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Background: Up to 50% of patients with psychotic-spectrum disorders are medication nonadherent. The use of real-time assessment via ecological momentary assessment (EMA) on mobile devices might offer important insights into adherence behaviors that cannot be measured in the clinic. However, existing EMA studies have only studied acutely ill patients during hospitalization or more stable patients in the community., Methods: Feasibility and acceptability of EMA in 65 patients with psychotic-spectrum disorders who were recently discharged from the hospital were assessed. EMA was administered for four weeks via study-provided mobile devices. Feasibility was measured by study recruitment/retention rates, patients' connectivity, and completion rates. Quantitative and qualitative acceptability data were collected., Results: Participants completed 28-31% of offered EMA assessments. The only significant predictor of reduced EMA completion was recent cannabis use. EMA completion was maintained from weeks 1 to 3 but significantly dropped at the fourth week. Patient acceptability feedback was generally positive; negative comments related primarily to technological problems., Conclusions: This was the first study to use EMA in recently discharged patients with psychotic-spectrum disorders. EMA is feasible and acceptable in this population, but completion rates were lower than in more stable samples. Future research should consider limiting the assessment period, screening for substance use, and integrating assessment with intervention elements to increase EMA engagement., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Published data suggest that cannabis use is associated with several negative consequences for individuals with bipolar disorder (BD), including new manic episode onset, psychosis, and functional disability. Yet much less is known about cannabis use disorders (CUDs) in this population, especially in more acutely symptomatic groups., Methods: To evaluate correlates of CUD comorbidity in BD, a retrospective chart review was conducted for 230 adult patients with bipolar I disorder (BDI) who were admitted to a university-affiliated private psychiatric hospital. Using a computer algorithm, a hospital administrator extracted relevant demographic and clinical data from the electronic medical record for analysis., Results: Thirty-six (16%) had a comorbid CUD. CUD comorbidity was significantly associated with younger age, manic/mixed episode polarity, presence of psychotic features, and comorbid nicotine dependence, alcohol use disorder (AUD), and other substance use disorders, but was associated with decreased likelihood of anxiety disorder comorbidity. With the exception of manic/mixed polarity and AUD comorbidity, results from multivariate analyses controlling for the presence of other SUDs were consistent with univariate findings., Conclusion: Patients with BD and comorbid CUDs appear to be a complex population with need for enhanced clinical monitoring. Given increasing public acceptance of cannabis use, and the limited availability of evidenced-based interventions targeted toward CUDs in BD, psychoeducation and other treatment development efforts appear to be warranted., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Previous research on patients' expectancies for improvement in clinical trials typically has been conducted after patients have already agreed to participate in a study. Depressed patients (n = 55) read 3 vignettes describing hypothetical clinical trials of antidepressant vs pill placebo, antidepressant vs antidepressant, and psychotherapy vs psychotherapy. Patients reported greater overall acceptability for psychotherapy over antidepressants. Patients had significantly greater expectancies for symptom reduction in either active comparator (medication or psychotherapy) compared with the placebo-controlled design. They also reported greater anticipated improvement and willingness to participate in the psychotherapy trial compared with either medication trial design. Patients' differential expectancies based on study design could lead to different patient populations being selected for these studies and influence clinical improvement., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Previous research suggests that patients with psychotic major depression (PMD) may differ from those with nonpsychotic major depression (NMD) not only in psychotic features but also in their depressive symptom presentation. The present study contrasted the rates and severity of depressive symptoms in outpatients diagnosed with PMD vs NMD., Method: The sample consisted of 1112 patients diagnosed with major depression, of which 60 (5.3%) exhibited psychotic features. Depressive symptoms were assessed by trained diagnosticians at intake using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and supplemented by severity items from the Schedule for Affective Disorders and Schizophrenia., Results: Patients with PMD were more likely to endorse the presence of weight loss, insomnia, psychomotor agitation, indecisiveness, and suicidality compared with NMD patients. Furthermore, PMD patients showed higher levels of severity on several depressive symptoms, including depressed mood, appetite loss, insomnia, psychomotor disturbances (agitation and retardation), fatigue, worthlessness, guilt, cognitive disturbances (concentration and indecisiveness), hopelessness, and suicidal ideation. The presence of psychomotor disturbance, insomnia, indecisiveness, and suicidal ideation was predictive of diagnostic status even after controlling for the effects of demographic characteristics and other symptoms., Conclusions: These findings are consistent with past research suggesting that PMD is characterized by a unique depressive symptom profile in addition to psychotic features and higher levels of overall depression severity. The identification of specific depressive symptoms in addition to delusions/hallucinations that can differentiate PMD vs NMD patients can aid in the early detection of the disorder. These investigations also provide insights into potential treatment targets for this high-risk population.

Previous research suggests that psychotic major depression (PMD) is associated with greater illness severity and functional impairment as well as poorer treatment response to antidepressants and psychotherapies compared with nonpsychotic major depression. Although patients with PMD exhibit a number of neurobiological abnormalities, little research has been conducted to date on possible psychological factors that are related to illness in this depression subtype. In the current study, baseline data were pooled from 2 clinical trials in which depressed patients (n = 235) were recruited during a psychiatric hospitalization for an acute episode. Twelve percent (n = 28) of this treatment-seeking sample met criteria for PMD and showed elevated levels of depression severity and dysfunctional beliefs compared with individuals with nonpsychotic major depression. However, even after controlling for depression severity and other relevant baseline variables, only a measure of common dysfunctional beliefs differentiated those with vs those without psychotic features. Furthermore, higher levels of depressive cognitions were related to poorer psychosocial functioning and suicidality in PMD patients. Results suggest that elevated levels of common negative cognitions in depressed patients may be associated with the presence of more severe psychotic symptoms. Adapted cognitive-behavioral treatments may be useful for treating patients with PMD specifically.