Emmett Larsen | SUNY: Stony Brook University (original) (raw)
Papers by Emmett Larsen
Frontiers in Psychiatry
IntroductionDespite advances in the treatment of bipolar disorder (BD), most patients do not achi... more IntroductionDespite advances in the treatment of bipolar disorder (BD), most patients do not achieve complete inter-episode recovery and functional disability is common. During periods of relative remission, many patients continue to experience neurocognitive dysfunction, reduced daytime activity levels, and sleep disturbances. This 8-week, randomized, placebo-controlled pilot study evaluated the feasibility, safety and preliminary efficacy of the wake-promoting drug, modafinil (Provigil®), on neurocognitive functioning, daytime sleepiness, and sleep quality in affectively-stable BD patients.MethodsTwelve individuals with affectively-stable BD were recruited and randomized to a flexible dose of modafinil (100 to 200 mg/day) or placebo, adjunctive to a therapeutic dose of a mood stabilizer. Weekly in-person visits tracked sleep quality and daytime sleepiness as well as side effects and mood symptoms. Neurocognitive functioning was assessed at baseline, week 4, and week 8.ResultsNo se...
Psychological Medicine, 2017
BackgroundOur previous work revealed substantial heterogeneity in the cognitive profile of bipola... more BackgroundOur previous work revealed substantial heterogeneity in the cognitive profile of bipolar disorder (BD) due to the presence of three underlying cognitive subgroups characterized as: globally impaired, selectively impaired, or cognitively intact. In an effort to determine whether these subgroups are differentially related to genetic risk for the illness, we investigated whether cognitive deficits were more pronounced in unaffected siblings (UAS) of BD probands within identified clusters.MethodsCluster analysis was used to identify cognitive clusters in BD (N = 60). UAS (N = 49) were classified into groups according to their proband sibling's cluster assignment; comparisons were made across all clusters and healthy controls (HCs; N = 71).ResultsThree cognitive clusters in BD emerged: a globally impaired (36.7%), a selectively impaired (30%), and a cognitively intact cluster (33.3%). UAS showed a qualitatively similar pattern to their BD siblings; UAS of the globally impai...
According to the Justified True Belief account of knowledge (JTB), a person can only truly know s... more According to the Justified True Belief account of knowledge (JTB), a person can only truly know something if they have a belief that is both justified and true (i.e., knowledge is justified true belief). This account was challenged by Gettier (1963), who argued that JTB does not explain knowledge attributions in certain situations, later called Gettier-type cases, wherein a protagonist is justified in believing something to be true but their belief was only correct due to luck. Lay people may not attribute knowledge to protagonists with justified but only luckily true beliefs. While some research has found evidence for these so-called Gettier intuitions (e.g., Machery et al., 2017a), Turri et al. (2015) found that participants attributed knowledge in Gettier-type cases at rates similar to cases of justified true belief. In a large-scale, cross-cultural conceptual replication of Turri and colleagues’ (2015) Experiment 1 (N = 4724), we failed to replicate this null result using a with...
Hallucinations are characterized by disturbances of perceptual processes involved in decision-mak... more Hallucinations are characterized by disturbances of perceptual processes involved in decision-making about environmental stimuli. Here, we examine whether cognitive and computational processes by which sensory information is integrated may offer insight into the perceptual mechanisms of hallucinatory symptoms. We used a multi-element perceptual averaging task in which observers made dichotomous judgments about the “average color” (red or blue) of an array of stimuli in trials that varied in the strength (mean) and reliability (variance) of the decision-relevant perceptual evidence. Generally, observers excluded or down-weighted extreme (outlying) perceptual evidence akin to a statistician excluding outlying data points; however, individuals prone to hallucinations afforded more weight to more extreme or untrustworthy evidence. Computational modeling showed that individuals prone to hallucinations tended not to use the optimal model in which evidence is integrated as a function of th...
Journal of Affective Disorders, 2018
Background: Schizophrenia (SZ) studies suggest that neurocognition predicts functional outcome an... more Background: Schizophrenia (SZ) studies suggest that neurocognition predicts functional outcome and that social cognition mediates this relationship. Bipolar disorder (BD) patients also have cognitive, social, and functional impairments but the relationship among these factors in BD is not well established. We assessed whether social cognition modulates the influence of neurocognition on community functioning in BD, as found in SZ. Methods: 200 BD patients and 49 healthy controls (HC) were administered and compared on a battery of tests assessing neurocognition, social cognition, and community functioning. We conducted a series of regression analyses to investigate potential mediation or moderation of social cognition on the relationship between neurocognition and community functioning. Results: BD patients performed worse on neurocognitive domains of processing speed, attention, verbal learning, and global neurocognition. Also, BD patients performed worse on theory of mind, the social cognition composite score, and community functioning. Neurocognition did not significantly predict functional outcome in our BD sample. However, we found a moderating effect of social cognition: among patients with poor social cognition, better neurocognition was associated with better community functioning, a relationship not seen in BD patients with good social cognition. Limitations: The study was limited by a relatively small HC group and assessing one subtype of functioning status. Conclusions: The relationship between neurocognition and community functioning in BD may be dependent on social cognition status, implying the presence of social cognitive heterogeneity. Results may be relevant to choosing proper treatment interventions depending on the patient's social cognitive level.
Social cognition deficits are recognized as key features of psychotic disorders, causing signific... more Social cognition deficits are recognized as key features of psychotic disorders, causing significant disability. Recent evidence supports that oxytocin may be a promising treatment to enhance social cognition. In this chapter, we review the biology of endogenous oxytocin, the mechanisms of action of exogenous oxytocin, and the role of oxytocin in social cognition. We present an overview of the current evidence by summarizing clinical trials of oxytocin across the spectrum of psychotic disorders. We also describe the results of clinical trials combining oxytocin with either psychotherapy or cognitive behavioral interventions. The latest literature has demonstrated that oxytocin may improve social cognition in severe mental disorders. Further studies are needed to clarify the therapeutic potential of oxytocin as a treatment for social cognitive deficits in psychotic disorders, and to develop specific evidence-based clinical guidelines.
Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, ... more Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms—namely psychosis, disorganization, negative symptoms, depression, and mania—remains unclear. Moreover, the differential effects of negative versus positive LEs is poorly understood. The present study utilizes an epidemiologic cohort of patients (N=428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48- and 120-month follow-ups. We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in psychotic (β= .07), disorganized (β= .07), manic (β= .08), and depressive symptoms (β= .06), and a decrease in negative symptoms (β= -.08). Conversely, positive LEs predicted fewer psychotic (β= -.04), disorganized (β= -.04), and negative (β= -.13) symptoms, and were unrelated to mood symptoms. Structural equation modeling confirmed tha...
Frontiers in Psychiatry
The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their wo... more The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their world, safety, and livelihood. Sources espousing misinformation and conspiracy theories frequently offer information that can help make sense of this uncertainty. Individuals high in intolerance of uncertainty (IU) may be particularly impacted by the impoverished epistemic environment and may thus be more drawn to conspiratorial thinking (CT). In the present work, we show across 2 studies (N = 519) that COVID-19-specific CT is associated with higher levels of IU as well as delusion-proneness, and paranoia. Furthermore, delusion-proneness and paranoia explained the relationship between IU and CT and emerged as independent partial correlates of CT even when controlling for other facets of schizotypy. In contrast, anxiety did not explain the relationship between IU and CT. Overall, our findings highlight the importance of individual differences in IU, delusion-proneness and paranoia in the de...
Frontiers in Public Health
The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relative... more The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relatively lower compliance with public health guidelines in younger adults. To develop strategies for reducing anxiety and increasing adherence with health guidelines, it is important to understand the factors that contribute to anxiety and health compliance in the context of COVID-19. Earlier research has shown that greater perceived risk of negative events and their costs are associated with increased anxiety and compliance with health behaviors, but it is unclear what role they play in a novel pandemic surrounded by uncertainty. In the present study we measured (1) perceived risk as the self-reported probability of being infected and experiencing serious symptoms due to COVID-19 and (2) perceived cost as financial, real-world, physical, social, and emotional consequences of being infected with COVID-19. Worry was assessed using the Penn State Worry Questionnaire (PWSQ) and health compliance ...
The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relative... more The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relatively lower compliance with public health guidelines in younger adults. To develop strategies for reducing anxiety and increasing adherence with health guidelines, it is important to understand the factors that contribute to anxiety and health compliance in the context of COVID-19. Earlier research has shown that greater perceived probability of negative events and their costs are associated with increased anxiety and compliance with health behaviors, but it is unclear what role they play in a novel pandemic surrounded by uncertainty. In the present study we measured 1) perceived probability as the self-reported probability of being infected and experiencing serious symptoms due to COVID-19 and 2) perceived cost as financial, real-world, physical, social and emotional consequences of being infected with COVID-19. Worry was assessed using the Penn State Worry Questionnaire (PWSQ) and health ...
Background: Mismatch negativity (MMN) amplitude is reliably reduced in psychotic disorders. While... more Background: Mismatch negativity (MMN) amplitude is reliably reduced in psychotic disorders. While several studies have examined this effect in first-degree relatives of individuals with schizophrenia, few have sought to quantify deficits in relatives of individuals with other psychotic disorders. While some studies conclude that, compared to healthy subjects, first-degree relatives of schizophrenia show reduced MMN, others contradict this finding, a discrepancy which extends to two recent meta-analyses. Furthermore, though MMN is often shown to be associated with cognitive impairments and clinical symptoms in psychotic disorders, to our knowledge no studies have sought to examine these relationships in studies of first-degree relatives. Method: The present study sought to clarify the extent of MMN amplitude reductions in a large sample of siblings of individuals with diverse psychotic disorders (n=65), compared to cases with psychosis (n=220) and never psychotic comparison subjects ...
Psychological Medicine
Background Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders... more Background Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms – namely reality distortion, disorganization, negative symptoms, depression, and mania – remains unclear. Moreover, the differential effects of negative v. positive LEs are poorly understood. Methods The present study utilizes an epidemiologic cohort of patients (N = 428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48-, and 120-month follow-ups. Results We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in reality distortion (β = 0.07), disorganized (β = 0.07), manic (β = 0.08), and depressive symptoms (β = 0.06), and a decrease in negative symptoms (β = −0.08). Conversely, positive LEs predicted fewer reality distortion (β = −0.04), disorganized (β = −0.04), and negative (β = −0.13) symptoms, and w...
The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their wo... more The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their world, safety, and livelihood. Explanatory frameworks to make sense of this uncertainty are offered by both official health-organizations as well as sources espousing misinformation and conspiracy theories. Individual differences that predispose towards conspiratorial thinking (CT) have been investigated by past work, but never in the context of the acute uncertainty of a global pandemic. In the present study we show that endorsement of COVID-19-specific conspiracy theories is associated with higher levels of intolerance of uncertainty, delusion-proneness, and paranoid ideation. Furthermore, delusion-proneness and paranoia mediated the relationship between intolerance to uncertainty and CT, and emerged as independent partial predictors of CT even when controlling for other facets of schizotypy. Overall, our findings highlight the importance of individual differences in intolerance to uncer...
Schizophrenia Research: Cognition
Frontiers in Psychiatry
IntroductionDespite advances in the treatment of bipolar disorder (BD), most patients do not achi... more IntroductionDespite advances in the treatment of bipolar disorder (BD), most patients do not achieve complete inter-episode recovery and functional disability is common. During periods of relative remission, many patients continue to experience neurocognitive dysfunction, reduced daytime activity levels, and sleep disturbances. This 8-week, randomized, placebo-controlled pilot study evaluated the feasibility, safety and preliminary efficacy of the wake-promoting drug, modafinil (Provigil®), on neurocognitive functioning, daytime sleepiness, and sleep quality in affectively-stable BD patients.MethodsTwelve individuals with affectively-stable BD were recruited and randomized to a flexible dose of modafinil (100 to 200 mg/day) or placebo, adjunctive to a therapeutic dose of a mood stabilizer. Weekly in-person visits tracked sleep quality and daytime sleepiness as well as side effects and mood symptoms. Neurocognitive functioning was assessed at baseline, week 4, and week 8.ResultsNo se...
Psychological Medicine, 2017
BackgroundOur previous work revealed substantial heterogeneity in the cognitive profile of bipola... more BackgroundOur previous work revealed substantial heterogeneity in the cognitive profile of bipolar disorder (BD) due to the presence of three underlying cognitive subgroups characterized as: globally impaired, selectively impaired, or cognitively intact. In an effort to determine whether these subgroups are differentially related to genetic risk for the illness, we investigated whether cognitive deficits were more pronounced in unaffected siblings (UAS) of BD probands within identified clusters.MethodsCluster analysis was used to identify cognitive clusters in BD (N = 60). UAS (N = 49) were classified into groups according to their proband sibling's cluster assignment; comparisons were made across all clusters and healthy controls (HCs; N = 71).ResultsThree cognitive clusters in BD emerged: a globally impaired (36.7%), a selectively impaired (30%), and a cognitively intact cluster (33.3%). UAS showed a qualitatively similar pattern to their BD siblings; UAS of the globally impai...
According to the Justified True Belief account of knowledge (JTB), a person can only truly know s... more According to the Justified True Belief account of knowledge (JTB), a person can only truly know something if they have a belief that is both justified and true (i.e., knowledge is justified true belief). This account was challenged by Gettier (1963), who argued that JTB does not explain knowledge attributions in certain situations, later called Gettier-type cases, wherein a protagonist is justified in believing something to be true but their belief was only correct due to luck. Lay people may not attribute knowledge to protagonists with justified but only luckily true beliefs. While some research has found evidence for these so-called Gettier intuitions (e.g., Machery et al., 2017a), Turri et al. (2015) found that participants attributed knowledge in Gettier-type cases at rates similar to cases of justified true belief. In a large-scale, cross-cultural conceptual replication of Turri and colleagues’ (2015) Experiment 1 (N = 4724), we failed to replicate this null result using a with...
Hallucinations are characterized by disturbances of perceptual processes involved in decision-mak... more Hallucinations are characterized by disturbances of perceptual processes involved in decision-making about environmental stimuli. Here, we examine whether cognitive and computational processes by which sensory information is integrated may offer insight into the perceptual mechanisms of hallucinatory symptoms. We used a multi-element perceptual averaging task in which observers made dichotomous judgments about the “average color” (red or blue) of an array of stimuli in trials that varied in the strength (mean) and reliability (variance) of the decision-relevant perceptual evidence. Generally, observers excluded or down-weighted extreme (outlying) perceptual evidence akin to a statistician excluding outlying data points; however, individuals prone to hallucinations afforded more weight to more extreme or untrustworthy evidence. Computational modeling showed that individuals prone to hallucinations tended not to use the optimal model in which evidence is integrated as a function of th...
Journal of Affective Disorders, 2018
Background: Schizophrenia (SZ) studies suggest that neurocognition predicts functional outcome an... more Background: Schizophrenia (SZ) studies suggest that neurocognition predicts functional outcome and that social cognition mediates this relationship. Bipolar disorder (BD) patients also have cognitive, social, and functional impairments but the relationship among these factors in BD is not well established. We assessed whether social cognition modulates the influence of neurocognition on community functioning in BD, as found in SZ. Methods: 200 BD patients and 49 healthy controls (HC) were administered and compared on a battery of tests assessing neurocognition, social cognition, and community functioning. We conducted a series of regression analyses to investigate potential mediation or moderation of social cognition on the relationship between neurocognition and community functioning. Results: BD patients performed worse on neurocognitive domains of processing speed, attention, verbal learning, and global neurocognition. Also, BD patients performed worse on theory of mind, the social cognition composite score, and community functioning. Neurocognition did not significantly predict functional outcome in our BD sample. However, we found a moderating effect of social cognition: among patients with poor social cognition, better neurocognition was associated with better community functioning, a relationship not seen in BD patients with good social cognition. Limitations: The study was limited by a relatively small HC group and assessing one subtype of functioning status. Conclusions: The relationship between neurocognition and community functioning in BD may be dependent on social cognition status, implying the presence of social cognitive heterogeneity. Results may be relevant to choosing proper treatment interventions depending on the patient's social cognitive level.
Social cognition deficits are recognized as key features of psychotic disorders, causing signific... more Social cognition deficits are recognized as key features of psychotic disorders, causing significant disability. Recent evidence supports that oxytocin may be a promising treatment to enhance social cognition. In this chapter, we review the biology of endogenous oxytocin, the mechanisms of action of exogenous oxytocin, and the role of oxytocin in social cognition. We present an overview of the current evidence by summarizing clinical trials of oxytocin across the spectrum of psychotic disorders. We also describe the results of clinical trials combining oxytocin with either psychotherapy or cognitive behavioral interventions. The latest literature has demonstrated that oxytocin may improve social cognition in severe mental disorders. Further studies are needed to clarify the therapeutic potential of oxytocin as a treatment for social cognitive deficits in psychotic disorders, and to develop specific evidence-based clinical guidelines.
Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, ... more Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms—namely psychosis, disorganization, negative symptoms, depression, and mania—remains unclear. Moreover, the differential effects of negative versus positive LEs is poorly understood. The present study utilizes an epidemiologic cohort of patients (N=428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48- and 120-month follow-ups. We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in psychotic (β= .07), disorganized (β= .07), manic (β= .08), and depressive symptoms (β= .06), and a decrease in negative symptoms (β= -.08). Conversely, positive LEs predicted fewer psychotic (β= -.04), disorganized (β= -.04), and negative (β= -.13) symptoms, and were unrelated to mood symptoms. Structural equation modeling confirmed tha...
Frontiers in Psychiatry
The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their wo... more The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their world, safety, and livelihood. Sources espousing misinformation and conspiracy theories frequently offer information that can help make sense of this uncertainty. Individuals high in intolerance of uncertainty (IU) may be particularly impacted by the impoverished epistemic environment and may thus be more drawn to conspiratorial thinking (CT). In the present work, we show across 2 studies (N = 519) that COVID-19-specific CT is associated with higher levels of IU as well as delusion-proneness, and paranoia. Furthermore, delusion-proneness and paranoia explained the relationship between IU and CT and emerged as independent partial correlates of CT even when controlling for other facets of schizotypy. In contrast, anxiety did not explain the relationship between IU and CT. Overall, our findings highlight the importance of individual differences in IU, delusion-proneness and paranoia in the de...
Frontiers in Public Health
The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relative... more The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relatively lower compliance with public health guidelines in younger adults. To develop strategies for reducing anxiety and increasing adherence with health guidelines, it is important to understand the factors that contribute to anxiety and health compliance in the context of COVID-19. Earlier research has shown that greater perceived risk of negative events and their costs are associated with increased anxiety and compliance with health behaviors, but it is unclear what role they play in a novel pandemic surrounded by uncertainty. In the present study we measured (1) perceived risk as the self-reported probability of being infected and experiencing serious symptoms due to COVID-19 and (2) perceived cost as financial, real-world, physical, social, and emotional consequences of being infected with COVID-19. Worry was assessed using the Penn State Worry Questionnaire (PWSQ) and health compliance ...
The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relative... more The novel coronavirus COVID-19 pandemic is associated with elevated rates of anxiety and relatively lower compliance with public health guidelines in younger adults. To develop strategies for reducing anxiety and increasing adherence with health guidelines, it is important to understand the factors that contribute to anxiety and health compliance in the context of COVID-19. Earlier research has shown that greater perceived probability of negative events and their costs are associated with increased anxiety and compliance with health behaviors, but it is unclear what role they play in a novel pandemic surrounded by uncertainty. In the present study we measured 1) perceived probability as the self-reported probability of being infected and experiencing serious symptoms due to COVID-19 and 2) perceived cost as financial, real-world, physical, social and emotional consequences of being infected with COVID-19. Worry was assessed using the Penn State Worry Questionnaire (PWSQ) and health ...
Background: Mismatch negativity (MMN) amplitude is reliably reduced in psychotic disorders. While... more Background: Mismatch negativity (MMN) amplitude is reliably reduced in psychotic disorders. While several studies have examined this effect in first-degree relatives of individuals with schizophrenia, few have sought to quantify deficits in relatives of individuals with other psychotic disorders. While some studies conclude that, compared to healthy subjects, first-degree relatives of schizophrenia show reduced MMN, others contradict this finding, a discrepancy which extends to two recent meta-analyses. Furthermore, though MMN is often shown to be associated with cognitive impairments and clinical symptoms in psychotic disorders, to our knowledge no studies have sought to examine these relationships in studies of first-degree relatives. Method: The present study sought to clarify the extent of MMN amplitude reductions in a large sample of siblings of individuals with diverse psychotic disorders (n=65), compared to cases with psychosis (n=220) and never psychotic comparison subjects ...
Psychological Medicine
Background Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders... more Background Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms – namely reality distortion, disorganization, negative symptoms, depression, and mania – remains unclear. Moreover, the differential effects of negative v. positive LEs are poorly understood. Methods The present study utilizes an epidemiologic cohort of patients (N = 428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48-, and 120-month follow-ups. Results We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in reality distortion (β = 0.07), disorganized (β = 0.07), manic (β = 0.08), and depressive symptoms (β = 0.06), and a decrease in negative symptoms (β = −0.08). Conversely, positive LEs predicted fewer reality distortion (β = −0.04), disorganized (β = −0.04), and negative (β = −0.13) symptoms, and w...
The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their wo... more The COVID-19 global pandemic has left many feeling a sense of profound uncertainty about their world, safety, and livelihood. Explanatory frameworks to make sense of this uncertainty are offered by both official health-organizations as well as sources espousing misinformation and conspiracy theories. Individual differences that predispose towards conspiratorial thinking (CT) have been investigated by past work, but never in the context of the acute uncertainty of a global pandemic. In the present study we show that endorsement of COVID-19-specific conspiracy theories is associated with higher levels of intolerance of uncertainty, delusion-proneness, and paranoid ideation. Furthermore, delusion-proneness and paranoia mediated the relationship between intolerance to uncertainty and CT, and emerged as independent partial predictors of CT even when controlling for other facets of schizotypy. Overall, our findings highlight the importance of individual differences in intolerance to uncer...
Schizophrenia Research: Cognition