Claudia Simons | Maastricht University (original) (raw)

Papers by Claudia Simons

Acta Psychiatrica Scandinavica, Mar 5, 2017

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Psychological Medicine, Apr 24, 2017

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Psychiatry Research-neuroimaging, May 1, 2023

Background: Parkinson disease monitoring is currently transitioning from periodic clinical assess... more Background: Parkinson disease monitoring is currently transitioning from periodic clinical assessments to continuous daily life monitoring in free-living conditions. Traditional Parkinson disease monitoring methods lack intraday fluctuation detection. Electronic diaries (eDiaries) hold the potential to collect subjective experiences on the severity and burden of motor and nonmotor symptoms in free-living conditions. Objective: This study aimed to develop a Parkinson disease-specific eDiary based on ecological momentary assessments (EMAs) and to explore its validation. Methods: An observational cohort of 20 patients with Parkinson disease used the smartphone-based EMA eDiary for 14 consecutive days without adjusting free-living routines. The eDiary app presented an identical questionnaire consisting of questions regarding affect, context, motor and nonmotor symptoms, and motor performance 7 times daily at semirandomized moments. In addition, patients were asked to complete a morning and an evening questionnaire. Results: Mean affect correlated moderate-to-strong and moderate with motor performance (R=0.38 to 0.75; P<.001) and motor symptom (R=0.34 to 0.50; P<.001) items, respectively. The motor performance showed a weak-to-moderate negative correlation with motor symptoms (R=−0.31 to −0.48; P<.001). Mean group answers given for on-medication conditions vs wearing-off-medication conditions differed significantly (P<.05); however, not enough questionnaires were completed for the wearing-off-medication condition to reproduce these findings on individual levels. Conclusions: We presented a Parkinson disease-specific EMA eDiary. Correlations between given answers support the internal validity of the eDiary and underline EMA's potential in free-living Parkinson disease monitoring. Careful patient selection and EMA design adjustment to this targeted population and their fluctuations are necessary to generate robust proof of EMA validation in future work. Combining clinical Parkinson disease knowledge with practical EMA experience is inevitable to design and perform studies, which will lead to the successful integration of eDiaries in free-living Parkinson disease monitoring.

Jmir mhealth and uhealth, May 11, 2020

Schizophrenia Research: Cognition, Dec 1, 2021

Background: Clinical staging has been developed to capture the large heterogeneity in schizophren... more Background: Clinical staging has been developed to capture the large heterogeneity in schizophrenia spectrum disorders. Including cognitive performance in the staging model may improve its clinical validity. Moreover, cognitive functioning could predict transition across stages. However, current evidence of the association between cognition and clinical staging is inconsistent. Therefore, we aim to assess whether cognitive parameters are associated with clinical stages in a large sample of patients with schizophrenia spectrum disorders and to identify cognitive markers at baseline that are associated with stage-transition at three and six-year follow-up. Methods: We applied the staging model of Fusar-Poli et al. (2017) in 927 patients with non-affective psychotic disorders, assessed at baseline, and after three and six-year follow-up. Cognitive performance was assessed with a standard test battery. Generalized linear mixed models were used to analyze associations of cognitive performance with staging and stage-transition at follow-up. Results: Findings showed that higher stages of illness were significantly associated with lower processing speed (F = 3.688, p = 0.025) and deficits in working memory (F = 6.365, p = 0.002) across assessments. No associations between cognitive parameters at baseline and stage-transition at three-and six-year follow-up were found. Conclusion: We conclude that processing speed and working memory were modestly associated with higher stages of illness in schizophrenia spectrum disorders, thereby slightly improving its clinical validity. However, associations were small and we found no evidence for predictive validity.

Journal of Affective Disorders, Feb 1, 2019

Schizophrenia Research, May 1, 2021

OBJECTIVE Cognitive alterations putatively contribute to the risk for suicide in individuals with... more OBJECTIVE Cognitive alterations putatively contribute to the risk for suicide in individuals with psychosis. Yet, a comprehensive assessment of social- and general-cognitive abilities in a large sample is lacking. METHODS Seven-hundred-fifteen individuals diagnosed with a psychotic disorder performed tasks of facial emotion recognition, Theory of Mind, and general cognitive functioning (sustained attention, set-shifting, IQ-tests and verbal learning) as part of the Genetic-Risk-and-Outcome-of-Psychosis (GROUP) study. Presence of past suicide attempt/s and/or current suicidal ideation was reported by 261 individuals and 454 individuals reported no suicide attempt or ideation. We used general linear models to investigate group differences in task performance. All analysis were controlled for age, sex, education, and psychotic symptom severity. RESULTS Individuals with suicide attempt and/or ideation showed better performance on the facial emotion recognition task and lower performance on tasks of sustained attention and verbal learning, compared to individuals without suicide attempt and/or ideation, without a clear effect of attempt or ideation. Theory of Mind performance was also better for individuals with suicide attempt and/or ideation, with largest differences between individuals who reported both attempts and ideation compared to individuals without suicide attempt and/or ideation. No effect of suicide attempt and/or ideation was found on misperception of facial emotions, IQ and set-shifting. Overall, effect sizes were small. CONCLUSION Higher sensitivity to social-emotional cues together with weakened attentional control and learning capacity was observed in individuals with psychosis and suicide attempt and/or ideation. This may suggest that insufficient capacity for regulating perceived social stress contributes to suicidal thoughts and behavior.

Schizophrenia Bulletin, May 21, 2023

Background Social cognitive impairment is a recognized feature of psychotic disorders. However, p... more Background Social cognitive impairment is a recognized feature of psychotic disorders. However, potential age-related differences in social cognitive impairment have rarely been studied. Study Design Data came from 905 individuals with a psychotic disorder, 966 unaffected siblings, and 544 never-psychotic controls aged 18–55 who participated in the Genetic Risk and Outcome of Psychosis (GROUP) study. Multilevel linear models were fitted to study group main effects and the interaction between group and age on emotion perception and processing (EPP; degraded facial affect recognition) and theory of mind (ToM; hinting task) performance. Age-related differences in the association between socio-demographic and clinical factors, and EPP and ToM were also explored. Study Results Across groups, EPP performance was associated with age (β = −0.02, z = −7.60, 95% CI: −0.02, −0.01, P < .001), with older participants performing worse than younger ones. A significant group-by-age interaction on ToM (X2(2) = 13.15, P = .001) indicated that older patients performed better than younger ones, while no age-related difference in performance was apparent among siblings and controls. In patients, the association between negative symptoms and ToM was stronger for younger than older patients (z = 2.16, P = .03). Conclusions The findings point to different age-related performance patterns on tests of 2 key social cognitive domains. ToM performance was better in older individuals, although this effect was only observed for patients. EPP was less accurate in older compared with younger individuals. These findings have implications with respect to when social cognitive training should be offered to patients.

Schizophrenia Bulletin, Apr 27, 2023

Schizophrenia Research, Sep 1, 2020

Bipolar disorder (BD) is highly heterogeneous in symptomatology. Narrowing the clinical phenotype... more Bipolar disorder (BD) is highly heterogeneous in symptomatology. Narrowing the clinical phenotype may increase the power to identify risk genes that contribute to particular BD subtypes. This study was designed to test the hypothesis that genetic overlap between schizophrenia (SZ) and BD is higher for BD with a history of manic psychosis. Analyses were conducted using a Mayo Clinic Bipolar Biobank cohort of 957 bipolar cases (including 333 with history of psychosis during mania, 64 with history of psychosis only during depression, 547 with no history of psychosis, and 13 with unknown history of psychosis) and 778 controls. Polygenic risk score (PRS) analysis was performed by calculating a SZ-PRS for the BD cases and controls, and comparing the calculated SZ risk between different psychosis subgroups and bipolar types. The SZ-PRS was significantly higher for BD-I cases with manic psychosis than BD-I cases with depressive psychosis (Nagelkerke's R 2 = 0.021; p = 0.045), BD-I cases without psychosis (R 2 = 0.015; p = 0.007), BD-II cases without psychosis (R 2 = 0.014; p = 0.017), and controls (R 2 = 0.065; p = 2 × 10 −13). No other significant differences were found. Our results show that BD-I with manic psychosis is genetically more similar to SZ than any other tested BD subgroup. Further investigations on genetics of distinct clinical phenotypes composing major psychoses may help refine the current diagnostic classification system.

Psychiatry Research-neuroimaging, 2019

Scientific Reports, Jun 9, 2023

Positive and negative symptoms are prominent but heterogeneous characteristics of schizophrenia s... more Positive and negative symptoms are prominent but heterogeneous characteristics of schizophrenia spectrum disorder (SSD). Within the framework of the Genetic Risk and Outcome of Psychosis (GROUP) longitudinal cohort study, we aimed to distinguish and identify the genetic and non-genetics predictors of homogenous subgroups of the long-term course of positive and negative symptoms in SSD patients (n = 1119) and their unaffected siblings (n = 1059) in comparison to controls (n = 586). Data were collected at baseline, and after 3-and 6-year follow-ups. Group-based trajectory modeling was applied to identify latent subgroups using positive and negative symptoms or schizotypy scores. A multinomial random-effects logistic regression model was used to identify predictors of latent subgroups. Patients had decreasing, increasing, and relapsing symptoms course. Unaffected siblings and healthy controls had three to four subgroups characterized by stable, decreasing, or increasing schizotypy. PRS SCZ did not predict the latent subgroups. Baseline symptoms severity in patients, premorbid adjustment, depressive symptoms, and quality of life in siblings predicted long-term trajectories while were nonsignificant in controls. In conclusion, up to four homogenous latent subgroups of symptom course can be distinguished within patients, siblings, and controls, while nongenetic factors are the main factors associated with the latent subgroups. Schizophrenia spectrum disorders are a highly heterogeneous disorder manifested by positive (i.e. delusions, hallucinations, disorganized thinking, speech, and motor behavior) and negative (i.e. diminished emotional expression, avolition, alogia, anhedonia, and asociality) symptoms 1. Schizophrenia is a severe and chronic form of schizophrenia spectrum disorders and is often followed by poor clinical and functional outcomes 2. Both positive and negative symptoms are crucial determinants of patients' recovery, along with cognitive deficits, other clinical (e.g., depressive symptoms, comorbidity), and non-clinical (e.g., life skills, social support, stigma) characteristics 3-7. Positive symptoms often respond to antipsychotic treatment, whereas negative symptoms are more complex to understand and tackle 2,3. Negative symptoms can be primary (intrinsic to schizophrenia) and secondary (caused by other factors such as positive symptoms, medication side-effects, substance abuse, and social isolation) but current research and clinical practice target them as one class of undistinguishable negative

Schizophrenia Research, Apr 1, 2012

Frontiers in Psychiatry, Aug 3, 2020

Background: Existing research shows that adults with an autism spectrum disorder (ASD) are more v... more Background: Existing research shows that adults with an autism spectrum disorder (ASD) are more vulnerable to develop overt psychosis. However, studies investigating (subclinical) psychotic experiences (PE) in ASD are scarce, and it is unknown if PE are accompanied with more distress in adults with ASD compared to the general population. This study examined lifetime PE and accompanying distress, momentary PE levels, and the impact of daily life stress and negative affect (NA) on momentary PE in males and females with ASD compared to controls. Methods: In 50 adults with ASD (males N= 26, females N= 24) and 51 adults without ASD (males N= 26, females N= 25), the Community Assessment of Psychic Experiences (CAPE) was used to analyze group differences in frequency and distress of lifetime subclinical positive, negative, and depressive symptoms. The Experience Sampling Method (ESM) was used to measure momentary PE, NA, and stress (activity-related, event-related, and social stress) for 10 days. Multilevel analyses were conducted to test whether stress and NA were associated with momentary PE and whether these associations were modified by group or sex. Results: Adults with ASD reported more lifetime CAPE negative and depressive symptoms, but similar levels of PE, than controls. Higher levels of accompanying distress were found in participants with ASD for each subscale. With respect to ESM momentary PE, higher levels were reported by adults with ASD and a stronger association between event-related stress and momentary PE was found compared to controls. This was not the case for NA, activity-related, and social stress. Overall, no significant differences between male and female outcomes were found. Conclusion: Adults with ASD are more prone to encounter lifetime subclinical negative and depressive symptoms and accompanying distress compared to adults without ASD. Similar levels of lifetime PE in both groups were still accompanied with more distress in the ASD group. Furthermore, higher levels of ESM momentary PE were found in participants

Journal of Affective Disorders, 2023

Schizophrenia Research, Dec 1, 2022

Schizophrenia Research, Aug 1, 2020

Background: Reports on the relationship between clinical insight and psychotic symptoms have show... more Background: Reports on the relationship between clinical insight and psychotic symptoms have shown inconsistent results, and the association between clinical insight and personality has rarely been addressed. The aim of this study was to examine whether personality is correlated cross-sectionally with insight level, and longitudinally with change in insight, beyond symptoms. Methods: Participants were a sub-sample of the Dutch Genetic Risk and Outcome of Psychosis (GROUP) project. Two hundred and eleven participants diagnosed with non-affective psychotic disorders took part in the crosssectional part of the study, of whom 136 took part in the three-year follow-up assessment. They were administered with self-report Birchwood insight scale and NEO-Five Factor Inventory, and clinicians assessed them according to PANSS and CDS symptoms scales. Results: Cross-sectional analysis showed baseline self-report insight was positively related to neuroticism and agreeableness and negatively related to extraversion. Longitudinal analysis showed change in level of self-reported insight was predicted by baseline-insight and change in symptoms of disorganization. Personality factors did not predict insight change (as measured either by self-report or by clinician assessment). Discussion: The cross-sectional findings showed self-report insight (as opposed to clinician-rated) is associated with personality traits, suggesting negative affect is related to higher level of insight and that having insight may be influenced by the wish to comply with views of professionals, or a tendency to cover up problems. The longitudinal findings imply that not personality but change in severity of symptoms of disorganization, and possibly other variables, predicts change in insight.

Scientific Reports, Jul 8, 2021

Prospective momentary psychological and biological measures of real-time daily life stress experi... more Prospective momentary psychological and biological measures of real-time daily life stress experiences have been examined in several psychiatric disorders, but not in adults with an autism spectrum disorder (ASD). The current electronic self-monitoring study examined associations between momentary daily life stressors and (i) negative affect (NA; emotional stress reactivity) and (ii) cortisol levels (biological stress reactivity) in males and females with ASD (N = 50) and without ASD (N = 51). The Experience Sampling Method, including saliva sampling, was used to measure three types of daily life stress (activity-related, event-related, and social stress), NA, and cortisol. Multilevel regression analyses demonstrated significant interactions between group and stress (i.e., activity-related and event-related stress) in the model of NA, indicating stronger emotional stress reactivity in the ASD than in the control group. In the model of cortisol, none of the group × stress interactions were significant. Male/female sex had no moderating effect on either emotional or biological stress reactivity. In conclusion, adults with ASD showed a stronger emotional stress (but not cortisol) reactivity in response to unpleasant daily life events and activities. The findings highlight the feasibility of electronic self-monitoring in individuals with ASD, which may contribute to the development of more personalized stress-management approaches. Observational and experimental stress studies report increased emotional stress levels in adults with an autism spectrum disorder (ASD) with respect to controls 1,2. However, there is no intensive time-series data on real-life, real-world momentary emotional stress reactivity derived from individuals with ASD. Emotional stress reactivity, defined as the effect of subjective appraisals of everyday stressors on negative affect (NA) can be studied via ecological momentary assessment (EMA) and has been used in a wide range of psychiatric disorders. For example, an increased emotional stress reactivity has been found in individuals at high risk for psychosis 3 , with psychotic illness 4 , and remitted bipolar disorder 5 compared to the general population. Evidence also shows that dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis may play a role in the altered stress processing of individuals with ASD, indicating that the stress hormone cortisol may be disturbed. However, reports on cortisol outcome measures are not very consistent. Both increased 6,7 , decreased 8,9 , or equal 10,11 cortisol responses to social stressors have been found in children and adolescents with ASD compared to non-ASD individuals. To our knowledge, only two experimental studies have investigated the cortisol response in adults with ASD; both studies found a comparable cortisol response to a social stressor in the ASD and control group 1,12. Because of this inconsistent pattern and the artificial nature of laboratory settings, studying cortisol response in a naturalistic environment may shed new light on the relationship between stress and cortisol in ASD. In the past decades, EMA studies investigated biological stress reactivity by studying associations between minor daily life stressors and momentary cortisol levels. For example, an increased cortisol response associated with daily stressors was demonstrated in 556 females in the general population 13. In addition, studies on psychiatric samples showed an increased cortisol response to daily stressors in participants with aboveaverage risk for psychosis 14 and a blunted cortisol response in participants with 22q11.2 deletion syndrome 15 relative to controls.