Emotional and motivational dysfunction is fundamental to schizophrenia, and yet the nature and scope of associated deficits are not well understood. This study assessed the integrity of emotional responding from the perspective of its underlying motivational systems during different phases of schizophrenia. Evaluative, somatic, and autonomic responses were measured during viewing of pictures categorized by emotional content, including threat, mutilation, contamination, illness, pollution, mild erotica, families, food and nature. Participants were 13 patients at ultra high-risk or prodromal for psychosis, 40 first-episode schizophrenia patients, 37 chronic schizophrenia patients, and 74 healthy comparison subjects. Irrespective of phase of illness, schizophrenia patients showed a robust and normal pattern of response across multiple systems, with differential engagement of the defensive and appetitive systems as a function of the motivational significance assigned to specific emotional contexts. Although the integrity of core motivational states also appeared to be intact in prodromal patients, a less consistent pattern of response was observed. As continuing efforts are made to identify emotional and motivational abnormalities in schizophrenia, identified deficits will likely be independent of a fundamental dysfunction in basic emotion and motivation response systems and involve integration with higher order processes.

The current coronavirus disease (COVID-19) pandemic has rapidly spread across the world. Individuals with stimulant use disorder are a vulnerable population, who are particularly at risk of negative outcomes during this pandemic due to several risk factors, including mental and physical comorbidities, weakened immune responses, high-risk behaviors, and barriers to healthcare access. Engaging patients with stimulant use disorder in regular treatment has become even more difficult during this pandemic, which has resulted in many cuts to addiction treatment programs. The most effective treatment options for stimulant use disorder are psychosocial interventions, which rely heavily on in-person interactions, posing an added challenge during physical distancing. In particular, contingency management (CM) is a behavioral therapy that utilizes tangible reinforcements to incentivize targeted behavior changes, and is an effective treatment intervention used for stimulant use disorder. This paper highlights the treatment challenges for individuals with stimulant use disorder and the importance of adapting CM programs during COVID-19. We present strategies for how CM can be adapted and its role expanded in a safe way during the COVID-19 pandemic to help prevent infection spread, stimulant use relapse, and worsened psychosocial consequences.

Individuals with schizophrenia face significant challenges in daily functioning, and while social cognition predicts how well patients respond to these challenges, associated physiological mechanisms remain unspecified. The present study draws from polyvagal theory and tested the hypothesis that respiratory sinus arrhythmia (RSA), an established indicator of the capacity to self-regulate and adapt to environmental demands, combines with social cognition to predict functional outcome. Using data from 41 schizophrenia patients and 36 healthy comparison subjects, we replicated group differences in RSA and social cognition and also demonstrated that RSA and social cognition interact to predict how effectively patients manage work and independent living activities. Specifically, RSA did not enhance functional outcomes when social cognition was already strong, but higher levels of RSA enabled effective role functioning when social-cognitive performance was impaired. Jointly, RSA and social cognition accounted for 40% of the variance in outcome success, compared with 21% when evaluating social cognition alone. As polyvagal theory suggests, physiological flexibility and self-regulatory capacity may compensate for poorer social-cognitive skills among schizophrenia patients.

Objectives: A little more than a decade ago British Columbia (BC) decided to improve the treatment of individuals suffering from severe concurrent disorders. They provided funding for the development of a novel evidence-based, recovery oriented, provincial tertiary inpatient treatment centre laid out for 100 beds. Integrated multidisciplinary treatment teams involving professionals from more than a dozen disciplines covering the full range of supports are now providing integrated services in one institution. We have seen changes in the population we treat and have adapted our approach. The basic concept was published in a paper 8 years ago. The current paper summarises changes in the population served, conceptual modifications, and continued issues. Methods: Reported changes in the population are based on a comparison of cross-sectional client interviews conducted 10 years ago (2009/10) and again from 2018 until 2020, mainly 2018/19. Results: Overall, we saw limited changes in the characteristics of the population such as age, gender, ethnic background, level of childhood trauma etc., but substantial changes in diagnoses, including changes in primary substances use disorders. We further present and discuss conceptual changes, such as changes in the model of care, and changes in daily practice, such as contact to, and interaction with community services. Conclusions: We feel that severe concurrent disorders continue to present a major challenge for any health care system. There continue to be substantial gaps both in research on this population and in availability of adequate health services. Services such as the one described in this paper for BC need to continue to evolve and be optimized, as they utilize innovations based on evidence that still requires further proof of practicability and efficacy. Objectifs: Il y a un peu plus d’une décennie, la Colombie-Britannique (CB) a décidé d’améliorer le traitement des personnes souffrant de troubles concomitants graves. Ils ont financé le développement d’un nouveau centre de soins tertiaires provincial de traitements éprouvés pour patients hospitalisés axé sur le rétablissement et doté de 100 lits. Des équipes de traitement multidisciplinaires intégrées regroupant des professionnels de plus d’une douzaine de disciplines couvrant toute la gamme des soutiens offrent maintenant des services intégrés dans un seul établissement. Nous avons vu des changements dans la population que nous traitons et avons adapté notre approche. Le concept de base a été publié dans un journal il y a 8 ans. Le présent document résume les changements dans la population desservie, les modifications conceptuelles et les problèmes persistants. Méthodes: Les changements signalés dans la population sont basés sur une comparaison d’entretiens transversaux avec des clients menés il y a 10 ans (2009/10) et à nouveau de 2018 à 2020, principalement 2018/19. Résultats: Dans l’ensemble, nous avons constaté des changements limités dans les caractéristiques de la population telles que l’âge, le sexe, l’origine ethnique, le niveau de traumatisme de l’enfance, etc., mais des changements substantiels dans les diagnostics, y compris des changements dans les troubles primaires liés à l’utilisation de substances. Nous présentons et discutons en outre des changements conceptuels, tels que les changements dans le modèle de soins et les changements dans la pratique quotidienne, tels que le contact et l’interaction avec les services communautaires. Conclusions: Nous pensons que les troubles concomitants graves continuent de représenter un défi majeur pour tout système de soins de santé. Il subsiste des lacunes substantielles tant dans la recherche sur cette population que dans la disponibilité de services de santé adéquats. Les services tels que celui décrit dans ce document pour la Colombie-Britannique doivent continuer d’évoluer et d’être optimisés, car ils utilisent des innovations basées sur des preuves qui nécessitent encore des preuves supplémentaires de faisabilité et d’efficacité.