IMPORTANCE Delay discounting is a behavioral economic index of impulsive preferences for smaller-immediate or larger-delayed rewards that is argued to be a transdiagnostic process across health conditions. Studies suggest some psychiatric disorders are associated with differences in discounting compared with controls, but null findings have also been reported. OBJECTIVE To conduct a meta-analysis of the published literature on delay discounting in people with psychiatric disorders. DATA SOURCES PubMed, MEDLINE, PsycInfo, Embase, and Web of Science databases were searched through December 10, 2018. The psychiatric keywords used were based on DSM-IV or DSM-5 diagnostic categories. Collected data were analyzed from December 10, 2018, through June 1, 2019. STUDY SELECTION Following a preregistered Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol, 2 independent raters reviewed titles, abstracts, and full-text articles. English-language articles comparing monetary delay discounting between participants with psychiatric disorders and controls were included. DATA EXTRACTION AND SYNTHESIS Hedges g effect sizes were computed and random-effects models were used for all analyses. Heterogeneity statistics, one-study-removed analyses, and publication bias indices were also examined. MAIN OUTCOMES AND MEASURES Categorical comparisons of delay discounting between a psychiatric group and a control group. RESULTS The sample included 57 effect sizes from 43 studies across 8 diagnostic categories. Significantly steeper discounting for individuals with a psychiatric disorder compared with controls was observed for major depressive disorder (Hedges g = 0.37; P = .002; k = 7), schizophrenia (Hedges g = 0.46; P = .004; k = 12), borderline personality disorder (Hedges g = 0.60; P < .001; k = 8), bipolar disorder (Hedges g = 0.68; P < .001; k = 4), bulimia nervosa (Hedges g = 0.41; P = .001; k = 4), and binge-eating disorder (Hedges g = 0.34; P = .001; k = 7). In contrast, anorexia nervosa exhibited statistically significantly shallower discounting (Hedges g =-0.30; P < .001; k = 10). Modest evidence of publication bias was indicated by a statistically significant Egger test for schizophrenia and at the aggregate level across studies. CONCLUSIONS AND RELEVANCE Results of this study appear to provide empirical support for delay discounting as a transdiagnostic process across most of the psychiatric disorders examined; the literature search also revealed limited studies in some disorders, notably posttraumatic stress disorder, which is a priority area for research.

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Cognitive rehabilitative programs for serious mental illness that rely on computer-based training for neuroplasticity should ensure opportunities for active skill development and therapist-supported techniques to overcome challenges with generalizing cognitive effects to everyday outcomes. (PsycINFO Database Record

Introduction Formal thought disorder is a hallmark feature of schizophrenia in which disorganized thoughts manifest as disordered speech. A dysfunctional semantic system and a disruption in executive functioning have been proposed as possible mechanisms for formal thought disorder and verbal fluency impairment. Traditional rating scales and neuropsychological test scores might not be sensitive enough to distinguish among types of semantic impairments. This has lead to the proposed used of a natural language processing technique, Latent Semantic Analysis (LSA), which offers improved semantic sensitivity. Method In this study, LSA, a computational, vector-based text analysis technique to examine the contribution of vector length, an LSA measure related to word unusualness and cosines between word vectors, an LSA measure of semantic coherence to semantic and phonological fluency, disconnectedness of speech, and adaptive functioning in 165 older inpatients with schizophrenia. Results In stepwise regressions word unusualness was significantly associated with semantic fluency and phonological fluency, disconnectedness in speech, and impaired functioning, even after considering the contribution of pre-morbid cognition, positive and negative symptoms, and demographic variables. Conclusions These findings support the utility of LSA in examining the contribution of coherence to thought disorder and the its relationship with daily functioning. Deficits in verbal fluency may be an expression of underlying disorganization in thought processes.

Neurocognitive impairments are observed in depression and associated with poor functioning. This study examined the efficacy and the effectiveness of cognitive remediation with supplemental Internet-based homework in treatment-resistant depression. Participants were randomized to treatment or wait list control conditions. Treatment consisted of 10 weeks of weekly group sessions and daily online cognitive exercises completed at home. The participants were assessed on cognitive, mood, motivation, and functioning measures. There was a significant time by treatment interaction for attention/processing speed and verbal memory. Changes in functioning were not significant, although improved cognition predicted improvements in functioning. Number of minutes of online exercise was associated with greater cognitive improvements. Cognitive deficits are malleable with behavioral treatment in a mood disorder characterized by severe and persistent symptoms.

People with mood disorders experience cognitive impairments that are predictive of functional disability. Cognitive remediation (CR) is an empirically validated intervention that is designed to remediate neurocognitive deficits and improve functioning. Although much of the focus of this treatment during the last decade has centred on attention deficit disorders, brain injury, and schizophrenia spectrum disorders, emerging evidence suggests that CR is an effective intervention for mood disorders and that these treatment effects translate into improvements in cognitive performance and possibly functioning. Our review aims to examine the profile and magnitude of cognitive impairments in mood disorders, review the evidence in support of CR for this population, and discuss future research directions in CR.

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