Evaluation of Generalization Paradigm Patterns Among Different Psychiatric Disorders

Evaluation of Generalization Paradigm Patterns Among Different Psychiatric Disorders (Schizophrenia, Affective Spectrum and Anxiety Disorders) - an Open, Single Center, Longitudinal Study

Learning includes the ability to generalize to new situations and respond to similar, yet not identical stimuli. In previous work, focused on stimulus generalization in healthy volunteers, tones that were negatively reinforced induce wider generalization curves than tones that were positively reinforced, and these in turn induce wider curves than neutral memory (Schechtman et al, 2010).

The current study aimed to evaluate those patterns in different clinical disorders (including Schizophrenia, Bipolar disorder, MDD, Anxiety disorders (Panic and GAD) and PTSD, and healthy subjects that would be used as a control), with consideration whether those patterns are unique to any specific disorder or state.

The generalization patterns evaluation would conduct twice though enable to compare the stability of those patterns during the course of the illness (i.e during remission compared to acute state).

The basic paradigm based on conditioning of a tone (sound) with unpleasant noise, and extinction of that conditioning afterword. During the 60 minutes of evaluation, the capability to discriminate between the original tone and similar but not identical tones, and the tendency to categorize similar tones as identical to the original tone. A neutral tone without conditioning will be used as reference. The clinical diagnosis will conduct by a senior psychiatrist, and the state would be evaluated using standard questionnaires

Study Overview

• Status: Unknown
• Conditions: PTSD; Bipolar Disorder; MDD; Schizophrenia Disorder; Anxiety Disorder (Panic Disorder or GAD)
• Intervention / Treatment: Behavioral: Generalization pattern

• Study Type: Observational
• Enrollment (Anticipated): 180

Contacts and Locations

Study Locations

• Israel
  • Hod hasharon, Israel
    • Recruiting
    • Shalvat Mental Health Center
    • Contact: Shahak Yariv, MD; Phone Number: 972-54-9876823; Email: dr.shahakyariv@gmail.com
    • Principal Investigator: Shahak Yariv, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Subjects with severe mental disorder in axis one (i.e Schizophrenia, Bipolar, MDD, Anxiety disorder including Panic or Generalized Disorders, PTSD)and healthy subjects that will be used as control- Thirty subjects at each of the groups.

Description

Inclusion Criteria:

• Men and women 20-65 years of age.
• Primary DSM-IV diagnosis of Schizophrenia, Schizoaffective, Bipolar (1 or 2) , Major depressive Disorder , Generalized anxiety disorder, panic disorder, post traumatic stress disorder based on SCID and confirmed by a senior psychiatrist, Or subjects without axis I or II diagnosis (control group).
• Capable and willing to provide informed consent. In any case when there is doubt about the patients' capacity to sign an informed consent, an independent doctor will assess the patient capacities to make treatment decisions with the clinical tool MacCAT-T.
• Able to adhere to the evaluation schedule.
• Able to read, hear, write and speak Hebrew.
• Has signed a written informed consent to participate in the study.

Exclusion Criteria:

• Patients with acute, unstable, significant, or untreated medical illness besides schizophrenia, anxiety disorder or affective disorder, including alcohol and drug dependence.
• Subjects with significant cognitive impairment including dementia, history of head injury, mental retardation, or any other cause to "organic" cognitive impairment.
• Current suicidal ideation or history of a suicide attempt in the past six month
• Subjects who were under compulsory hospitalization.
• Subjects with any other dominant axis I or II diagnosis mainly anxiety disorders, which might interfere with the evaluation of the above disorders.

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Schizophrenia; Subjects who are suffering from Schizophrenia or Schizoaffective disorder acording to the DSM-IV-R criteria	Behavioral: Generalization pattern; During evaluation a conditioning of a tone (conditioning stimulus) and aversive sound ("metal scratch") will conduct (another tone which will be un-conditioning stimulus for control). Generalization patterns will be evaluated, by measuring the differentiation capability between different tones ("neutral" and "aversive") before and after the conditioning, and after extinction phase. The generalization will also be measured by the "generalization curve" that plotted from displaying tones, different from the original tones, and asked the subject whether the current tone is original or new
Control; Healthy subjects without any mental ilness in axis I or II.	Behavioral: Generalization pattern; During evaluation a conditioning of a tone (conditioning stimulus) and aversive sound ("metal scratch") will conduct (another tone which will be un-conditioning stimulus for control). Generalization patterns will be evaluated, by measuring the differentiation capability between different tones ("neutral" and "aversive") before and after the conditioning, and after extinction phase. The generalization will also be measured by the "generalization curve" that plotted from displaying tones, different from the original tones, and asked the subject whether the current tone is original or new
Bipolar; Subjects who are suffering from bipolar I or 2 disorder acording to the DSM-IV-R criteria	Behavioral: Generalization pattern; During evaluation a conditioning of a tone (conditioning stimulus) and aversive sound ("metal scratch") will conduct (another tone which will be un-conditioning stimulus for control). Generalization patterns will be evaluated, by measuring the differentiation capability between different tones ("neutral" and "aversive") before and after the conditioning, and after extinction phase. The generalization will also be measured by the "generalization curve" that plotted from displaying tones, different from the original tones, and asked the subject whether the current tone is original or new
MDD; Subjects who are suffering from Major Depressive disorder acording to the DSM-IV-R criteria	Behavioral: Generalization pattern; During evaluation a conditioning of a tone (conditioning stimulus) and aversive sound ("metal scratch") will conduct (another tone which will be un-conditioning stimulus for control). Generalization patterns will be evaluated, by measuring the differentiation capability between different tones ("neutral" and "aversive") before and after the conditioning, and after extinction phase. The generalization will also be measured by the "generalization curve" that plotted from displaying tones, different from the original tones, and asked the subject whether the current tone is original or new
Anxiety; Subjects who are suffering from Panic disorder or from Generalized Anxiety disorder acording to the DSM-IV-R criteria	Behavioral: Generalization pattern; During evaluation a conditioning of a tone (conditioning stimulus) and aversive sound ("metal scratch") will conduct (another tone which will be un-conditioning stimulus for control). Generalization patterns will be evaluated, by measuring the differentiation capability between different tones ("neutral" and "aversive") before and after the conditioning, and after extinction phase. The generalization will also be measured by the "generalization curve" that plotted from displaying tones, different from the original tones, and asked the subject whether the current tone is original or new
PTSD; Subjects who are suffering from Post Traumatic Stress Disorder acording to the DSM-IV-R criteria	Behavioral: Generalization pattern; During evaluation a conditioning of a tone (conditioning stimulus) and aversive sound ("metal scratch") will conduct (another tone which will be un-conditioning stimulus for control). Generalization patterns will be evaluated, by measuring the differentiation capability between different tones ("neutral" and "aversive") before and after the conditioning, and after extinction phase. The generalization will also be measured by the "generalization curve" that plotted from displaying tones, different from the original tones, and asked the subject whether the current tone is original or new

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Generalization pattern differentiation	Compare the generalization curve and the differentiation between positive, negative and neutral valency bias	60 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State or trait differentiation	to find the stability of the outcome between the two visits, and whether there is correlation with clinical state and the generalization patterns	4-24 weeks

Collaborators and Investigators

• Sponsor: Shalvata Mental Health Center
• Collaborators: Weizmann Institute of Science
• Investigators: Principal Investigator: Shahak Yariv, MD, Shalvata Mental Health Center

Study record dates

Study Major Dates

• Study Start: March 1, 2011
• Primary Completion (Anticipated): December 1, 2012
• Study Completion (Anticipated): June 1, 2013

Study Registration Dates

• First Submitted: December 27, 2011
• First Submitted That Met QC Criteria: December 27, 2011
• First Posted (Estimate): December 29, 2011

Study Record Updates

• Last Update Posted (Estimate): December 29, 2011
• Last Update Submitted That Met QC Criteria: December 27, 2011
• Last Verified: December 1, 2011

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Pathologic Processes; Schizophrenia Spectrum and Other Psychotic Disorders; Bipolar and Related Disorders; Schizophrenia; Disease; Problem Behavior; Anxiety Disorders; Mental Disorders; Bipolar Disorder; Panic Disorder
• Other Study ID Numbers: SHA-04-11