränsad utsträckning på deltagarnas möjligheter att lära sig sjukdomshantering och schizofrenisymtom tycks ha begränsad inverkan på programutfallet. Resultaten stöder även antagandet att IMRS är ett användbart instrument för att utvärdera sjukdomskontroll och återhämtning för personer med schizofreni eller schizoaffektiv sjukdom, vilket erbjuder en kortfattad och ekonomisk metod att utvärdera effekterna av IMR.

Cochlear implant (CI) devices afford many profoundly deaf individuals worldwide partially restored hearing ability. Although CI users achieve remarkable speech perception with contemporary multichannel CI devices, their music perception ability is generally unsatisfactory. Improved CI-mediated music perception ability requires that the underlying constraints hindering processing of music-relevant information need to be identified and understood. This study puts forward a systematic approach, informed by the neurocognitive mechanisms underlying music perception in normal hearing (NH), for investigating implant-mediated music perception. Psychoacoustical experiments were used to explore the extent to which music-relevant information delivered to the central auditory system following peripheral electrical stimulation supports music perception. Task-specific stimuli and test procedures were developed to assess perception of pitch, rhythm and loudness information, both as separate and in combined form, in sound-field listening conditions. CI users’ unsuccessful judgement of the musical character of short, novel single-voice melodies suggests that insufficient information reaches the central auditory processing system to effect a unified musical percept. This is despite sound field frequency discrimination behaviour being better than had been expected and rhythm perception ability with regard to short tone sequences of varying pitch and rhythmic complexity being comparable to that of NH listeners. CI listeners also performed similarly to NH listeners during pitch-dependent loudness perception tasks. Within the framework of a hierarchical, modular processing system underlying music perception, it appears that early pitch processing deficits propagate throughout the music processing system to exert an overriding inhibitory perceptual effect. The outcomes of this study not only underline the importance of delivering sufficient pitch information to the electrically stimulated auditory system but also show that music perception in CI-mediated hearing should be investigated and understood as the outcome of an integrated perceptual system. / Thesis (PhD)--University of Pretoria, 2011. / Electrical, Electronic and Computer Engineering / Unrestricted

Hintergrund: Mangelnde Krankheitseinsicht bei Schizophrenie ist ein verbreitetes Phänomen, dessen Zusammenhänge mit Outcome-Maßen wie Krankheitsverlauf, Funktionsniveau und Lebensqualität vielfach belegt sind. Trotz vieler unterschiedlicher Ansätze zur Erklärung der Entstehung von Krankheitseinsicht ist sie bisher nur unzureichend verstanden. Obwohl angenommen wird, dass verschiedene Faktoren wie kognitive und motivationale Voraussetzungen Einsicht limitieren können, stehen die Identifikation von spezifischen Einflussgrößen sowie die empirische Überprüfung distinkter Prozesse und deren Wirkgefüges aus. Die Integration unterschiedlicher Ansätze in mehrfaktorielle Modelle, wie Startup (1996) nahe legt, gilt als vielversprechend. Diese sollten insbesondere vermutete motivationale Einflussgrößen enthalten, die bisher nur unzulänglich berücksichtigt wurden. Methoden: Es wurden drei empirische Studien zur Überprüfung und Erweiterung des multifaktoriellen Ansatzes von Startup (1996) zur Erklärung mangelnder Krankheitseinsicht (G12 aus der Positive and Negative Syndrome Scale [PANSS]: Kay, Fiszbein & Opler, 1987) durchgeführt. An großen heterogenen Stichproben (N = 248; N = 111; N = 95) wurden zunächst das Regressionsmodell nach Startup (1996) sowie die dort implizierten Einsichts-subtypen überprüft. Zweitens wurden zur Vorhersage von Einsicht (Scale to Assess Unawareness of Mental Disorder [SUMD]: Amador & Strauss, 1990) schrittweise soziodemographische, klinische (PANSS) und kognitive Maße (Wisconsin Card Sorting Test [WCST]: Heaton, Chelune, Talley, Kay & Curtiss, 1993) sowie Stigmatisierung (Self-Stigma of Mental Illness Scale [SSMIS]: Corrigan, Watson & Barr, 2006) als ein Maß motivational relevanter Einflüsse in ein multiples Regressionsmodell eingefügt. Zur Charakterisierung unterschiedlicher Einsichts-Subgruppen wurden diese drittens anhand von soziodemographischen, klinischen und kognitiven Variablen sowie zusätzlich durch subjektive Krankheitskonzepte (Illness Perception Questionnaire for Schizophrenia [IPQS]: Lobban, Barrowclough & Jones, 2005) vorhergesagt. Ergebnisse: Der von Startup (1996) berichtete kurvilineare Zusammenhang zwischen Einsicht und Neurokognition wurde regressionsanalytisch bestätigt. Die Varianzaufklärung der Einsicht durch neurokognitive Maße fiel jedoch eher gering (R2 = .052) aus. Durch das Hinzufügen einer Stigmatisierungsvariable (Zustimmung der Patienten zu negativen schizophreniespezifischen Stereotypen) in das Regressionsmodell wurde die Varianzaufklärung signifikant, aber schwach verbessert (ΔR2 = .049). Je mehr die Patienten den negativen Stereotypen zustimmten, desto uneinsichtiger waren sie. Es konnten außerdem drei Einsichtssubgruppen identifiziert werden: eine Gruppe ohne Einsichts- und Kognitionseinschränkungen, eine mit Defiziten in beiden Bereichen und eine Gruppe, die trotz intakten kognitiven Vermögens mangelnde Einsicht vorwies (17 - 30 %). Zur multinomialen Vorher-sage der letztgenannten Subgruppe trugen insbesondere die subjektiven Bewertungen zur Kontrollierbarkeit und zur eigenen emotionalen Reaktion signifikant bei (R²N = .56). Patienten, die die eigene Erkrankung für weniger kontrollierbar und stärker emotional relevant hielten, hatten niedrigere Einsichts-Scores. Diskussion: Die vorliegende Arbeit gilt als Beleg für die Existenz unterschiedlicher einsichtslimitierender Prozesse und ergänzt damit bisherige, überwiegend monokausale Ansätze zur Erklärung der Genese mangelnder Krankheitseinsicht. Die Bedeutung kognitiver Defizite scheint für einen Teil der Patienten evident. Darüber hinaus wurde für einen substantiellen Anteil an Patienten auch die Annahme motivierter Uneinsichtigkeit gestützt. Erstmalig wurden spezifisch mit motivational reduzierter Einsicht assoziierte Faktoren aufgedeckt: die stärkere Zustimmung zu negativen Stereotypen als Hinweis auf Stigmatisierungsprozesse, geringere wahrgenommene Kontrollierbarkeit der eigenen Erkrankung und eine stärkere emotionale Reaktion auf die Erkrankung. Es wird angenommen, dass verringerte Einsicht die Bedeutung dieser negativen Kognitionen (z. B. zur Kontrollierbarkeit, zur emotionalen Bedeutung oder zu Stereotypen wie Gewalttätigkeit) reduzieren kann, da diese wegen der Uneinsichtigkeit nicht auf die eigene Person übertragen werden. Der Mangel an Einsicht könnte daher auch einen Selbstschutz darstellen. In Bezug auf therapeutische Interventionen erscheinen kognitive Trainings folglich nur für einige Patienten sinnvoll, während für andere eher motivierende und an den subjektiven Einstellungen und Bewertungen ansetzende Behandlungsmaßnahmen zu berücksichtigen sind. Dafür bieten sich insbesondere moderne kognitiv-verhaltenstherapeutische Behandlungsansätze wie Motivational Interviewing oder Methoden der kognitiven Umstrukturierung an. Die Entwicklung und Integration einsichtsspezifischer Interventionen, für die aus der vorliegenden Arbeit Ansatzpunkte ableitbar sind, wird darüber hinaus empfohlen.

The intent of this thesis is to provide an in-depth overview of the neurological manifestations associated with long COVID. The review aimed to assess the cognitive functioning symptoms associated with SARS-CoV-2 post-infection (PASC), investigate the potential mechanisms by which SARS-CoV-2 affects the nervous system, contributing to cognitive fatigue, brain fog, and cognitive dysfunction, and explore the parallels between SARS-CoV-2 and Alzheimer’s Disease. Neuroinflammation emerges as a shared element among these mechanisms, significantly impacting cognitive function. The parallels between COVID-19 and Alzheimer's Disease offer insights into how Alzheimer's affects cognition, aiding in understanding COVID-19's impact. The review underscores a notable gender disparity: women exhibit a greater susceptibility to the adverse effects of COVID-19, yet research in this domain remains limited. It advocates for further investigation into sex-specific differences and emphasizes the importance of understanding and spreading awareness about long COVID's impact on neurocognitive function and the nervous system, given the tendency among many medical professionals to underestimate its significance.

Misinformation, oder „Fake News“, ist in der Online-Kommunikation weit verbreitet und beeinflusst Diskurs und Zusammenleben. Es ist jedoch wenig darüber bekannt, wie wir auf individueller Ebene beeinflusst werden, wenn wir Meinungen bilden und Urteile ableiten. Diese Dissertation untersucht die kognitiven und Gehirn Mechanismen, die der Verarbeitung sozialer, personenbezogener Misinformation zugrunde liegen. Proband*innen wurden mit negativen, positiven oder relativ neutralen personenbezogenen Nachrichten konfrontiert, die entweder verbal als unglaubwürdig gekennzeichnet waren, z.B. "angeblich", oder aus bekannten Medienquellen stammten, die als glaubwürdig oder unglaubwürdig wahrgenommen wurden. Die Ergebnisse zeigten, dass soziale Urteile stark vom emotionalen Gehalt beeinflusst waren, unabhängig von der Glaubwürdigkeit. Elektrophysiologische Korrelate früher emotionaler und erregungsbezogener Prozesse sowie Korrelate späterer evaluierender Verarbeitung waren verstärkt für Personen, die mit emotionalen Inhalten assoziiert wurden—unabhängig von der Glaubwürdigkeit der Information. Emotionale Inhalte wirken also nicht nur auf die unwillkürliche und früher Reaktion auf Nachrichten, sondern sogar auf Prozesse, für die erwartet wurde, dass sie die Information aufgrund ihrer Glaubwürdigkeit evaluieren würden. Um zu intervenieren, bewerteten die Proband*innen vor der Konfrontation mit Schlagzeilen explizit die Glaubwürdigkeit der Quelle. Dies half teilweise, die Glaubwürdigkeit positiver Nachrichteninhalte zu verarbeiten. Die Einsicht in die fehlende Glaubwürdigkeit hatte jedoch keinen Einfluss auf die Effekte negativer Nachrichteninhalte. Unsere Ergebnisse zeigen, wie der emotionale Gehalt sozialer Misinformation das Gehirn und das Urteilsvermögen beeinflussen kann, selbst wider besseres Wissen über die fehlende Glaubwürdigkeit. Perspektivisch helfen diese Erkenntnisse, uns den Herausforderungen von Misinformation aus Sicht der individuellen Kognition zu stellen. / Misinformation, also called “fake news”, is highly prevalent in online communication affecting public discourse and social coexistence. However, little is known about how we are affected by it on the individual level when we derive opinions and judgments. This dissertation investigates the cognitive and brain mechanisms underlying the processing of social, person-related misinformation. Participants were exposed to negative, positive, or relatively neutral news about other persons that was either verbally marked as untrustworthy by adding e.g., “allegedly”, or stemmed from well-known media sources perceived as trusted or distrusted. We found that social person judgments strongly relied on the emotional content independent of the credibility, showing how social misinformation affects person evaluation although it is perceived as untrustworthy. Electrophysiological indexes of early emotional and arousal-related processes, as well as correlates of later evaluative processing were enhanced for persons associated with emotional contents regardless of the credibility of the information. This shows the pronounced influence of emotional contents not only on the initial and early response to news, but even on processes that were expected to evaluate the information on merit of its credibility. In a first attempt to intervene, participants explicitly evaluated the credibility of the source before reading the headlines. This helped to overcome the bias for positive news and process its credibility to some degree. However, the insight into the lack of credibility had no influence on the effects of negative news on brain responses and social judgments. Our results demonstrate how emotional content in social misinformation can affect mind, brain, and judgments even against better knowledge of its lacking credibility. In perspective, these insights help to face the challenges of misinformation from the perspective of the individual’s cognition.

Acute sleep loss may lead to elevated fatigue, decreased energy, and diminished cognitive performance. Traditionally, sleep extension is used to restore mood and cognitive function to baseline levels following insufficient sleep, yet this method may not be feasible or preferred. Acute exercise may serve as an affordable and relatively safe intervention to reduce detriments to daytime functioning following sleep loss. The primary purpose of this study was to examine the effects of moderate-intensity aerobic exercise on neurocognitive function following acute sleep restriction. A secondary aim was to examine the effects of exercise in subjective reports of fatigue, energy, and sleepiness following acute sleep restriction. Fifty-six participants, matched by sex, age, and chronotype, were randomly assigned to either an exercise (EX) or seated control (SC) condition. Following a 4-hour sleep restriction protocol, participants completed the oddball paradigm before and after 20 minutes of exercise or stationary sitting. P3 amplitude and latency, arousal, sleepiness, energy, and fatigue were assessed during the experiment. After controlling for pre-test differences, P3 latency was significantly faster following exercise relative to the control group. No significant P3 amplitude differences were observed between conditions. The EX group displayed significant improvements in arousal, sleepiness, energy, and fatigue compared to the SC group. Findings suggest that 20 minutes of moderate-intensity aerobic exercise following acute sleep restriction may improve cognitive processing speeds, as well as improve arousal, sleepiness, energy, and fatigue.

Objective: Lack of insight into illness is common in patients with schizophrenia diagnoses. It is supposed to reflect deficits of executive functioning that are frequently assessed with the Wisconsin Card Sorting Test. Studies on the remediability of WCST deficits in schizophrenia, however, raise doubts about its construct validity and suggest the use of a dynamic pretest-training-posttest paradigm (WCSTdyn) and single-case analysis (Reliable Change Index, RCI) in studies on insight. Moreover, a multifactorial etiology with neurocognitive and motivational factors, as suggested by Startup's (1996) model, has to be taken into consideration. The model hypothesizes a quadratic function of the relationship between insight and cognition, which means that both cognitively impaired and cognitively intact patients with low insight are to be expected. Method: Three interrelated studies on WCSTdyn and insight were conducted. In study 1, the split-half reliability of the WCST-128 was investigated in a non-psychiatric sample (N = 110). Study 2 compared different RCI single-case tests of significance of intraindividual change on data from N = 400 patients with schizophrenia diagnoses. Furthermore, a typology with three homogenous subgroups was developed and first steps toward an external validation were taken. In study 3, the three types of test-takers were compared on two measures of insight (Item G12 of the Positive and Negative Syndrome Scale [PANSS]; Osnabrueck Scale of Therapeutic Attitudes and Identification of Psychological Problems in Schizophrenia [OSSTI]). The model by STARTUP (1996) was tested by means of regression and cluster analyses including scales on coping (Freiburg Questionnaire of Coping with Illness, FKV: MUTHNY, 1989) and defensiveness (Eppendorf Schizophrenia Inventory, ESI-FR: MAß, 2001; N = 85). Results: The WCST-64 was sufficiently stable (r_tt = .70 [Total Number Correct]). Concordances of different RCI methods were high (kappa = .72 - .90). 45 % of the sample consisted of high scorers, in 43 % a low initial score could be normalized by a short training intervention (learners), and in only 12 % of the sample the WCST deficits were not amenable to training (nonlearners). Insight of nonlearners was significantly reduced (G12: g = 0,45). Finally, three clusters were identified with configurations of insight and WCSTdyn scores consistent with the prediction by STARTUP (1996). Patients with intact neurocognition but low insight responded in a significantly more defensive manner (g = 0,38). They did not differ in self-rated coping, however. A quadratic relationship could not be confirmed. Conclusion: The RCI-based performance typology developed in studies 1 and 2 is a universally applicable analytic tool for future studies on insight-limiting neurocognitive deficits with the WCSTdyn. Results from study 3 point in the direction of a multifactorial etiology of lack of insight in schizophrenia with differential contributions of neurocognitive deficits (e.g., interference control) and defensiveness.